Malnutrition in acute care patients: A narrative review

Objectives: This narrative review assesses the current prevalence of malnutrition, the methods for detection of malnutrition, the factors associated with malnutrition, and the effects of malnutrition in the acute care patients. Design: A narrative review methodology was employed. Data sources: CINAHL, Pub Med, and MEDLINE electronic databases were searched from 1996 to 2005, for English language articles. Search terms of malnutrition, acute care patients, nutrition assessment, and nutrition screening were used. Review method: The titles and abstracts of 857 articles were examined. Full text of the articles were obtained only when abstracts described undernutrition, malnutrition, protein-energy malnutrition, nutrition assessment, nutrition screening, factors contributing to malnutrition, or resultant outcomes of malnutrition in adult acute care patients. Additionally, a hand search through reference lists of retrieved articles was done. The articles reviewed included empirical reports (110), reviews (25), commentaries (4), and reports from professional associations (10). Results: Currently, malnutrition ranges from 13-78% among acute care patients. Different methods of detecting malnutrition make it difficult to determine the prevalence among acute care patients. Additionally, many nutritionscreening tools used to detect malnutrition have not undergone rigorous testing for validity, reliability, sensitivity, and specificity. Numerous personal and organizational factors affect the nutritional status of acute care patients. Diminished nutritional status contributes to increased use of hospital resources and increased hospital costs. Conclusion: Malnutrition continues to be a significant problem among acute care patients. The Subjective Global Assessment tool has the most diagnostic value for acute care patients. Simple measures, like documenting height and weight on admission, and assessing patient's nutritional intake, weight status, and medications that alter nutritional intake could assist in early detection of malnutrition in the acute care patient. (0 2006 Elsevier Ltd. All rights reserved.