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The impact of malnutrition on health care use in hospital outpatients

Published online by Cambridge University Press:  01 April 2010

A. L. Cawood ,
S. Rust ,
E. Walters ,
R. J. Stratton  and
M. Elia
A. L. Cawood
Affiliation:
Medical Affairs, Nutricia Ltd, Trowbridge, BA14 0XQ, UK
S. Rust
Affiliation:
Nutrition and Dietetic Department, Southampton General Hospital, Southampton SO16 6YD, UK
E. Walters
Affiliation:
Nutrition and Dietetic Department, Southampton General Hospital, Southampton SO16 6YD, UK
R. J. Stratton
Affiliation:
Medical Affairs, Nutricia Ltd, Trowbridge, BA14 0XQ, UK
M. Elia
Affiliation:
Institute of Human Nutrition, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
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Abstract

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Proceedings of the Nutrition Society , Volume 69 , Issue OCE2: Malnutrition Matters, Joint BAPEN and Nutrition Society Meeting, 13–14 October 2009, Cardiff , 2010 , E149
Copyright
Copyright © The Authors 2009

Malnutrition is common and costly, yet remains under-recognised and under-treated(Reference Elia and Russell1). Previous studies have shown that the ‘Malnutrition Universal Screening Tool’ (‘MUST’)(Reference Elia2) predicts clinical outcome in hospitalised elderly(Reference Stratton3); however, the clinical consequences of malnutrition in outpatients has not been investigated.

One hundred and ninety four outpatients (age 54 (sd 17.19) years; 45% female) were screened for malnutrition using ‘MUST’ at Southampton General Hospital between July 2008 and June 2009. Healthcare use was collected prospectively during the subsequent 6 months (hospital admissions (planned and emergency), length of hospital stay and outpatient appointments). The patients attended a range of outpatient clinics (40% gastroenterology, 21% surgical, 17% medical, 8% oncology and 14% other). Eighteen percent were at risk of malnutrition (12% medium and 6% high risk). Age and sex were not significantly related to malnutrition risk.

Outpatients at risk of malnutrition experienced significantly more hospital admissions (planned and emergency) and had a significantly longer length of hospital stay (table). The use of healthcare resources progressively increased from low to medium and high risk of malnutrition (table).

Med=medium risk; #=statistically significant ANOVA. Length of stay mean±sd.

*=Statistically significant; Chi2 test; †statistically significant (P(trend)=0.018).

The impact of malnutrition on admissions remained significant even when adjusted for age. Six month mortality was higher in at risk patients (5.7%) compared to low risk (2.5%) although this was not significant (P=0.322, Chi2).

This study shows that malnutrition in general outpatients is associated with increased health care use. Identifying and appropriately treating malnutrition could potentially reduce health care costs.

References

1. Elia, M & Russell, C (2009) Combating Malnutrition: Recommendations for Action. Redditch, Worcs.: BAPEN.Google Scholar
2. Elia, M (2003) The ‘MUST’ Report. Redditch, Worcs.: BAPEN (http://www.bapen.org.uk).Google Scholar
3. Stratton, RJ et al. (2006) Br J Nutr 95, 325–330.CrossRefGoogle Scholar