In the ageing and increasingly overweight population, the chronic disease burden is high. Therefore, a lot of effort is being made to prevent and counteract overweight and obesity. But malnutrition is also still common, particularly in the healthcare setting, and has far-reaching negative consequences for health. Because the presence of overweight can hinder the detection of malnutrition, and considering the ongoing overweight epidemic, Iris van Vliet evaluated the current malnutrition detection practices for their performance in the increasingly overweight hospital population.
New measurement methods
For her research, Iris van Vliet collected data on four nursing wards of the University Medical Center Groningen to evaluate the current malnutrition screening and assessment practices in the hospital. In these patients, the currently used malnutrition screening method (MUST) was compared to a newer, alternative screening method (PG-SGA SF). The PG-SGA SF focuses less on weight, but instead also screens for malnutrition risk factors, such as symptoms that can hinder food intake (nutrition impact symptoms, for instance, nausea or problems swallowing). She also investigated presence of malnutrition in kidney transplant recipients using assessment methods to measure muscle mass.
Better detection of malnutrition risk in hospital patients
From her research, it appears that the new screening method (PG-SGA SF) detects a 2.5-fold higher percentage of patients at increased malnutrition risk compared with the currently used screening. The difference in identification was particularly apparent in overweight patients: the currently used MUST hardly detected any patients with an increased risk for malnutrition (5%), while the PG-SGA SF showed that over a third (36%) of the patients were at increased risk. Importantly, the PG-SGA SF was better able to identify those patients who had a greater risk for worse clinical outcomes, such as a prolonged hospital stay or re-admission to the hospital.
Moreover, malnutrition is even more prevalent in patients at hospital discharge (36%) than at admission and the risk of deterioration during hospital stay is high. Of the patients who were initially well-nourished, 30% was malnourished at hospital discharge.
Malnutrition in kidney transplant recipients
Van Vliet’s study of patients who had previously undergone kidney transplantation showed that one in seven is malnourished. However, this can hardly be detected based on their weight alone. Almost a quarter of the malnourished kidney transplant recipients were, in fact, overweight. Instead, the vast majority of malnutrition in these patients was diagnosed based on the presence of low muscle mass. In these patients, both low muscle mass and low muscle strength were found to be associated with a higher risk of mortality. Assessment of muscle mass and muscle strength are, however, currently not part of standard hospital care routine.
‘Current approach is falling short’
According to Van Vliet, these studies show malnutrition is still common in hospital patients. ‘The current approach is falling short. With the current screening practices alone, a considerable amount of malnutrition (risk) in the hospital remains ‘hidden’. This has consequences for patient health as well as for the health care burden. Better detection of malnutrition and malnutrition risk is possible by implementing of more adequate screening and assessment methods in practice. This requires investment in practice-based research, adaptation of the current policies and guidelines, and a strong position of dietetics in hospitals.’ According to Van Vliet, the recognition and continued treatment of malnutrition after hospital discharge is also crucial. ‘This requires an more integral approach and a close collaboration with care partners in the region.’
Iris van Vliet (born in Taipei, Taiwan, in 1992) studied Nutrition and Dietetics at Hanze University of Applied Sciences and Psychology at the University of Groningen. She conducted her research at the SHARE research institute of the UMCG. Her thesis is titled: ‘Hidden hunger in the hospital? Recognition of malnutrition and malnutrition risk in complex hospital care’. She is currently working as a dietician and researcher at the UMCG.
Her research is elaborated on in this lecture for the Medical Public Academy at the UMCG: Te dik en toch ondervoed: 'verborgen honger’ (‘Overweight, yet malnourished: “hidden hunger”’).