Journal of Obesity & Eating Disorders

Description

Insufficient screening and management of malnutrition can significantly increase morbidity and mortality rates. The primary objectives of this study were to assess the characteristics and clinical outcomes of malnourished patients referred to a specialized outpatient clinic for malnutrition management, as well as to compare these outcomes based on the severity of malnutrition. Additionally, the study aimed to identify factors associated with severe malnutrition and mortality, and to evaluate the consistency of prescribed medical nutrition therapy with European society for clinical nutrition and metabolism guidelines as a secondary objective. This retrospective observational study involved the analysis of malnourished adults referred to the specialized nutrition consultation of a teaching University Hospital over a period of 50 months. Malnutrition diagnosis was based on criteria established by the Global Leadership Initiative on Malnutrition, which included body composition assessment through bioimpedance analysis. Statistical analysis employed Chi-square or Fisher tests, Student's t-tests or Wilcoxon rank-sum tests, and multivariable logistic regression to identify factors associated with severe malnutrition and mortality.

Malnutrition severity

A total of 108 malnourished adults were included in the study, with 74% classified as severely malnourished. The predominant secondary diagnosis among these patients was digestive cancer (48.2%). During the median follow-up period of 70 days after the initial nutritional consultation, 11% of patients required hospital admission, 19% experienced infections, and 23.1% succumbed to mortality, with no significant differences observed based on malnutrition severity. Comparative analysis revealed that severely malnourished individuals exhibited lower body mass index and Fat Mass Index (FMI), as well as higher levels of total body water compared to moderately malnourished subjects. Notably, a low FMI was the sole factor significantly associated with severe malnutrition. However, no specific factors were identified as significantly correlated with mortality. The study also found a moderate level of consistency (47.1%) between prescribed medical nutrition therapy and ESPEN guidelines for nutritional care. In conclusion, adults referred to specialized nutritional consultations typically present with severe malnutrition and face significant risks of complications, resulting in elevated mortality rates. A low FMI was identified as a key indicator of severe malnutrition. Early diagnosis, prompt management of malnutrition, and timely referral to clinical nutrition units are recommended to enhance patient outcomes. The study underscores the importance of effective screening and management of malnutrition to mitigate its adverse effects. Identifying malnourished patients and initiating appropriate interventions promptly can help improve clinical outcomes and reduce mortality rates. Additionally, adherence to established guidelines for medical nutrition therapy is essential to ensure optimal care for malnourished individuals. Further research is needed to explore additional factors influencing severe malnutrition and mortality, as well as to enhance the consistency of medical nutrition therapy with clinical guidelines.

Nutritional assessment

Ultimately, addressing malnutrition comprehensively requires a multidisciplinary approach involving healthcare providers, nutritionists, and patients themselves to achieve the best possible outcomes and improve overall quality of life. Furthermore, this study highlights the critical need for comprehensive nutritional assessment and intervention strategies tailored to individual patient needs. By identifying factors associated with severe malnutrition and mortality, healthcare providers can develop targeted interventions to address these challenges effectively. Moreover, efforts to improve the consistency of medical nutrition therapy with established guidelines, such as those provided by ESPEN, are essential for optimizing patient care and outcomes. Continued research into the multifaceted aspects of malnutrition and its management will further enhance our understanding and enable the development of more effective strategies to combat this significant healthcare issue.