Saudi Journal of Gastroenterology
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Year : 1998  |  Volume : 4  |  Issue : 3  |  Page : 172-175
Malnutrition among hospitalized patients in King Khalid university hospital, Riyadh


Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia

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Date of Submission15-Oct-1996
Date of Acceptance23-Mar-1998
 

   Abstract 

The present study was undertaken to determine the incidence of malnutrition among hospitalized patients. A cross-sectional study of patients were evaluated for findings suggestive of protein calorie malnutrition (PCM). Hundred and sixty patients admitted to the medical and surgical wards over a period of five months were studied. Anthropometrics and biochemical measurements were used. Nutrition status was calculated based on some nutrition parameters weight for height, midarm, circumference, serum albumin and total lymphocyte count. Anthropometric measurements, weight for height and midarm circumference reflected malnutrition (PCM) of 33.8% and 30% respectively. The overall prevalence of obesity was 21%. A higher proportion (23.9%) of medical cases were found to be obese compared to surgical cases (19.7%). If malnutrition can be documented on hospital admission, attempts can be made to reverse malnutrition in the high risk patients.

How to cite this article:
Bani IA, Al-Kanhal MA. Malnutrition among hospitalized patients in King Khalid university hospital, Riyadh. Saudi J Gastroenterol 1998;4:172-5

How to cite this URL:
Bani IA, Al-Kanhal MA. Malnutrition among hospitalized patients in King Khalid university hospital, Riyadh. Saudi J Gastroenterol [serial online] 1998 [cited 2019 Nov 21];4:172-5. Available from: http://www.saudijgastro.com/text.asp?1998/4/3/172/33914


The interest in nutrition assessments has increased considerably over the last decade, as malnutrition has been documented in hospitalized patients[1],[2],[3],[4] and shown to be associated with an increased prevalence of complications and a high mortality among hospitalized patients[5],[6]. Precise information on the frequency and severity of malnutrition in hospital patients is difficult to obtain, but there is growing awareness of the problem and of the fact that a patient's nutrition status may deteriorate while in hospital receiving sophisticated and expensive care. However, there is few documented evidence of the incidence of malnutrition among either the general or hospitalized adult population within the Kingdom of Saudi Arabia. A study carried out among 200 Saudi surgical patients showed that 39.5% had evidence of malnutrition[7]. In another study of 714 patients, weight for height for male adults was significantly lower than NCHS standards[8]

This preliminary study was carried out to determine the incidence of malnutrition in hospital patients.


   Patients and methods Top


Subjects enrolled in the study were 160 patients admitted to the general medical and surgical wards at King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia, between January and May 1992. Five to 10 patients a week were enrolled randomly in the study. KKUH serves as a teaching base for King Saudi University and one of the largest tertiary hospitals in the Kingdom of Saudi Arabia. Within the Department of Nutrition, both inpatient and outpatient services were provided.

Admission data obtained from each patient's medical chart included demographic data (age, sex, and occupation), anthropometric data (weight and height), and routine laboratory tests which included serum albumin, hemoglobin, and total lymphocyte count (TLC). Serum albumin was determined by the automated bromocresol green dye-binding. Hematological tests were determined by Coulter Counter. TLC was calculated from the white blood cell count (WBC) and differential (TLC = lymphocytes x WBC).

Anthropometric evaluation included measurement of weight, height, midarm circumference and triceps skinfold thickness. Midarm circumference was measured with arm straight and relaxed, using non­stretch measuring tape and triceps skinfold (TSF) was measured using Lange skinfold calipers (Cambridge Scientific Industries, Cambridge, Maryland). The average of three readings on the dominant arm was used. From these values, the percentage of weight-height, arm circumference and skinfold thickness were calculated. Number of days hospitalized (length of stay) was calculated from discharge information.

Results were expressed as frequencies, percentages, and mean + SD. The study protocol was approved by the Center for Research and Development, College of Applied Medical Sciences, King Saud University. Data obtained were analyzed statistically by using Statistical Package for Social Studies (SPSS)[9].


   Results Top


[Table - 1] shows demographic data collected on 160 hospital admissions (84 medical and 76 surgical). Among the medical cases 41 were males and 43 females. The respective numbers for the surgical cases, 36 males and 40 females. Patients' mean age was 42.5 + 19 and 43.4 + 17.3 for the medical and surgical cases, respectively. The mean length of hospital stay was 5 + 3.5 days and 6 + 4.5 days for the medical and surgical cases, respectively. However, the differences between the two groups were not significant.

A number of charts lacked basic nutrition parameter such as weight and height [Table - 2] The missing values ranged from 13.8% for TLC to 53.8% for albumin. The frequency of subnormal values varied for the different variables [Table - 3].

The results of the anthropometric data in all the cases showed that weight for height, upper arm circumference and skinfold thickness reflected malnutrition of 33.8%, 30% and 27.5%, respectively. Kwashiorkor like syndrome was found to be uncommon, reflected as one surgical case. In the medical cases, the corresponding figures for the anthropometric data was 35.7%, 28.6% where surgical cases 31.6%, 28.6% and 22.4% respectively.

Common reasons for medical admission were cardiac, gastrointestinal, neurologic, endocrine, nutritional, and metabolic diseases. Surgical patients underwent surgery involving cholecystectomy, herniorrhaphy, anorectal disease, gastrointestinal carcinoma and peptic ulcer disease.


   Discussion Top


Precise information on frequency and severity of malnutrition in hospital patients is difficult to obtain, but there is growing awareness of the problem and of the fact that a patient's nutritional status may deteriorate while in the hospital receiving sophisticated and expensive care.

This study was undertaken to determine the prevalence of abnormal findings suggestive of protein-calorie malnutrition in a group of hospitalized patients. The prevalence of findings suggestive of malnutrition on admission was 33.8% for all patients.

In the medical patients, malnutrition was found in 35.7% compared to 31.1% in surgical patients. The incidence of malnutrition among Saudi surgical patients was reported as 39.5% and correlates well with the figures from United Kingdom and United States of America[1],[3]. Bistrian and co-workers (1976) reported malnutrition in 44% of general medical patients and approximately 50% of surgical patients, employing a series of anthropometric and laboratory measurements of nutrition status. In Scandinavia, Symreng et al reported that 28% of hospitalized surgical patients were malnourished[6]

Marasmus-like syndrome is easy to diagnose based on severe fat and muscle wasting resulting from prolonged calorie deficiency[10]. However, minimum criteria for the diagnosis of kwashiorkor like syndrome are: serum albumin below 2.8g/dl and at least one of the following: poor wound healing, decubitus ulcers or skin breakdown, easy hair pluck­ability and edema.

In the present study, there was only one patient suffering from kwashiorkor-like syndrome. Our study suggests that among Saudi hospitalized patients suffering from malnutrition, marasmus-like syndrome is the predominant form of malnutrition. This is in agreement with Chang et al (1985) who reported that 89% of malnourished patients has marasmus[7]

The similarities in the incidence of malnutrition in Saudi Arabia and developed industrial countries would suggest that malnutrition seems consistently present, despite considerable differences in the type of hospital studied, socioeconomic background of the patients, and despite the medical specialty, under which the patient was admitted.

This study has also shown that obesity is a public health problem in Saudi Arabia affecting 23.9% and 19.7% of the medical and surgical patients, respectively. In Saudi Arabia, this is the product of the adoption of dietary habits influenced by increased wealth, traditional social habits and very heavy advertising by western food manufacturers[11]

Five patients had serum albumin levels below 3.5 g/dl. Twenty patients had depressed TLC (<1500/mm 3 ). Low values for TLC in combination with low serum albumin may indicate protein­ calorie malnutrition. However, low values also are seen during stress, infection, liver diseases, and cancer among the elderly[12].

A study by Robinson et al[13] reported that 45% of malnourished patients, compared with 30% of normal nourished and 37% of the borderline malnourished patients, were hospitalized longer than allowed length of stay. Therefore, early diagnosis and `treatment of malnutrition may decrease length of stay, and thus, cost incurred by the hospital.

The overriding cause of malnutrition concerns food consumption, and is a failure to consume sufficient food to meet bodily needs. The refusal of food may be another factor. It was estimated that the average plate waste in Saudi hospitals represented 40% of the meal cost/participant/day[14]

If hospital patients are malnourished, doctors and nurses should be aware of the consequences. There are many complications associated with malnutrition and these include poor wound healing, dehiscence, precipitation of bed sores, increase susceptibility to infections, and increased toxicity of drugs and muscle atrophy[15]

Another concern in this study relates to the high percentage of missing values for each of the nutritional markers. Reasons for missing data at 48 hours after admission is unknown. The extent to which important nutrition markers affected either clinical results or the time needed of data collection is not known. Unless sufficient information is available for identification of patients at nutrition risk, appropriate nutrition intervention cannot be implemented early during hospitalization for the high-risk patient. The clinical dietitian can be the key person in an institution to initiate efforts to improve admission data collection. Frey and Littleton[16] have shown that a screening program can be managed in small institution with one dietitian and one technical support person.

The findings in this study point to a significant frequency of malnutrition in hospitalized patients. The types of patients admitted and the quality of care provided is likely to be representative of most tertiary care hospitals in the Kingdom.

Malnutrition must be recognized, and recognition carries with it responsibility. Determined efforts should be made to provide nutritional support to improve patients' well-being and quality of life.

Nutrition screening is an important step in establishing the patients' need for nutritional care. Also, it is first step in establishing the value of clinical nutritional services. This may result in a greater use of service providers - the dietitians. Furthermore, the results of this study will lead to increased awareness of the importance of nutritional care among hospitalized patients.

 
   References Top

1.Bistrian BR, Blackburn GL, Vitale J, Cochran D & Naylor J. Prevalence of malnutrition in general medical patients. JAMA 1976; 235:1567-70.  Back to cited text no. 1    
2.Mullen JL, Gertner MH, Buzby GP, Goodhart GL, & Rosato EF. Implications of malnutrition in the surgical patient. Arch Surg 1979;114:121-5.  Back to cited text no. 2    
3.Weinsier RL, Hunker EM, Keumdiek CL & Butterworth CE. A prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr 1979;32:418-26.  Back to cited text no. 3    
4.Bani IA & Hamour O. Assessment of nutrition status of Sudanese surgical patients. J of Theoreti Surg 1987;2:73.  Back to cited text no. 4    
5.Apelgren KN, Rhombeau JL, Towmey PL & Miller RA. Comparison of nutrition indices and outcome in critically-ill patients. Crit Care Med 1982;10:305-7.  Back to cited text no. 5    
6.Symreng T, Anderberg B, Kagedal B, Norr A, Schildt B & Sjodahl R Nutritional assessment and clinical course in 112 elective surgical patients. Acta Chir Scand 1983;149:657-62.  Back to cited text no. 6    
7.Chang RWS, Richardson R, Adams J, and Hatton I. Incidence among Saudi Surgical patients: A preliminary survey. Saudi Med J 1985;6:459-67.  Back to cited text no. 7    
8.Al-Othaimen Al. Food habits, nutrition status and disease patterns in Saudi Arabia. PhD Thesis. University of Surrey Guildford, England. 1991.  Back to cited text no. 8    
9.Nie N, Hull CH, Jenkins JG, Steinbrenner K, Bent D: Statistical Package for the Social Sciences, User Guide. SPSS Inc., SPSS-X User's Guide, 3rd edn. Chicago: SPSS Inc., 1988:314-72.  Back to cited text no. 9    
10.Heimburger DC and Weinsier RL. In Heimburger DC and Weinsier R (Eds). Hospital Associated Malnutrition Handbook of Clinical Nutrition. St. Loius, Baltimore, Mosby, 1997:169-81.  Back to cited text no. 10    
11.Gibbon A. Cultural and cross cultural influences in the dietary habits in Saudi Arabia. In Moyal MF (Ed)), Diet and Lifestyle: New Technology, John Libbey Eurotext Ltd. London, Paris. 1988:139-42.  Back to cited text no. 11    
12.Kamath SK, Lawler M, Smith AE, Kalat T & Olson R. Hospital malnutrition: A 33-hospital screening study. J Am Diet Assoc 1986;86:203-6.  Back to cited text no. 12    
13.Robinson G. Goldstein M & Levine GM. Impact of nutritional support on DRG length stay. J P E Nutr 1987;11:49-51.  Back to cited text no. 13    
14.Al-Shoshan AA. Study of Regular Diet of Selected Hospitals of the Ministry of Health in Saudi Arabia: Edible Plate Waste and Monetary Value. J R Soc Health 1992;112:7-11.  Back to cited text no. 14    
15.Dickerson J. The problem of hospital induced malnutrition: Nursing Times 1995;91:44-5.  Back to cited text no. 15    
16.Frey PW & Littleton Em. The nutrition care profile: An aid to delivery of quality nutrition care in a small community hospital. J Am Diet Assoc 1984;84:1468-9.  Back to cited text no. 16    

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Correspondence Address:
Ibrahim A Bani
Department of Community Health Services, College of Applied Medical Sciences, P.O. Box 10219, Riyadh 11433
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


PMID: 19864768

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    Tables

  [Table - 1], [Table - 2], [Table - 3]



 

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