Short- and Long-term Health Adverse Outcomes Associated With Nutrition Disorders and Nutrition Related Conditions in Hospitalized Older People

Malnutrition is associated with health adverse outcomes such as higher risk of mobility disability, falls and, fractures and higher mortality. Malnutrition had been defined as "a state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease". In 2018, the European Society for Clinical Nutrition and Metabolism (ESPEN) revisited nutrition and nutrition-related conditions definitions in the ESPEN guidelines on definitions and terminology of clinical nutrition based on the findings of the last decades. Nutrition disorders and nutrition related conditions were divided in 5 categories: Malnutrition/undernutrition, sarcopenia and frailty, overweight and obesity, micronutrients abnormalities, and refeeding syndrome. The definition of malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria is globally accepted by de scientific community since this was launched in 2019. The presence of at least one phenotypic (i.e., nonintentional weight loss, low body mass index or low muscle mass) and one etiologic criterion (i.e., reduced food intake or inflammation) were required to define malnutrition.

Malnutrition is a common pathological condition in older adults that can further influence and aggravate health-related muscle decline. Sarcopenia is known as a natural progressive decline in skeletal muscles occurring with age, with an age-related decline in muscle strength. According to the criteria published in 2019 by the European Working Group on Sarcopenia in Older People (EWGSOP2), this process is defined by the presence of low muscle strength and low muscle mass.

Patients in acute care are likely to present higher stay and risk of mortality. However, the mortality have rarely been applied in acute care, due to difficulties to administer Dual X-ray Absorptiometry (DXA), the gold standard method for muscle mass in acute care. Pragmatic approaches to assess nutrition and nutrition-related condition are urgently needed to provide better quality of care in clinical practice in geriatric medicine.

The primary objective of this study is to determine the impact of nutrition disorders and nutrition-related conditions at baseline (admission in hospitalization) on the all-causes mortality risk in hospitalized older people.

Secondarily, this study evaluates their impact on other health adverse outcomes: falls, fractures, rehospitalization, institutionalization, all-cause admission in intensive care, length of hospital stay, length of ventilation and USI stay.

Finally, the diagnostic performance indicators of the Mini Nutritional Assessment (MNA-SF) and the Geriatric Nutritional Risk Index (GNRI) for malnutrition assessment following the GLIM criteria were calculated.

Study Overview

• Status: Recruiting
• Conditions: Nutrition Disorders

• Study Type: Observational
• Enrollment (Anticipated): 224

Contacts and Locations

• Study Contact: Name: Marie Claessens, MD; Phone Number: 32472488182; Email: marie.claessens@chu-brugmann.be

Study Locations

• Belgium
  • Brussels, Belgium
    • Recruiting
    • CHU Brugmann
    • Contact: Marie Claessens, MD; Phone Number: 32472488182; Email: marie.claessens@chu-brugmann.be

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients aged ≥60 and over admitted to the geriatric healthcare unit and/or the COVID-19 unit of the CHU Brugmann Hospital, between 01/01/2016 and 12/10/2021.

Description

Inclusion Criteria:

• Patients aged ≥60 and over admitted to the geriatric healthcare unit and/or the COVID-19 unit of the CHU Brugmann Hospital, between 01/01/2016 and 12/10/2021.
• Patients who had the assessment of nutrition disorders and/or nutrition related conditions available during their hospital admission.

Exclusion Criteria:

- No exclusion criteria based on demographical or medical data were applied.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Retrospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
All-cause mortality	Vital status (death/alive)	From 2016 till 2021

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Falls	Falls (yes/no)	From 2016 till 2021
Fractures of upper and lower limbs and/or hip and/or vertebrae	Fractures of upper and lower limbs and/or hip and/or vertebrae (yes/no)	From 2016 till 2021
Re-hospitalization	Unplanned readmission in hospital (yes/no)	From 2016 till 2021
Institutionalization	Institutionalization (yes/no)	From 2016 till 2021
All-cause admission in intensive care	All-cause admission in intensive care (yes/no)	From 2016 till 2021
Mechanical ventilation	Mechanical ventilation (yes/no)	From 2016 till 2021
Length of hospital stay time from admission to discharge	Length of hospital stay time from admission to discharge	From 2016 till 2021
Sensitivity	Diagnostic performance indicators: the ability of a screening test to identify malnourished patients according to the GLIM criteria.	From 2016 till 2021
Specificity	Diagnostic performance indicators: the ability of a screening test to identify non-malnourished patients according to the GLIM criteria.	From 2016 till 2021
Positive predictive value (PPV)	Positive predictive value is the proportion of positive screening test results that are true positives for the diagnosis of malnutrition according to GLIM criteria.	From 2016 till 2021
Negative predictive value (NPV)	Negative predictive value (NPV) is the proportion of negative screening test results that are true negative for the diagnosis of malnutrition according to the GLIM criteria.	From 2016 till 2021
Area under the ROC curve (AUC)	A measure of the precision of a quantitative diagnostic test, which gives equal weight to sensitivity and specificity.	From 2016 till 2021

Collaborators and Investigators

• Sponsor: Brugmann University Hospital
• Investigators: Principal Investigator: Marie Claessens, CHU Brugmann

Study record dates

Study Major Dates

• Study Start (Actual): October 12, 2021
• Primary Completion (Anticipated): December 31, 2022
• Study Completion (Anticipated): December 31, 2022

Study Registration Dates

• First Submitted: March 3, 2022
• First Submitted That Met QC Criteria: March 3, 2022
• First Posted (Actual): March 11, 2022

Study Record Updates

• Last Update Posted (Actual): March 11, 2022
• Last Update Submitted That Met QC Criteria: March 3, 2022
• Last Verified: March 1, 2022

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nutrition Disorders
• Other Study ID Numbers: CHUB-Nutrition disorders

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No