Assessment of Malnutrition in Hospitalized Patients: a Quasi Study (AMMRP)

Malnutrition among hospitalized patients is a critical, yet often overlooked, public health issue associated with increased complications, longer hospital stays, higher mortality, and greater healthcare costs. In Iraq, factors such as dietary patterns, the burden of chronic diseases, and healthcare constraints may increase the risk of hospital-acquired malnutrition. Current standard care may not include systematic nutritional screening or protocol-driven support. This trial aims to test whether implementing an individualized nutritional support program can improve clinical outcomes for at-risk medical inpatients in Iraqi hospitals, building upon evidence from international studies

Study Overview

• Status: Not yet recruiting
• Conditions: Alzheimer s Disease; COPD , Neurology , ICU; Alzheimer
• Intervention / Treatment: Other: Nutritional Assessment and Medication Review; Other: Nutritional Assessment and Medication Review

• Study Type: Observational
• Enrollment (Estimated): 300

Contacts and Locations

• Study Contact: Name: mawj ali Principal Investigator, College of Pharmacy, University of Bas, BPharm; Phone Number: +9647705746266; Email: mawjali92@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of hospitalized adult patients admitted to Al-Basrah Teaching Hospital and Al-Fayhaa General Hospital in Basra, Iraq. The cohort primarily includes individuals admitted to the Medical wards, Surgical wards, and the Neurology Intensive Care Unit (ICU).

This population represents a diverse clinical spectrum, with a particular focus on patients suffering from chronic inflammatory conditions and neurodegenerative disorders, specifically Chronic Obstructive Pulmonary Disease (COPD) and Alzheimer's Disease. The population is characterized by varying levels of nutritional risk and complex pharmacotherapy regimens (polypharmacy). Participants are recruited within the first 48 hours of admission to capture point-prevalence data. The demographic includes both males and females aged 18 years and older, representing the urban and suburban population served by the Basra Health Directorate.

Description

Inclusion Criteria:

• Age: Adult patients aged $\ge$ 18 years.Setting: Patients admitted to the Medicine, Surgery, or Neurology Intensive Care Unit (ICU) wards at Al-Basrah Teaching Hospital or Al-Fayhaa General Hospital.Duration of Stay: Patients who have been hospitalized for a minimum of 48 hours (to ensure a baseline for malnutrition screening and medication review).Clinical Conditions: Patients with various primary diagnoses, including specific subgroups with Chronic Obstructive Pulmonary Disease (COPD) and Alzheimer's Disease.Informed Consent: Patients or their legal guardians (especially for those in the ICU or with cognitive impairment) who provide written or verbal informed consent.

Exclusion Criteria:

• Maternity/Obstetrics: Pregnant or lactating women, as nutritional requirements and physiological BMI changes differ from the general adult population.

Terminal Illness: Patients in end-of-life or palliative care where nutritional intervention is no longer a clinical goal.

Incomplete Records: Patients with missing medical or medication charts that prevent the accurate identification of Medication-Related Problems (MRPs).

Short Stay: Patients planned for discharge or transfer within less than 48 hours of admission.

Psychiatric Disorders: Patients with primary psychiatric diagnoses that may interfere with the ability to conduct nutritional assessments (unless a guardian is present).

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Hospitalized Adults in Basrah; This cohort consists of 200 adult patients (age > 18 years) admitted to the Medicine, Surgery, and Neurology ICU wards of Al-Basrah Teaching Hospital and Al-Fayhaa General Hospital.

Other: Nutritional Assessment and Medication Review; Intervention Description"This observational intervention consists of a multi-disciplinary clinical assessment conducted in three distinct phases for each enrolled participant:Validated Two-Step Nutritional Evaluation: Unlike standard hospital screening, this study uses the Nutritional Risk Screening (NRS-2002) as an initial filter. Patients identified as 'at risk' (score $\ge$ 3) are immediately subjected to the Global Leadership Initiative on Malnutrition (GLIM) criteria. This provides a definitive diagnosis by combining phenotypic criteria (non-volitional weight loss, low BMI, or reduced muscle mass) with etiologic criteria (reduced food intake/malabsorption or disease-related inflammation/chronic illness).Specialized Comorbidity Analysis: The assessment specifically targets the impact of Chronic Obstructive Pulmonary Disease (COPD) and Alzheimer's Disease on nutritional status, evaluating how respiratory hypermetabolism and cognitive impairment act as independent drivers of malnutri; Other Names: NRS-2002 and GLIM-based Nutritional Assessment; Point Prevalence Malnutrition Screening; Other: Nutritional Assessment and Medication Review; To distinguish your research from a standard hospital audit or a basic nutritional survey, your description must highlight the systematic, two-step diagnostic workflow and the integration of clinical pharmacy oversight.Use the following detailed description for your entry:Intervention Description"This observational intervention consists of a multi-dimensional clinical assessment conducted in three specific phases for each participant:Validated Two-Step Nutritional Protocol: Unlike standard care, which may lack formal screening, this intervention applies the Nutritional Risk Screening (NRS-2002) within 48 hours of admission. Participants identified as 'at risk' (score $\ge$ 3) are immediately subjected to the Global Leadership Initiative on Malnutrition (GLIM) criteria. This provides a definitive diagnosis by combining phenotypic criteria (non-volitional weight loss, low BMI, or reduced muscle mass) with etiologic criteria (reduced food intake/malabsorption or disease-related inflammati; Other Names: NRS-2002 and GLIM-based Nutritional Assessment; Point Prevalence Malnutrition Screening; Assessment of Malnutrition and Medication-Related Problems (AMMRP)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
oint Prevalence of Malnutrition using GLIM Criteria and NRS-2002	The primary goal is to determine the prevalence of malnutrition among hospitalized adult patients in Al-Basrah Teaching Hospital and Al-Fayhaa General Hospital. All participants are first screened using the Nutritional Risk Screening (NRS-2002). For those identified as "at risk" (score $\ge$ 3), a definitive diagnosis is made using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Diagnosis requires at least one phenotypic criterion (non-volitional weight loss, low BMI, or reduced muscle mass) and one etiologic criterion (reduced food intake/malabsorption or disease-related inflammation/chronic illness, such as COPD or critical illness in the Neurology ICU). The prevalence will be reported as the percentage of the total cohort meeting the GLIM diagnostic threshold.	Within 48 hours of hospital admission
Point Prevalence of Malnutrition using GLIM Criteria , NRS2002	The primary goal is to determine the prevalence of malnutrition among hospitalized adult patients in Al-Basrah Teaching Hospital and Al-Fayhaa General Hospital. All participants are first screened using the Nutritional Risk Screening (NRS-2002). For those identified as "at risk" (score $\ge$ 3), a definitive diagnosis is made using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Diagnosis requires at least one phenotypic criterion (non-volitional weight loss, low BMI, or reduced muscle mass) and one etiologic criterion (reduced food intake/malabsorption or disease-related inflammation/chronic illness, such as COPD or critical illness in the Neurology ICU). The prevalence will be reported as the percentage of the total cohort meeting the GLIM diagnostic threshold.	Within 48 hours of hospital admission.

Collaborators and Investigators

• Sponsor: AlFayhaa General Hospital
• Collaborators: Ministry of Health, Iraq; University of Basrah

Publications and helpful links

General Publications

• Azzolino D, Lucchi T. Malnutrition in older adults: a wider view. Lancet. 2023 Nov 25;402(10416):1976. doi: 10.1016/S0140-6736(23)01780-4. No abstract available.

Helpful Links

• The leading international body for clinical nutrition. This link provides the guidelines for the NRS-2002 screening tool and nutrition in the ICU, which are the foundations of the AMMRP protocol.

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): September 1, 2026

Study Registration Dates

• First Submitted: March 11, 2026
• First Submitted That Met QC Criteria: March 11, 2026
• First Posted (Actual): March 16, 2026

Study Record Updates

• Last Update Posted (Actual): March 16, 2026
• Last Update Submitted That Met QC Criteria: March 11, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Hospital Malnutrition , Nutritional Risk Screening ,GLIM Criteria; Medication-Related Problems (MRPs
• Additional Relevant MeSH Terms: Pathologic Processes; Chronic Disease; Disease Attributes; Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pathological Conditions, Signs and Symptoms; Pulmonary Disease, Chronic Obstructive; Organization and Administration; Health Services Administration; Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Epidemiologic Measurements; Patient Care Management; Medication Systems; Nutrition Assessment; Medication Review
• Other Study ID Numbers: hospitalized malnutrition; AMMRP-2026-BASRA (Other Identifier: University of Basrah , College of Pharmacy)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: "Individual Participant Data (IPD) will not be publicly shared to ensure the confidentiality and privacy of the patients recruited from Al-Basrah Teaching and Al-Fayhaa General Hospitals, particularly those in the Neurology ICU and those with sensitive diagnoses like Alzheimer's disease. Currently, there is no institutional mandate from the University of Basrah or the Basrah Health Directorate to share raw datasets. However, the aggregate results, statistical summaries, and the final thesis findings will be made available through the university library and potential journal publications. Requests for specific data for meta-analysis may be considered by the principal investigator and supervisor upon reasonable request and formal ethical approval."

Study Data/Documents

1. Study Protocol
   Information identifier: mawjali92@gmail.com
   Information comments: "This research is a prospective, cross-sectional observational study conducted as part of a Master's degree in Clinical Pharmacy.

Drug and device information, study documents

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