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TalkingNutrition

Providing perspectives on recent research into vitamins and nutritionals

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Nutrition Advice and Hospitalization Outcomes

By Michael McBurney

Nobody wants to be admitted to the hospital yet according to the U.S. Centers for Disease Control and Prevention (CDC), 20% of people report at least one emergency department visit in 2011. The most common reasons are injuries from falls, being struck  by a person or object, motor vehicle traffic accidents, and cuts. We know that a greater focus on safety can reduce the chances of being involved in an accident leading to an emergency visit.

Nutrition is also at the heart of many chronic non-communicable diseases – heart disease, cancer, chronic respiratory diseases, stroke, diabetes, Alzheimer’s. The latest CDC statistics (Table 91) find 49% of Americans taking at least one prescription drug, 22% taking ≥3, and 11% taking ≥5 during the past 30 days. Prescription drugs account for 12% of personal health care expenditures (Table 113). Increasingly, health professionals and consumers are showing their willingness to use drugs to treat NCDs. Is there evidence that improved nutrition behaviors are also being adopted?

The answer doesn’t look promising. Kelly Tappenden, PhD, RD from the University of Illinois reports (video) that 1 of every 3 patients entering American hospitals are malnourished.  These numbers are not unique to the United States and its health care system. Schindler and colleagues, in a survey of 21,007 patients in 325 European hospitals from 25 countries, report 27% of patients were classified as being at ‘nutritional risk’ in hospitals which performed nutritional screening.  Imoberdorf and colleagues report that nearly 1 in 5 patients admitted to Swiss hospitals is severely undernourished. 41% of patients admitted to hospital in Australia and New Zealand are at risk of malnutrition (Agarwal et al., 2012). Brazilian data suggests that 28-73% of patient admissions have nutritional deficits (Raslan et al., 2010). As Dr Tappenden says, malnourished patients have poorer outcomes – increased levels of complications, greater lengths of stay and higher re-admission rates. Malnutrition at time of admission is associated with poorer outcomes for patients and increased healthcare costs for everyone.

Addressing the nutritional status of patients admitted to hospitals can improve patient outcomes and control health care costs. We can also take action now. Hopefully none of us will have an emergency trip in our future but better nutrition is good insurance. A new study by Mishra and colleagues shows that workplace interventions can reduce fat intakes (total and saturated fat, and cholesterol) and significantly increase the consumption of vitamin C, beta-carotene (provitamin A), potassium, magnesium and dietary fiber.

Start eating more nutritiously, exercise regularly, and use a dietary supplement if needed. It can be a life saver.

Citation

National Center for Health Statistics. Health, United States. 2012: With special feature on emergency care. Hyattsville, MD. 2013.

Imoberdorf R, Meier R, Krebs P, Hangartner PJ, Hess B, Staubli M, Wegmann D, Ruhlin M, Ballmer PE. Prevalence of undernutrition on admission to Swiss hospitals. 2010 Clin Nutr doi:10.1016/j.clnu.2009.06.005

Agarwal E, Ferguson M, Banks M, Bauer J, Capra S, Isenring E. Nutritional status and dietary intake of acute care patients: Results from the Nutrition Care Day Survey 2010. 2012 Clin Nutr doi:10.1016/j.clnu.d011.08.002

Raslan M, Gonzalez MC, Goncalves Dias MC, Nasciemento M, Castro M, Marques P, Segatto S, Torrinhas RS, Cecconello I, Waitzberg D. Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. 2010 Nutr doi:10.1016/j.nut.2009.07.010

Schindler K, Pernicka E, Laviano A, Howard P, Schutz T, Bauer P, Grecu I, Jonkers C, Kondrup J, Ljungqvist O,Mouhieddine M, Pichard C, Singer P, Schneider S, Schuh C, Hiesmayr M, The NutritionDay Audit Team. How nutritional risk is assessed and managed in European hospitals: A survey of 21,007 patients findings from the 2007-2008 cross-sectional nutritionDay survey. 2010 Clin Nutr doi:10.1016/j.clnu.2010.04.001

Kyle UG, Coss-Bu JA. Nutritional assessment and length of hospital stay. 2010 Can Med Assoc  J doi:10.1503/cmaj.101256

Mishra S, Barnard ND, Gonzales J, Xu J, Agarwal U, Levin S. Nutrient intake in the GEICO multicenter trial: the effects of a multicomponent worksite intervention. 2013 Eur J Clin Nutr doi:10.1038/ejcn.2013.149


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