Ingles

ARTICLE IN PRESS
Clinical Nutrition (2006) 25, 563–572

http:/ /intl.elsevierhealth.com/journals/clnu

ORGINAL ARTICLE

The German hospital malnutrition study
Matthias Pirlicha,Ã, Tatjana Schutza, Kristina Normana, Sylvia Gastella, ¨ b Heinrich Josef Lubke , Stephan C. Bischoffc, Ulrich Bolderd, ¨ e ¨ Thomas Frieling , Helge Guldenzophf, Kristian Hahng, Karl-Walter Jauchd, h KarinSchindler , Jurgen Steini, Dorothee Volkertj, Arved Weimannk, ¨ l ¨ Hansjorg Werner , Christiane Wolfm, Gudrun Zurchern, ¨ o a Peter Bauer , Herbert Lochs
Medizinische Klinik—Gastroenterologie, Hepatologie und Endokrinologie, Charite—Universitatsmedizin Berlin, D 10098 Berlin, Germany ´ ¨ b Helios Kliniken Emil von Behring, Medizinische Klinik II, Berlin Germany c Medizinische Hochschule Hannover,Gastroenterologie, Hepatologie und Endokrinologie, Hannover, Germany d Klinikum der Universitat Regensburg, Klinik und Poliklinik fur Chirurgie, Regensburg, Germany ¨ ¨ e Klinikum Krefeld, Medizinische Klinik II, Krefeld, Germany f Malteser Krankenhaus Bonn-Hardtberg, Geriatrie, Bonn, Germany g Sankt Katharinen-Krankenhaus, Geriatrische Klinik, Frankfurt, Germany h AKH Wien,Klinik fur Innere MedizinIII, Wien, Austria ¨ i Universitatsklinikum Frankfurtam Main, Medizinische Klinik I-ZAFES, SP Gastroenterologie und ¨ Klinische Ernahrung, Frankfurt, Germany ¨ j Rheinische Friedrich-Wilhelms-Universitat Bonn, Institut fur Ernahrungswissenschaft, Bonn, Germany ¨ ¨ ¨ k Stadtisches Klinikum St. Georg, Allgemein- und Visceralchirurgie ¨ l Evangelisches Krankenhaus Elisabethenstift, Klinik furGeriatrie, Darmstadt, Germany ¨ m Charite Universitatsmedizin Berlin, Klinik fur Frauenheilkunde und Geburtshilfe, Berlin, Germany ´ ¨ ¨ n Universitatsklinikum Freiburg, Innere Medizin I, Hamatologie/Onkologie, Sektion Ernahrungsmedizin und ¨ ¨ ¨ Diatetik, Freiburg, Germany ¨ o Medizinische Universitat Wien, Medizinische Statistik, Wien, Austria ¨
Received 12 December 2005; accepted 21 March 2006
aKEYWORDS
Hospital malnutrition;

Summary Background & aims: Malnutrition is frequently observed in chronic and severe diseases and associated with impaired outcome. In Germany general data on prevalence and impact of hospital malnutrition are missing.

ÃCorresponding author. Medizinische Klinik und Poliklinik, Charite—Universitatsmedizin Berlin, D 10098 Berlin, Germany. ´ ¨

Tel.: +49 30 450514062; fax: +49 30 450 514901. E-mail address: matthias.pirlich@charite.de (M. Pirlich). 0261-5614/$ - see front matter & 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2006.03.005

ARTICLE IN PRESS
564
Prevalence; Subjective global assessment; Hospital setting; Elderly; Nutritional assessment

M. Pirlich et al.Methods: Nutritional state was assessed by subjective global assessment (SGA) and by anthropometric measurements in 1886 consecutively admitted patients in 13 hospitals (n ¼ 1073, university hospitals; n ¼ 813, community or teaching hospitals). Risk factors for malnutrition and the impact of nutritional status on length of hospital stay were analyzed. Results: Malnutrition was diagnosed in 27.4% ofpatients according to SGA. A low arm muscle area and arm fat area were observed in 11.3% and 17.1%, respectively. Forty-three % of patients X70 years old were malnourished compared to only 7.8% of patients o30 years. The highest prevalence of malnutrition was observed in geriatric (56.2%), oncology (37.6%), and gastroenterology (32.6%) departments. Multivariate analysis revealed three independent riskfactors: higher age, polypharmacy, and malignant disease (all Po0:01). Malnutrition was associated with an 43% increase of hospital stay (Po0:001). Conclusions: In German hospitals every fourth patient is malnourished. Malnutrition is associated with increased length of hospital stay. Higher age, malignant disease and major comorbidity were found to be the main contributors to malnutrition....