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(1) Background: Malnutrition in hospitalized patients is prevalent worldwide, but the severity of the issue is often underestimated by practitioners. The purpose of this study is to investigate the prevalence of malnutrition and inadequate eating behaviour in a geriatric sample. (2) Methods: Two hospitals participated with six wards on nutritionDay in 2017, 2018 and 2019. Nutritional status, food intake, and nutritional interventions were analyzed for all patients ≥ 65 years (n = 156), using the official nutritionDay questionnaires. Malnutrition risk is identified by Malnutrition Universal Screening Tool (MUST), malnutrition by the ESPEN criteria (European Society of Clinical Nutrition and Metabolism). (3) Results: According to MUST (n = 136) 16.9% (n = 23) were at medium risk of malnutrition, 33.8% (n = 46) at high risk of malnutrition, 28.1% (n = 38) were malnourished. Overall, 62.8% (n = 98) showed an inadequate eating behaviour during hospital stay. Moreover, patients with inadequate nutrition had significantly worse self-reported health statuses (p = 0.001, r = −0.276), were less able to walk on nutritionDay (p = 0.002, r = −0.255), had eaten little in the week before admission to hospital (p &lt, 0.001, r = −0.313), and had an increased length of stay (p = 0.036, r = −0.174). (4) Conclusion: To identify malnourished patients is a significant barrier for practitioners seeking to administer specific, tailored interventions. Malnutrition screening protocols must be improved, just as nutrition monitoring in general.

BACKGROUND & AIMS Across the globe, the prevalence of hospital malnutrition varies greatly depending on the population served and on local socioeconomic conditions. While malnutrition is widely recognized to worsen patient outcomes and add financial burdens to healthcare systems, recent data on hospital malnutrition in Latin America are limited. Our study objectives were: (1) to quantify the prevalence of malnutrition risk in Latin American hospital wards, and (2) to explore associations between nutritional risk status, in-hospital food intake, and health outcomes. METHODS On nutritionDay (nDay), a specific day every year, hospital wards worldwide can participate in a one-day, cross-sectional audit. We analyzed nDay data collected in ten Latin American countries from 2009 to 2015, including demographic and nutrition-related findings for adult patients (≥18 years) from 582 hospital wards/units. Based on patient-reported responses to questions related to the Malnutrition Screening Tool, we determined the prevalence of malnutrition risk (MST score ≥2). We also summarized patient-reported food intake on nDay, and we analyzed staff-collected outcome data at 30 days post-nDay. RESULTS The prevalence of malnutrition risk in the Latin American nDay study population (N = 14,515) was 39.6%. More than 50% of studied patients ate one-half or less of their hospital meal, ate less than normal in the week before nDay, or experienced weight loss in the prior three months. The hospital-mortality hazard ratio was 3.63 (95% CI [2.71, 4.88]; P

Zusammenfassung Hintergrund Mangelernährung ist ein nach wie vor herausforderndes Problem in der Krankenhausversorgung, speziell bei geriatrischen Patient*innen. Dennoch findet das Thema in der Praxis nur wenig Beachtung. Ziel und Methodik Im Zentrum der vorliegenden Datenanalyse steht die Fragestellung, inwiefern sich der Ernährungsstatus von zuhause lebenden geriatrischen Patient*innen, von in der stationären Pflege lebenden, unterscheidet. Hierfür wurden Daten aus insgesamt 4 Erhebungen (3-mal nutritionDay plus eine zusätzliche Erhebung) zusammengefasst. Es konnten 258 Patient*innen (≥ 65 Jahre) in die Auswertung aufgenommen werden; ein Mangelernährungsrisiko wurde anhand des Malnutrition Universal Screening Tool (MUST), eine manifeste Mangelernährung anhand der ESPEN-Kriterien festgestellt. Ergebnisse Zu Hause leben 86,0 % (n = 222) der Patient*innen, in stationären Pflegeeinrichtungen 14,0 % (n = 36). Die in der stationären Pflege lebenden Patient*innen weisen eine ausgeprägtere Morbidität auf, sichtbar anhand der größeren Anzahl an in der Klinik verbrachten Nächten in den letzten 12 Monaten (Mdn 10,0 vs. 5; p 0,007), der höheren Anzahl der Medikamente (Mdn 9,0 vs. 7,0; p 0,002) sowie stärkeren Einschränkungen beim Gehen (Mdn 3,0 vs. 1,0; p p n = 10 vs. 20,1 %; n = 40; p 0,062). Schlussfolgerung Sowohl zu Hause als auch in der stationären Langzeitpflege lebende geriatrische Patient*innen weisen einen erheblichen Anteil an Mangelernährung auf. Ein zuverlässig durchgeführtes Screening zu Beginn und im Verlauf des Klinikaufenthaltes ist in jedem Fall dringend erforderlich, da nur so die Betroffenen erkannt werden. Ein regelmäßiges Screening im ambulanten Bereich wie auch der stationären Langzeitpflege ist ebenso erforderlich.

Summary Background Poor adherence to intensive care unit (ICU) guidelines is common, leading to suboptimal nutritional care. This study determined current ward-based nutrition care practices in the Indian ICU setting, comparing them to international best-practice guidelines and provided patient demographic, clinical and nutritional information to serve as baseline data for future benchmarking. Methods This multi-site cross-sectional retrospective study analysed data collected from nutritionDay worldwide audits (2012–2016) across ICUs from a chain of urban private hospitals in India. Additional guideline-specific data were collected through questionnaires and phone interviews with the Head of Dietetics Departments in the participating hospitals. Results Overall, 10 ICUs and 457 participants were included. It was common practice to use modified versions of the Mini Nutritional Assessment-Short Form (MNA-SF) and Subjective Global Assessment (SGA) for nutrition screening and assessment. Nearly half the participants (n = 222, 49%) received nutrition orally. A majority of the remaining participants received enteral nutrition (n = 163, 36%) or no nutrition (n = 60, 13%) at the time of data collection. The calories prescribed for most participants were between 1500 and 1999 kilocalories per day (n = 207, 45%), with no nutrition planned for 115 (25%) participants. Three-quarters (n = 129, 74%) of participants on EN received the planned calories, while 24% (n = 42) were given less than planned. Conclusion Overall, most participants received the calories planned for enteral nutrition. The use of modified screening and assessment tools and suboptimal delivery of EN remains a global problem for critical care, possibly requiring a more pragmatic approach to nutritional therapy.

Aim Current literature regarding the prevalence and consequences of poor dietary intake and risk of malnutrition in older adults is limited to wealthier regions including the United States, Europe and Australasia. With a rapidly ageing population in India, this prospective observational study aimed to evaluate hospital food intake and malnutrition risk and their impact on hospital length of stay, readmission rates and in-hospital mortality of older adults in Indian hospitals. Methods Data collected during nutritionDay worldwide audits (2014-2016), in five urban, private hospitals in India included baseline demographic and clinical data on patients aged ≥60 years. Proportion of food consumed at one main meal was recorded and data on length of stay, readmissions and in-hospital mortality were collected 30 days post-baseline. Results A total of 262 participants (mean age: 69 ± 8 years; 65% males) were recruited. Mapped malnutrition risk (mapped Malnutrition Screening Tool [mMST] score ≥ 2) on admission was 31% and increased to 44% during the course of hospitalisation. Over one quarter of participants consumed ≤50% of their meal (28%). Over half the participants were found to be eating poorly (59%) and those identified as at risk of malnutrition were not offered additional nutrition support. The median LOS was 8 days (range: 1-92), 30-day readmission rates were 7% and in-hospital mortality was 0.4%. Malnutrition risk and poor food intake were not associated with health-related outcomes. Conclusion Older adults in Indian acute care hospitals have a noticeable prevalence of malnutrition risk and poor food intake. There is an opportunity for future research to focus on identifying and managing nutritional issues.

BACKGROUND: Obesity [Body Mass Index (BMI) > 30 kg/m2] is a risk factor for disease conditions enhancing hospitalization and mortality risks, but higher BMI was paradoxically reported to reduce mortality in several acute and chronic diseases. Unintentional weight loss (WL) is conversely associated with disease development and may worsen patient outcome, but the impact of weight loss and its interaction with obesity in modulating risk of death in hospitalized patients remain undefined. METHODS: We investigated the ESPEN nutritionDay database of non-critically ill hospitalized patients to assess the impact of self-reported 3-month WL (WL1:2.5-6.6%; WL2: 6.6-12.6%, WL3: >12.6%) and its interaction with BMI in modulating 30-day in-hospital mortality. Multivariate Cox regression was used to estimate hazard ratios (HR), with stable weight (WL0) as reference category. RESULTS: In 110835 nDay patients, 30-day mortality increased with increasing WL. Male gender, increasing disease severity index PANDORA score (age, nutrient intake, mobility, fluid status, cancer and main patient group) and not having had surgery also predicted 30-day mortality. HR for 30-day mortality remained significantly higher compared to WL0 for WL2 and WL3 after multiple adjustment. Adjusted HR and its increments through increasing weight loss categories were comparable in lean (BMI30 kg/m2). Impact of gender, PANDORA score and surgery on 30-day mortality were conversely comparable in the three BMI groups. CONCLUSIONS: These results indicate that self-reported WL could represent a relevant prognostic factor in every hospitalized patient. Overweight and obesity per se have no protective impact against WL-associated mortality.

Background/Objectives Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) p Results Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.

Hospital length of stay (LOS) is an important clinical and economic outcome and knowing its predictors could lead to better planning of resources needed during hospitalization. This analysis sought to identify structure, patient, and nutrition-related predictors of LOS available at the time of admission in the global nutritionDay dataset and to analyze variations by country for countries with n &gt, 750. Data from 2006–2015 (n = 155,524) was utilized for descriptive and multivariable cause-specific Cox proportional hazards competing-risks analyses of total LOS from admission. Time to event analysis on 90,480 complete cases included: discharged (n = 65,509), transferred (n = 11,553), or in-hospital death (n = 3199). The median LOS was 6 days (25th and 75th percentile: 4–12). There is robust evidence that LOS is predicted by patient characteristics such as age, affected organs, and comorbidities in all three outcomes. Having lost weight in the last three months led to a longer time to discharge (Hazard Ratio (HR) 0.89, 99.9% Confidence Interval (CI) 0.85–0.93), shorter time to transfer (HR 1.40, 99.9% CI 1.24–1.57) or death (HR 2.34, 99.9% CI 1.86–2.94). The impact of having a dietician and screening patients at admission varied by country. Despite country variability in outcomes and LOS, the factors that predict LOS at admission are consistent globally.

Summary Background and aims European and North American guidelines on Parenteral Nutrition (PN) and large Randomized Controlled Trials give divergent advices on nutritional therapeutic strategies for critically ill patients. We therefore investigated differences in therapeutic strategies of clinicians between European and Non-European Intensive Care Units (ICU) regarding start day of PN, preferred route of administration and prescription of total energy targets over the years. Methods In this study 16,032 patients from 1389 different ICUs were included. Data collection was performed in 28 different European and Non-European ICUs from 2007 to 2018 via nutritionDay, a worldwide-standardized one-day multinational cross-sectional audit. Results In this analysis an abrupt delay in PN start days was observed in 2011 (7.64 days (4.31; 19.97); p = 0.001) and 2012 (6.41 days (3.1; 9.72); p = 0.001), which was significantly reversed within the following years until 2018. In European, compared to Non-European countries PN prescription was increased (27% versus 13%). Patients from North-America received significantly less kcal per day compared to Europe (−4.3 kcal kg−1 (−6.9; −1.6); p = 0.001). Conclusions Our study provides further evidence on transatlantic discrepancies in nutritional therapy of ICU patients. Regular audits, such as nutritionDay are substantial for self-reflection of clinical daily practice of intensivists. It is time for worldwide consensus in nutritional therapy by developing worldwide guidelines and supporting standardization in nutrition care of critically ill patients.

Purpose: Patients with colorectal cancer (CRC) often experience malnutrition and weight loss, largely resulting from reduced dietary intake. The aim of this study was to identify determinants of reduced dietary intake in order to facilitate early recognition of malnutrition and optimise nutritional treatment. Methods: Data from nutritionDay, an international 1-day survey investigating patient, disease and food profiles, were used. To identify determinants of dietary intake, defined as normal vs. reduced in the last week, univariate and multivariate logistic regressions were performed. Results: Of 1131 hospitalised CRC patients, 54% reported reduced dietary intake. Patient- and disease-related characteristics significantly associated with reduced dietary intake were female gender (odds ratio (OR) 1.38), cancer stage III (OR 1.52) or IV (OR 1.70) vs. I, performance status 2 (OR 1.56), 3 (OR 2.37) or 4 (OR 4.15) vs. 0, duration since hospital admission of ≥ 4 days (OR 4–7 days, 1.91; 8–21 days, 1.97; > 21 days, 1.92) vs. < 4 days, and unintentional weight loss (OR 2.56). Additionally, higher symptom scores of pain, weakness, depression, tiredness and lack of appetite were associated with reduced intake. Conclusions: Patient- and disease-related determinants for reduced dietary intake were being female, higher cancer stage, worse performance status, duration since hospital admission ≥ 4 days and unintentional weight loss. Furthermore, multiple symptoms were associated with a reduced dietary intake. Future trials should assess whether early recognition of patients at risk of malnutrition and the combination of treating symptoms and dietary advice result in improved intake and treatment-related outcomes.

Summary Background & aims Oral nutritional supplements (ONS) can be helpful for nursing home (NH) residents to prevent or treat malnutrition. Presently little is known about the use of ONS in NHs and the factors associated with its use. Thus, the aim of this analysis was to describe the use of ONS in NHs participating in the nutritionDay project and to determine characteristics of NH residents receiving ONS. Methods Data from nutritionDay (nD), a cross-sectional multicenter study with standardized questionnaires on resident and NH level were analyzed. NH residents participating between 2007 and 2014 aged 65 years or older were included. Unit characteristics (2 variables), general residents' characteristics (18), residents' nutritional status (3) and residents' nutrition (4) were of interest as potential predictors of the use of ONS (no vs yes). Univariate binary logistic regression (LR) analyses were performed for all variables, and significant predictors (p Results 13.9% of 23,689 NH residents received ONS. Univariate analysis identified all variables as predictors. After multivariate analysis 19 variables remained in the model (Nagelkerke's R2 = 0.319). Odds ratios (OR [95% Confidence Interval]) of receiving ONS were highest in residents receiving supplementary parenteral nutrition (29.05 [14.85–56.81]; however only 1.1% of all participants) and fortified diet (11.91 [8.52–16.64]; 5.7%). The odds ratio of receiving ONS was 3.26 ([2.86–3.71]; 18.3%) for residents being classified as at risk of malnutrition and 4.56 ([3.86–5.40]; 10.0%) for malnourished residents according to NH staff. Low BMI and weight loss in the last year increased the odds of receiving ONS by 2.34 ([1.93–2.84]; 16.0%) and 1.38 ([1.23–1.54]; 32.8%), respectively. Furthermore, increasing age, cognitive and functional impairment, low food intake on nD, neurological disease and cancer were associated with an increased likelihood of the use of ONS. In NH units with a nutritional expert (67.1%) and units performing a nutritional assessment at least once a month (71.6%), the odds of receiving ONS were also significantly increased (1.89 [1.71–2.10] and 1.17 [1.06–1.29]). Conclusion In NHs who participated in the nutritionDay, ONS are used for residents with poor nutritional and functional status and often in combination with other nutritional interventions. Future studies need to clarify the role of NH staff in the prescription and distribution of ONS and focus on the reasons for and adequacy of the use of ONS in NHs.

Despite high prevalence at hospital admission, disease related malnutrition (DRM) remains under recognized and undertreated. DRM is associated with increased morbidity, hospital readmission rate, and burden for the healthcare system. The compelling need to increase awareness and knowledge through an international survey has triggered the launch of the nutritionDay (ND) concept.ND is a worldwide annual systematic collection and analysis of data in hospital wards, intensive care units and nursing homes. ND is based on questionnaires to systematically collect and analyze the patient's characteristics, food intake and nutrition support, as well as the determinants of their environment (facility, health care personal, etc …). Questionnaires, outcome documentation sheets and step-by-step guidance are available as download in 30 languages.ND has described the nutritional status and behavior of over 150,000 hospitalized patients and nursing home's patients in over 56 participating countries. These data allowed a local, regional, national and international benchmarking at different levels (i.e. type of medical pathologies, care facilities, etc.) and over time. Sixteen peer-reviewed publications have already been released and picture the international scene of DRM.This review presents the 10-year of the ND project development and shows how ND serves all health care professionals to optimize nutrition care and nutrition related structures. ND keeps progressing and is likely to become a standard tool for determining the nutritional status and behavior of hospitalized patients and nursing home's population.

Summary Introduction To determine the nutrition practice in intensive care units and the associated outcome across the world, a yearly 1 day cross sectional audit was performed from 2007 to 2013. The data of this initiative called “nutritionDay ICU” were analyzed. Material and methods A questionnaire translated in 17 languages was used to determine the unit's characteristics, patient's condition, nutrition condition and therapy as well as outcome. All the patients present in the morning of the 1 day prevalence study were included from 2007 to 2013. Results 9777 patients from 46 countries and 880 units were included. Their SAPS 2 was median 38 (IQR 27–51), predicted mortality was 30.7% ± 26.9, and their SOFA score 4.5 ± 3.4 with median 4 (IQR 2–7). Administration of calories did not appear to be related to actual or ideal body weight within all BMI groups. Patients with a BMI 40 received slightly less calories than all other BMI groups. Two third of the patients were either ventilated or were in the ICU for longer than 24 h at nutritionDay. Routes of feeding used were the oral, enteral and parenteral routes. More than 40% of the patients were not fed during the first day. The mean energy administered using enteral route was 1286 ± 663 kcal/day and using parenteral nutrition 1440 ± 652 kcal/day. 60 days mortality was 26.0%. Discussion This very large collaborative cohort study shows that most of the patients are underfed during according to actual recommendations their ICU stay. Prescribed calories appear to be ordered regardless to the ideal weight of the patient. Nutritional support is slow to start and never reaches the recommended targets. Parenteral nutrition prescription is increasing during the ICU stay but reaching only 20% of the population studied if ICU stay is one week or longer. The nutritional support worldwide does not seem to be guided by weight or disease but more to be standardized and limited to a certain level of calories. These observations are showing the poor observance to guidelines.

Reduced food intake is a frequent problem at a hospital setting, being a cause and/or consequence of malnutrition. Food presentation can affect food intake and induce nutritional benefit.To investigate the effect of improved meal presentation supported by gastronomy expertise on the food intake in adults hospitalized in internal medicine departments.Controlled before and after study.Two hundred and six newly hospitalized patients in internal medicine departments were included and divided in two groups, a) control: receiving the standard lunch from the hospital and b) experimental: receiving a lunch improved in terms of presentation by the advices received by the Institut Paul Bocuse, Ecully, Lyon, France together with the hospital kitchen of the Beilinson Hospital, without change in the composition of the meal. The amount of food left at the participants' plates was estimated using the Digital Imaging Method, which consisted in photographing the plates immediately to previous tray collection by the researcher. In addition, the nutritionDay questionnaire was used to measure other variables concerned to their food intake during hospitalization. Charlson Comorbidity Index was calculated.There was no significant difference between the groups regarding demography or Charlson Comorbidity Index. Patients who received the meal with the improved presentation showed significantly higher food intake than those who received the standard meal, despite reported loss in appetite. Participants from the experimental group left on their plate less starch (0.19 ± 0.30 vs. 0.52 + 0.41) (p 0.05) and less from the main course than the control group (0.18 + 0.31 vs. 0.46 + 0.41) (p 0.05). However, both of the groups left the same amount of vegetables (0.37 + 0.36 vs. 0.29 + 0.35) (p 0.05). Both of the groups were asked how hungry they were before the meal and no significance was shown. More participants from the experimental group reported their meal to be tasty in comparison to those in the control group (49.5% vs. 33.7% p 0.005). Length of stay was not different but readmission rate decreased significantly in the study group (p 0.02) from 31.2% to 13.5%.Improvement of meal presentation at a hospital setting can increase food intake, reduce waste food substantially and reduce readmission rate to hospital.

Summary Background and objectives Despite the proven benefits of oral nutrition supplements (ONS), its prescription in Thailand are far less than it should mainly due to limitation of reimbursement. Our aim was to compare hospital outcomes between hospitalized patients receiving only hospital food to those receiving hospital food with ONS. Methods and study design An annual cross-sectional survey, NutritionDay (nD), in Thailand was conducted in 2 hospitals from 2010 to 2015. The hospital outcomes were followed at day 30 after first evaluation. Logistic regression and Cox regression were performed to compare outcome between groups. Results 524 hospitalized patients, 472 with only hospital food and 52 with ONS, were included. Patients with ONS had longer hospital stay prior to recruitment, reported more physical dependencies, and ate less food. The ONS group was less likely to be discharged within 30 days as compared to hospital food group (unadjusted OR 0.28, 95% CI 0.16–0.52) but this effect was not significant after adjustment for length of stay before nD and PANDORA score (adjusted OR 0.62, 95% CI 0.3–1.34). Cox regression showed a trend to decreased rate of discharge within 30 days in the ONS group. Conclusions This cross-sectional study showed a trend of worse outcomes associated with ONS prescription which might be related with higher mortality risk according to PANDORA score and longer previous hospital stay of the patients in the ONS group. Since the 2 studied groups were not comparable, further studies in this specific population should be performed.

The nutritionDay (nD) initiative has been promoted by the European Society for Clinical Nutrition and Metabolism (ESPEN) to assess and audit the nutritional status of hospitalized patients, as well as to promote awareness. Israel has been participating annually in this project since 2006.To evaluate the proportion of malnourished patients in Israel in comparison with the rest of the world.Data were collected by staff members and the hospitalization outcomes were followed up at day 30. The data were analyzed by the Vienna coordinating center, using "my SQL" (Structured Query Language), an open source relational database management system and analyzed, using SAS (Statistical Analysis System) version 9.2.In Israel, 2303 patients (in 114 various medical specialty units) were included in the study during a 7-year survey, while 4316 units recruited 91,351 patients in the world (W), between 2006 and 2012, The median age of patients was 68 years, with 44% of females and BMI of 27 ± 6 (25 in W). Israel had a higher proportion of nutrition care teams per patient (in 88% of the units) than W (71%) (p 0.05). 43% of the patients had a weight loss within the last 3 months prior to admission (same for W); 36.7% described a decrease in eating more than 50% of their normal food intake (21.3% in W). Food intake at nD showed that 51.4% of the patients ate half to nothing of the served meal (56.2% in W). In Israel, more patients received hospital modified diets (13% vs. 8.2% in W), but less supplements (5.7% vs. 8.3% in W) or enteral/parenteral nutrition (9.0% vs. 13.5% in W, p 0.05). Length of hospital stay was shorter in Israel (11 days vs. 14 days in W, p 0.05) and mortality was similar (3.9% vs. 3.8% in W).Malnutrition of hospitalized patients in Israel was found comparable to the rest of the world. However, in Israel in spite of the higher nutrition staff member/patient ratio there was no increase in the administration of supplements or artificial nutrition to malnourished patients in the surveyed units. Also, the length of hospital stay was shorter and was not associated with an increase in mortality.

Aims Prevalence of malnutrition is a common and serious issue responsible for the morbidity and mortality rate among hospitalized patients. We aimed to provide an actual and comprehensive situation of the nutritional characteristics, nutritional support and the risk factors for malnutrition among hospitalized patients in China. Methods We analyzed the data from nutritionDay audit 2016 in China. The international daylong cross-sectional survey was performed on November 10th, 2016 via filling out several questionnaires regarding information on patients’ illness, food intake history, weight change and nutritional care. Re-assessment of patients’ outcome questionnaire was performed 30 days later. Results Total of 781 patients from 9 hospitals and 8 kinds of departments were enrolled in this report. Of these, malnutrition rate was 29.6%. Parenteral nutrition (251/344, 73.0%) was the primary nutrition support form in Chinese hospitals. However, 41.8% (136/325) of patients at nutritional risk or already diagnosed with malnutrition did not received any form of nutritional support, whereas 34.0% (155/456) well-nourished patients did. Patients with malnutrition had extended length of hospital stay and poor 30-day outcomes compared to well-nourished patients. Nutritional support could benefit nutritional risk or malnutrition patients, rather than well-nourished patients. Moreover, major lesion types, self-related health, food intake last week were independent risk factors of malnutrition (all p

Disease-related malnutrition (DRM) is prevalent in hospitals and is associated with increased care needs, prolonged hospital stay, delayed rehabilitation and death. Nutrition care process related activities such as screening, assessment and treatment has been advocated by scientific societies and patient organizations but implementation is variable. We analysed the cross-sectional nutritionDay database for prevalence of nutrition risk factors, care processes and outcome for medical, surgical, long-term care and other patients (n = 153,470). In 59,126 medical patients included between 2006 and 2015 the prevalence of recent weight loss (45%), history of decreased eating (48%) and low actual eating (53%) was more prevalent than low BMI (8%). Each of these risk factors was associated with a large increase in 30 days hospital mortality. A similar pattern is found in all four patient groups. Nutrition care processes increase slightly with the presence of risk factors but are never done in more than 50% of the patients. Only a third of patients not eating in hospital receive oral nutritional supplements or artificial nutrition. We suggest that political action should be taken to raise awareness and formal education on all aspects related to DRM for all stakeholders, to create and support responsibilities within hospitals, and to create adequate reimbursement schemes. Collection of routine and benchmarking data is crucial to tackle DRM.

Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European countries. The aim of this study was to put the problem into perspective by comparing the prevalence of malnutrition in countries from opposite parts of the continent. Six countries - Croatia, Estonia, Greece, Lithuania, Poland, and Turkey - participated in the study. A short questionnaire was used to assess DRM: its prevalence, the current situation in hospitals, regulations for reimbursement, and general healthcare circumstances. Data from ESPEN's NutritionDay 2006 were used to broaden the perspective. At admission in October 2012, 4068 patients were assessed. The study was performed in 160 hospitals and 225 units with 9143 beds. The highest proportions of patients with 3 or more points on the Nutritional Risk Screening 2002 were observed in Estonia (80.4%) and Turkey (39.4%), whereas the lowest were in Lithuania (14.2%). The provision of nutrition support was best in Turkey (39.4% required intervention, 34.4% received intervention) and Poland (21.9% and 27.8%, respectively). Nutrition support teams (NSTs) are active in some countries, whereas in others they virtually do not exist. The prevalence of malnutrition was quite high in some countries, and the nutrition approach differed among them. It could be the result of the lack of reimbursement, inactive or nonexistent NSTs, and low nutrition awareness. Those facts confirmed that the continuation of FAM activities is necessary.

Summary Background & aims Several large and long-term prospective studies have assessed the association of body-mass index (BMI) next to age with the risk of death in the general population, but few have examined the association with in-hospital mortality. We investigated the association between BMI, age and in-hospital mortality. Methods We used data collected during 9 consecutive one-day/year surveys (NutritionDay in hospital 2006–2014) conducted in non-critically ill adult patients from 2,183 hospitals across 51 nations from 4 continents. We examined the association of BMI and age with the risk of in-hospital (30-day) death using logistic regression analysis adjusted for multiple confounders. Results Crude mortality rates were 3.6% (95%CI, 3.5–3.7) and 2.1% (95%CI, 2.0–2.3) in the overall cohort (N = 97,344) and in those assessed within 72 hours since admission (N = 32,363), respectively. BMI and age were independently associated with the risk of death (no interaction observed), which decreased with BMI and increased with age. In the overall cohort, compared to normal weight status (BMI 18.5–24.9 kg/m 2 ), death odds ratios for underweight (BMI Conclusion In adult hospitalized patients BMI and age are independent predictors of in-hospital mortality. Low body weight is confirmed being a risk factor for death as in the general population, while overweight and obesity appear protective conditions. In the hospital setting, the use of normal weight status as reference low-risk category could also be challenged.

Background. Poor nutritional status and weight loss are associated with poor survival in patients with COPD. Surprisingly, only limited information is available in hospitalized patients. Aim. We evaluated relations between nutritional status, weight changes, nutritional intake, and all-cause mortality in hospitalized patients with COPD. Methods. The NutritionDay initiative is an ongoing multinational registry in 56 countries that collects a wealth of data, including weight trajectory and nutritional indices: body mass index (BMI), body weight changes within last 3 months, nutritional intake during last week and on the survey day. We have linked this information with all-cause in-hospital mortality. Results. 5518 patients with COPD (73±12 years, 56% men, BMI of 26.0±6.7 kg/m 2 ); 10% had BMI 40). Weight loss within the last 3 months was self-reported by 50% of patients. During the last week, 31% reported to eat less than half of what they normally eat; on the survey day, 52% ate half or less of their lunch/dinner. 30-day in-hospital mortality was 5%. Mortality was lowest in patients with normal food intake on survey day (2.3%) and during the week prior to the survey day (2.3%); if patients ate less than half, mortality increased to 12.4% and 9.2%, respectively (p Conclusions. Low BMI, weight loss and inadequate food intake are common in hospitalized patients with COPD and are associated with increased all-cause in-hospital mortality.

Aim: Malnutrition is a significant issue for hospitals worldwide. This project examined malnutrition prevalence and associated factors including meal consumption in an Australian hospital. Methods: The cross-sectional study was undertaken at a private hospital in Brisbane, Australia, for 'nutritionDay in Europe' 2009. Nutritional status (subjective global assessment), demographic, medical condition and intake data were collected from 147 inpatients across five medical specialties. Results: The present study found 19.7% (29) of patients were malnourished (17.7% mild to moderately malnourished, 2% severely malnourished). Unintentional weight loss was reported by 39.5% of patients (58) and 49% of patients (72) reported eating less than normal. There were 41.5% of patients (61) who reported not having their usual appetite, with 46.3% (68) eating half or less of a hospital meal. The likelihood of being malnourished increased 4.0 times (CI 1.4-11.6, P= 0.01) for patients who ate less than normal during the previous week and 15 times (CI 4.2-53.5, P < 0.001) for those patients who reported eating less than one quarter to nearly nothing. The likelihood of being malnourished increased 2.9 (CI 1.1-7.6, P= 0.026) and 4.8 (CI 1.6-14.3, P= 0.005) times for patients consuming less than half of breakfast and dinner respectively. Binary logistic regression modelling found a malnutrition screening tool score of ≥2 and average meal consumption of 50% or less were predictors of malnutrition. Conclusions: The present study provides evidence of the increased likelihood of malnutrition in relation to decreased meal consumption and provides insights for future interventions in the acute care setting. © 2011 The Authors. Nutrition & Dietetics

Dysphagia is a major healthcare problem as it increases the risk of malnutrition, dehydration, aspiration pneumonia, and death. The aims of this analysis of data from nursing homes (NHs) worldwide were to examine prevalence rates of dysphagia, to identify characteristics of residents with dysphagia, and to describe which type of nutrition residents with dysphagia receive.One-day cross-sectional study, repeated in yearly intervals since 2007.926 NH units from 19 countries.NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older, from Europe and North America, and with available information on dysphagia.Data on resident and unit level were collected on nutritionDay by local nursing staff using standardized questionnaires. Residents' nutritional status, nutritional intake, general residents' characteristics, and unit characteristics were of interest as potential predictors of dysphagia (no vs yes). Univariable generalized estimating equations were performed for all variables, and significant predictors (P .01) included in a multivariable analysis. Nutritional strategies (type of diet, use of oral nutritional supplements, tube feeding, and parenteral nutrition) are described for residents with and without dysphagia.Dysphagia was reported in 13.4% of the 23,549 residents included, with great variation in the prevalence rates between participating countries. Twelve variables of 23 remained in the multivariable model [area under the receiver operating curve = 0.898; 95% confidence interval (CI) 0.892-0.904; P .001]. Residents who were not able to eat lunch orally on nutritionDay were 14.90 [odds ratio (OR); 95% CI 9.61-23.11] times more likely to have dysphagia compared with residents who ate everything. ORs of dysphagia were higher for residents with chewing problems (OR 10.48; 95% CI 8.98-12.23), immobile (OR 5.10, 95% CI 4.25-6.11) and partially mobile residents (OR 1.94; 95% CI 1.64-2.29) compared to mobile residents, and residents with severe cognitive impairment (OR 1.99; 95% CI 1.64-2.42). Poor nutritional status, digestive diseases, neurologic diseases, dehydration, and use of antibiotics were also related to a higher risk of dysphagia. The most common nutritional strategy for residents with dysphagia was providing texture-modified diet (42.5%) followed by normal diet (28.2%). One-quarter of residents with dysphagia received oral nutritional supplements additionally, 7.4% of residents with dysphagia received tube feeding exclusively, and 8.0% in combination with oral nutrition.This analysis of NHs participating in the nutritionDay provides important insight into the current awareness of dysphagia, associated factors, and nutritional strategies. Residents who were unable to eat orally, malnourished, or dehydrated suffered more often from dysphagia, which substantiates the challenges of providing safe and adequate nutrition for residents with dysphagia. Adequacy and efficiency of different nutritional strategies need to be clarified in future studies.

nutritionDay is a 1-day cross-sectional survey identifying how nutrition care is provided. This paper provides results of the first 2 Canadian nutritionDay surveys. In November 2010 and 2011, data from standardized questionnaires were collected from 193 units in Canadian hospitals consisting of unit demographics and patient information including weight history, health status, nutrition assessment, nutrition therapy, food intake and 30-day outcomes. Results indicated that overall, 46% of the 1905 patients reported weight loss in the previous 3 months, and in half of these it was greater than 5 kg. Only 50% of the units had nutrition teams and nutrition therapy was provided to less than 14% of patients. More than 50% of patients ate less than normal in the previous week and 57% ate less than half of their meal on nutritionDay. Within the next 30 days the majority of patients went home, 10% remained in hospital, and 6% were readmitted. In this study, nutritionDay provided relevant information on nutrition assessment, weight history, food intake, nutrition therapy, length of stay, and outcomes in participating Canadian institutions. Data from 2010 and 2011 can help to both reflect on current practices and define continuous improvements through benchmarking with the overall goal of mitigating suboptimal nutrition intake during hospitalization.

Malnutrition has been identified as affecting patient outcome. The purpose of this study was to correlate the nutritional status of hospitalized patients with their morbidity, mortality, length of hospital stay and costs. The patients were nutritionally assessed within the first 72 h of hospital admission. The patients' charts were surveyed on the incidence of complications and mortality. Hospital costs were calculated based on economic tables used by insurance companies. Multivariate logistic regression analysis and the Cox regression model were used to identify possible confounding factors. A P

Background & aims A system for screening of nutritional risk is described. It is based on the concept that nutritional support is indicated in patients who are severely ill with increased nutritional requirements, or who are severely undernourished, or who have certain degrees of severity of disease in combination with certain degrees of undernutrition. Degrees of severity of disease and undernutrition were defined as absent, mild, moderate or severe from data sets in a selected number of randomized controlled trials (RCTs) and converted to a numeric score. After completion, the screening system was validated against all published RCTs known to us of nutritional support vs spontaneous intake to investigate whether the screening system could distinguish between trials with a positive outcome and trials with no effect on outcome. Methods The total number of randomized trials identified was 128. In each trial, the group of patients was classified with respect to nutritional status and severity of disease, and it was determined whether the effect of nutritional intervention on clinical outcome was positive or absent. Results Among 75 studies of patients classified as being nutritionally at-risk, 43 showed a positive effect of nutritional support on clinical outcome. Among 53 studies of patients not considered to be nutritionally at-risk, 14 showed a positive effect (P=0.0006). This corresponded to a likelihood ratio (true positive/false positive) of 1.7 (95% CI: 2.3-1.2). For 71 studies of parenteral nutrition, the likelihood ratio was 1.4 (1.9-1.0), and for 56 studies of enteral or oral nutrition the likelihood ratio was 2.9 (5.9-1.4). Conclusion The screening system appears to be able to distinguish between trials with a positive effect vs no effect, and it can therefore probably also identify patients who are likely to benefit from nutritional support.

Background In the general population, poor self-rated health (SRH) is associated with malnutrition; however,these associations have not been studied in hospitalized patients. We aimed to evaluate SRH, indicators ofnutrition, nutritional status and their association with in-hospital mortality.Materials and methods The study is based on data from the nutritionDay, a multinational, multicentre Euro-pean-wide standardized 1-day cross-sectional survey of nutritional factors, food intake and in-hospital mortalityin hospitalized patients. A data set of surveys on SRH in 2010 and 2011 was used in the analysis.Results Complete sets of data were available for 28 106 patients (64 18 years, 50% men, 7% terminally ill).In relation to body mass index, 7% were undernourished and 16% were obese. Fair/poor SRH was reported by59% of patients and was associated with low food intake during the previous week or on survey day(P < 0 005). Thirty-day in-hospital mortality was 3%; in adjusted multivariate survival analysis, fair/poor SRH[hazard ratio (HR) 1 53, 95% confidence interval (CI) 1 14–2 05] and reduced food intake [nothing eaten (HR2 13, 95% CI 1 46–3 11) or not allowed to eat on nutritionDay (HR 2 01, 95% CI 1 30–3 11)] predicted fataloutcome. At particularly high risk were patients who rated their health poor and had reduced food intake on thesurvey day or within the previous week with relative risks of 7 37 and 8 80, respectively.Conclusions We demonstrated high prevalence of poor SRH and insufficient food intake in hospitalizedpatients. This was associated, particularly in combination, with increased risk of in-hospital mortality.Keywords Cross-sectional survey, mortality, nutritional intake, self-rated health.Eur J Clin Invest 2014; 44 (9): 813–824

Background. To ascertain the potential contributors to nutritional risk manifestation and to disclose the factors exerting a negative impact on hospital length of stay (LOS), by means of poor nutritional status, in a nonselected hospitalized population.Materials and Methods. NutritionDay project questionnaires were applied to 295 adult patients. Study parameters included anthropometric data, demographics, medical history, dietary-related factors, and self-perception of health status. Body Mass Index (BMI) and Malnutrition Universal Screening Tool (MUST) were calculated for each participant. MUST score was applied for malnutrition assessment, while hospital LOS constituted the outcome of interest.Results. Of the total cohort, 42.3% were at nutritional risk and 21.4% malnourished. Age, gender, BMI, MUST score, autonomy, health quality, appetite, quantity of food intake, weight loss, arm or calf perimeter (P<0.001, for all), and dietary type (P<0.01) affected nutritional status. Poor nutrition status (P=0.000), deteriorated appetite (P=0.000) or food intake (P=0.025), limited autonomy (P=0.013), artificial nutrition (P=0.012), weight loss (P=0.010), and arm circumference P=0.007) were the most powerful predictors of hospital LOS >7 days.Conclusion. Nutritional status and nutrition-related parameters such as weight loss, quantity of food intake, appetite, arm circumference, dietary type, and extent of dependence confer considerable prognostic value regarding hospital LOS in acute care setting.