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Q J Med 2000; 93: 93-98
© 2000 Association of Physicians

Still hungry in hospital: identifying malnutrition in acute hospital admissions

I.E. Kelly, S. Tessier, A. Cahill, S.E. Morris, A. Crumley, D. McLaughlin, R.F. McKee and M.E.J. Lean1

From the Department of Human Nutrition, University of Glasgow, Royal Infirmary, Glasgow, and 1 Department of Surgery, Royal Infirmary, Glasgow, UK

Received 4 August 1999 and in revised form 9 December 1999

Address correspondence to Professor M.E.J. Lean, Department of Human Nutrition, University of Glasgow, Royal Infirmary, Glasgow G31 2ER

We assessed the prevalence, methods for recognition and clinical management of malnutrition in acute admissions in a large academic inner-city hospital. Of a total of 337 patients, it was possible to measure both height and weight in 219 patients (65% of admissions). As an alternative for bed-bound patients, mid-upper arm circumference was not very reliable in predicting BMI (sensitivity 98%; specificity 65%), and waist circumference even less so. Of these, 13% were malnourished (body mass index BMI <18.5 kg/m2 or BMI 18.5–20 kg/m2 with reported weight loss >3 kg in the last 3 months). Six patients (31% of those with BMI <18.5 kg/m2) and one with BMI 18.5–20 kg/m2 were recognized as suffering from malnutrition and referred to the dietitian. Review of case records could not establish if the diagnosis was missed in the remainder, or if a conscious decision was taken not to manage malnutrition actively. Malnutrition in acute hospital admissions goes apparently unrecognized and unmanaged in 70% of cases. Since there are serious consequences, and effective simple treatment is readily available, increased awareness is required, with routine assessment of nutritional status in all patients.


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