Malnutrition and Clinical Outcomes: The Case for Medical Nutrition Therapy

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Abstract

Malnutrition is not a new or a rare problem. In studies involving more than 1,327 hospitalized adult patients, 40% to 55% were found to be either malnourished or at risk for malnutrition, and up to 12% were severely malnourished. Surgical patients with likelihood of malnutrition are two to three times more likely to have minor and major complications as well as increased mortality; and their length of stay can be extended by 90% compared with the stay of well-nourished patients. Hospital charges are reported to be from 35% to 75% higher for malnourished patients than for well-nourished patients. Obtaining data to assess the nutritional status of patients is essential to optimal patient care, especially for patients at high risk for malnutrition. Nutrition assessment can be done with readily available and relatively inexpensive methods. But it is not enough to assess and identify malnutrition. Outcomes are improved and costs are saved only when appropriate intervention follows. This article identifies many well-conducted, published studies that support the findings that health outcomes of malnourished patients can be improved and that overall use of resources can be reduced by nutrition counseling, oral diet and oral supplements, enteral formula delivered via tube, and parenteral nutrition support via central or peripheral line. Early nutrition assessment and appropriate nutrition intervention must be accepted as essential for the delivery of quality health care. Appropriately selected nutrition support can address the problem of malnutrition, improve clinical outcomes, and help reduce the costs of health care. J Am Diet Assoc. 1996; 96:361-366,369.

Section snippets

Prevalence of Malnutrition

Malnutrition is a critical health problem among all ages and across the continuum of care. It is estimated that more than 15 million people are treated yearly in US hospitals for illnesses, injuries, and social conditions that place them at high risk for malnutrition (3).

Malnutrition occurs in even the best of US hospitals. In eight studies involving more than 1,347 hospitalized adult patients, 40% to 55% were found to be either malnourished or at risk for malnutrition (4), (5), (6), (7), (8),

Outcomes and Costs of Malnutrition

In light of today's interest in health care costs, researchers are looking at malnutrition as a hidden cause of rising costs (16). Many retrospective and prospective studies of medical and surgical patients show that compared with well-nourished patients, malnourished patients, regardless of age, endure longer hospital stays (5), (17), (18), (19), (20), (21) and have higher costs (17), (19), (20), (22), (23), (24), (25), (26), (27). Additionally, malnourished patients experience slower healing

Methods of Identifying Nutritional Risk

Health care providers can readily identify malnourished patients. Nutrition assessment can be done with readily available and relatively inexpensive methods. The methods chosen must be sensitive and specific and have positive predictive value. Clinical indicators coupled with patient histories can effectively document the presence or likelihood of malnutrition (47). The expertise of available personnel, laboratory capability, cost, and the patient population will determine the selection of

Nutrition Intervention for Malnutrition

It is not enough to assess patients and identify malnutrition. Outcomes are improved and costs are saved only when appropriate nutrition intervention is given. Nutrition intervention for diagnoses that are likely to respond to treatment can improve clinical outcomes and save health care costs. The array of nutrition modalities available to clinicians has increased within the past few years. Options range from a specially planned diet of traditional foods to total parenteral nutrition support,

Need for Clinical Outcome Studies

Given today's emphasis on reducing health care costs, outcomes studies are necessary to better quantify the benefits and cost-effectiveness of nutrition intervention and services. To date, few clinical nutrition studies have measured outcome in terms of clinical rather than biochemical end points, and fewer have addressed the economic value of nutrition intervention (96). Many opportunities exist for outcome research in clinical settings. The American Dietetic Association has established an

Cost Savings Through a Team Approach

Outcome data collection and evaluation are responsibilities of each member of the health care team. Cost-effective benefits of specially trained nutrition support teams have been delineated (100), and nutrition support teams with expertise in clinical outcome research can help avoid methodologic flaws and intervening factors that can confound results of clinical outcome studies (101), (102). For example, recommendations of a specially trained nutrition support team to change patients from total

Summary and Applications

Malnutrition is not a new or a rare problem. It is a problem with costs that can be reduced when timely nutrition screening and assessment are followed by appropriate nutrition intervention.

Obtaining data to assess the nutritional status of patients is essential to optimal patient care, especially for patients at high risk for malnutrition (106). It is not enough to assess and identify malnutrition. Outcomes are improved and costs are saved only when appropriate nutrition intervention is made

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