This document summarizes a presentation on research into hospital malnutrition at Prince Muhammad Bin AbdulAziz Hospital. The study found malnutrition prevalence of 39% among admitted patients, rising to around 50% when adjusted. 14% of patients were severely malnourished. Malnutrition is associated with increased length of hospital stay, medical complications, and costs. The presenter calls for efforts to address malnutrition as a quality initiative to improve patient outcomes and lower healthcare costs.

1. Hospital Malnutrition-Research
Experience at PMBAH,MNGHA
Presenter:Atta-ur-Rehman, Ph.D (Clinical Nutrition)
Prince Muhammad Bin AbdulAziz Hospital, AlMadinah AlMunawarrah
Ministry of National Guard Health Affairs

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Hospital Malnutrition-Research Experience at
PMBAH,MNGHA
Principal Investigator: Atta-ur-Rehman, Ph.D (Clinical Nutrition)
Co-Investigators:
Mr.Meshal Al Malki
Ms.Nur Adila Saminghan
Prince Muhammad Bin AbdulAziz Hospital, AlMadinah AlMunawarrah
Ministry of National Guard Health Affairs

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Conflict of interest:
Authors report no conflict of interest for this study.

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Background
Malnutrition:
Malnutrition is the inadequate intake of nutrients, particularly protein, over time and
may contribute to chronic illness and acute disease or illness and infection. People can
be underweight or overweight (obese) and malnourished when they lack sufficient
nutrients needed to promote healing, rehabilitation, and reduce the risk of medical
complications.

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Hospital Malnutrition
 Primary PEM: Protein Energy Malnutrition(PEM)
- Acute or chronic deficiency of both Protein and calories
 Secondary PEM:
-Results from a disease or medical condition

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Despite cutting edge advances in clinical nutritional
therapy and nutritional assessment techniques,
Protein- Energy Malnutrition(PEM) is consistently
found in 30- 55 % of acutely ill hospitalized patients in
America.
Ref:
Correia MI, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: A systematic review [published online ahead of print July 19, 2016]. Clin Nutr.
http://dx.doi.org/10.1016/j.clnu.2016.06.025.
Malnutrition in Hospitalized Patients

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Does it exist in Hospitals?

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 According to European Society for Clinical Nutrition and
Metabolism (ESPEN): Malnutrition is common in European
hospitals, and the average prevalence is 35%, with a range
from 10 - 85%.
ESPEN:2007
Prevalence of Malnutrition

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Causes of Undernutrition
 Failure to record height and weight
Prolonged glucose, saline I/V fluids
Failure to observe food intake
Withholding meals because of tests
Unrecognized needs due to injury or illness
Delayed or inadequate nutrition support
Charles Butterworth 1974:The Skeleton in the hospital Closet.

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British Association for Parenteral and
Enteral Nutrition (BAPEN)-2007
The BAPEN report also found that malnourished patients had
more:
General Practitioner visits (65% increase)
Hospital admissions (82% increase)
>30% longer Length of Stay
Greater likelihood of admission to care homes

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Prevalence of Malnutrition
 Stratton’s research in the United Kingdom
found that malnutrition was common in 58%
of patients and was associated with longer
hospital stays and poor outcomes.
 Stratton RJ, King DL, Stroud MA, et al: Malnutrition Universal Screening
Tool predicts mortality and length of hospital stay in acutely ill elderly. Brit
J of Nutr 200695:325-330

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Clinical Consequences
 10% impaired Immune function
• 20% impaired wound and rehabilitation
• 30% pneumonia and pressure ulcers
• 40% Death (pneumonia)
 Martindale R Physiologic Basis of Surgery 2008

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Objectives
Specific Objective:
To examine the magnitude of Malnutrition in admitted patients at
the time of presentation.
Secondary Objective:
To study the exact level of Severe Malnutrition in the hospitalized
patients.

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Methodology
-Study Design : Retrospective cohort
-Sample Size: 173 patients age > 18 years with no critical illness, full codes status.
-Duration: admitted and evaluated during Aug,2016-Dec,2017.
-Study Analysis: Descriptive Statistics

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Methodology:
Patients were labelled as
-well nourished (Grade A),
-Moderately Malnourished (Grade B)
-Severely Malnourished (Grade C)
-Trained clinical dietitians, using the Subjective Global Assessment (SGA)
-A tool which is embedded in the Best-care software for the electronic medical charting of the patients.
-Demographic data (gender, age, health information, including number of active diagnoses, ward/unit
(medical, surgical, mixed medical/surgical) were included.

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Prevalence of Malnutrition at PMBAH
Malnutrition was prevalent in 39% patients.
When adjusted prevalence was around 50%.
14% patients were Severely Malnourished
(PMBAH STUDY 2017-18 : under publication)

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Results:

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Results?

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Benefits are proven-Cost Saving
Enormous cost savings by addressing hospital malnutrition.
- One hospital developed a comprehensive program, which resulted in a savings of $2.4 million over a 2-year
period due to decreased LOS.
- Savings were estimated at $1,000 for each patient at high risk of malnutrition
Reference:
Brugler L, DiPrinzio MJ, Bernstein L: The five-year evolution of a malnutrition treatment program in a community hospital. J Qual Improve 1999;25(4):191-206.

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Benefits are proven-Clinical
 25% reduction in pressure ulcer incidence (1)
14% fewer overall complications (2)
28% decrease in avoidable readmissions (3)
2 Day reduction in average length of stay (4)
1. Stratton RJ et al. Ageing Res Rev. 2005;4:422-450.
2. Milne AC, et al. Cochrane Database Syst Rev. 2009 Apr 15(2):CD003288. DOI:10.1002/14651858.
3. Gariballa S et al. Am J Med 2006; 119:693-699.
4. Brugler L et al. J Qual Improv 1999; 25:191-206.

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A Window of Opportunity

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Malnutrition

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Conclusion
 Malnutrition prevalence is alarming and a cause of Poor
health outcomes
 Develop Malnutrition Prevention Team / Taskforce
 MOH, Regulators, Hospital management has a vital role
 Should launch Malnutrition Care - As a Quality Initiative