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Protein, malnutrition and wasting disorders

How does nutritional state change during a subacute admission? Findings and implications for practice

European Journal of Clinical Nutrition volume 70, pages 607–612 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

Nutritional status influences patients’ clinical and functional outcomes. The aims were to identify changes in nutritional state during subacute care and associated participant characteristics.

Subjects/Methods:

A longitudinal study was undertaken with consecutive patients admitted to subacute care wards during a 3-month period. Participants were recruited under a waiver of consent to reflect the usual demographic. Change in classification (malnourished, at risk of malnutrition, well nourished) of the full Mini Nutritional Assessment (full MNA) between admission and discharge was the primary outcome. Weight (kg), mid-arm and calf circumference (cm) change were secondary outcomes. Hand grip strength (kg) and fat-free mass (kg) (assessed using bioelectrical impedance analysis) were measured for a consenting subgroup.

Results:

Participants (n=248, 36.7% male) had a median age of 80 years and a length of stay of 17 days. On admission, 29.1% were classified as malnourished. By discharge, nutritional classification remained stable for 62.0% of participants (n=132), declined for 10.3% (n=22) and improved for 27.7% (n=59, including 52.5% malnourished on admission). Impaired cognition (odds ratio (OR)=0.169, P=0.002) and higher full MNA score at admission (OR=0.870, P=0.001) reduced odds of improvement in full MNA. There was no change in hand grip strength (n=46), but there was a decline in mean fat-free mass (−1.1 kg, 95% confidence interval: −0.1 to −2.2 kg, P=0.043, n=24).

Conclusions:

Multidisciplinary care supports the nutritional state of most patients admitted to subacute care. Those with cognitive impairments or at risk of malnutrition were less likely to demonstrate improvement and may benefit from more intensive or tailored nutritional care.

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Article 12 November 2020

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Acknowledgements

The authors acknowledge the support of the dietetic and ward staff at The Peter James Centre, Eastern Health. This research was unfunded. JC is the recipient of an Australian Postgraduate Award (APA) scholarship and a Monash University Postgraduate Publication Award.

Author contributions

All authors contributed to the conception, development of the study and read and approved the final manuscript. JC conducted data collection, analyses and wrote the manuscript. JP, HT and CH supervised data collection, analyses and contributed to the interpretation of the results and revision of the manuscript.

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Authors and Affiliations

  1. Department of Nutrition and Dietetics, Be Active Sleep Eat Facility, Monash University, Notting Hill, VIC, Australia

    J Collins, J Porter, H Truby & C E Huggins

  2. Eastern Health Dietetics Department, Box Hill, VIC, Australia

    J Porter

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Correspondence to J Collins.

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Collins, J., Porter, J., Truby, H. et al. How does nutritional state change during a subacute admission? Findings and implications for practice. Eur J Clin Nutr 70, 607–612 (2016). https://doi.org/10.1038/ejcn.2016.2

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