In the current issue of the Journal of the Academy of Nutrition and Dietetics, healthcare experts have focused on hospitalized patients with malnutrition in the US and presented data elucidating the extent of the serious healthcare issue.

Malnutrition is a major contributor to multiple morbidities, decreased physical and cognitive function, and impaired quality of life, as well as increased hospital readmissions and overall higher healthcare costs.

Malnutrition among hospitalized patients remains a serious issue that has been underdiagnosed and undertreated for decades. It is estimated that approximately 20% paediatric patients and 30% adult patients aged 60 and older are malnourished.

In one of the largest studies, researchers evaluated ~6,000,000 adult hospitalizations using a large collaborative multi-institutional database to assess the rate of malnutrition diagnoses and institutional variables associated with higher rates of malnutrition diagnosis.  

The team determined that only 5% of hospitalized adult patients had medical diagnoses of malnutrition during their hospital stay. The researchers found that institutional culture influences missing malnutrition diagnoses.

Hospitals with higher rates of malnutrition identification had a higher volume of patients, higher hospital ranking, and greater patient satisfaction. While the value of establishing a malnutrition diagnosis is to prompt malnutrition-based interventions because malnutrition represents a potentially modifiable risk factor for patient care.

Nutrition diagnosis is a first step to providing adequate overall nutrition medical therapy. Quality improvement efforts aimed at a better structure and process have a key role in improving the identification of malnutrition and, perhaps, the overall nutrition care pathway.

Pediatric malnutrition is also underdiagnosed according to researchers. The study points to discrepancies in coding, which highlight the need for improved nutrition education and awareness among healthcare providers, as well as the integration of registered dietician nutritionists into multi-disciplinary acute care teams.

The study findings emphasize the need for a nationwide benchmarking program for early identification of at-risk patients. Accurate documentation is not only necessary to provide quality care, but also for appropriate hospital- and provider- reimbursement and adequate resource allocation.

Malnutrition in older adults most often goes unidentified, undiagnosed, and untreated. This is partly due to the lack of training and education of healthcare providers in the clinical characteristics of malnutrition in today's adults, who may be overweight or obese but also malnourished.

Unfortunately, in today's adults, being overweight or obese masks the presence of malnutrition. It is important to understand that malnutrition contributes to immune system compromise, infections, poor wound healing and development of pressure sores, physical frailty, and falls and fractures.

The gaps in diagnosis and treatment of malnutrition also affect older adults by promoting longer hospital stays, more ICU admissions and hospital readmissions, and admission to assisted living and nursing homes.

By improving malnutrition knowledge, diagnosis, intervention, and the timeliness of these activities, we can prevent the serious consequences and burden of malnutrition on patients, caregivers, and our healthcare system, the researchers said.