Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study

Detalhes bibliográficos
Autor(a) principal: Marinho, Ricardo
Data de Publicação: 2021
Outros Autores: Pessoa, Ana, Lopes, Marta, Rosinhas, João, Pinho, João, Silveira, Joana, Amado, Ana, Silva, Sandra, Oliveira, Bruno, Marinho, Anibal, Jager-Wittenaar, Harriët
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182
Resumo: Introduction: Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians’ impression of nutritional risk and evaluation by Nutritional Risk Screening 2002.Material and Methods: A cross-sectional multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Data on demographics, previous hospital admissions, primary diagnosis, and Charlson comorbidity index score were collected. Nutritional risk at admission was assessed using Nutritional Risk Screening 2002. Agreement between physicians’ impression of nutritional risk and Nutritional Risk Screening 2002 was tested by Cohen’s kappa.Results: The study included 729 participants (mean age 74 ± 14.6 years, 51% male). The main reason for admission was respiratory disease. Mean Charlson comorbidity index score was 5.8 ± 2.8. Prevalence of nutritional risk was 51%. Nutritional risk was associated with admission during the previous year (odds ratio = 1.65, 95% confidence interval: 1.22 - 2.24), solid tumour with metastasis (odds ratio = 4.73, 95% confidence interval: 2.06 - 10.87), any tumour without metastasis (odds ratio = 2.04, 95% confidence interval:1.24 - 3.34), kidney disease (odds ratio = 1.83, 95% confidence interval: 1.21 - 2.75), peptic ulcer (odds ratio = 2.17, 95% confidence interval: 1.10 - 4.25), heart failure (odds ratio = 1.51, 95% confidence interval: 1.11 - 2.04), dementia (odds ratio = 3.02, 95% confidence interval: 1.96 - 4.64), and cerebrovascular disease (odds ratio = 1.62, 95% confidence interval: 1.12 - 2.35). Agreement between physicians’ evaluation of nutritional status and Nutritional Risk Screening 2002 was weak (Cohen’s kappa = 0.415, p < 0.001).Discussion: Prevalence of nutritional risk in the Internal Medicine population is very high. Admission during the previous year and multiple comorbidities increase the odds of being at-risk. Subjective physician evaluation is not appropriate for nutritional screening.Conclusion: The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.
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spelling Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI StudyPrevalência de Risco Nutricional à Admissão na Enfermaria de Medicina Interna em Portugal: Estudo Transversal Multicêntrico ANUMEDIHospitalizationInternal MedicineMalnutritionNutritional AssessmentAvaliação NutricionalDesnutriçãoHospitalizaçãoMedicina InternaIntroduction: Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians’ impression of nutritional risk and evaluation by Nutritional Risk Screening 2002.Material and Methods: A cross-sectional multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Data on demographics, previous hospital admissions, primary diagnosis, and Charlson comorbidity index score were collected. Nutritional risk at admission was assessed using Nutritional Risk Screening 2002. Agreement between physicians’ impression of nutritional risk and Nutritional Risk Screening 2002 was tested by Cohen’s kappa.Results: The study included 729 participants (mean age 74 ± 14.6 years, 51% male). The main reason for admission was respiratory disease. Mean Charlson comorbidity index score was 5.8 ± 2.8. Prevalence of nutritional risk was 51%. Nutritional risk was associated with admission during the previous year (odds ratio = 1.65, 95% confidence interval: 1.22 - 2.24), solid tumour with metastasis (odds ratio = 4.73, 95% confidence interval: 2.06 - 10.87), any tumour without metastasis (odds ratio = 2.04, 95% confidence interval:1.24 - 3.34), kidney disease (odds ratio = 1.83, 95% confidence interval: 1.21 - 2.75), peptic ulcer (odds ratio = 2.17, 95% confidence interval: 1.10 - 4.25), heart failure (odds ratio = 1.51, 95% confidence interval: 1.11 - 2.04), dementia (odds ratio = 3.02, 95% confidence interval: 1.96 - 4.64), and cerebrovascular disease (odds ratio = 1.62, 95% confidence interval: 1.12 - 2.35). Agreement between physicians’ evaluation of nutritional status and Nutritional Risk Screening 2002 was weak (Cohen’s kappa = 0.415, p < 0.001).Discussion: Prevalence of nutritional risk in the Internal Medicine population is very high. Admission during the previous year and multiple comorbidities increase the odds of being at-risk. Subjective physician evaluation is not appropriate for nutritional screening.Conclusion: The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.Introdução: A subnutrição associada à doença apresenta grande morbimortalidade e necessita de intervenção precoce. Contudo, a sua identificação assenta frequentemente no julgamento médico. Adicionalmente, sendo a enfermaria de Medicina Interna o pilar do hospital, é essencial maior conhecimento sobre o estado nutricional desta população. Os objetivos consistiram em determinar a prevalência de risco nutricional na enfermaria de Medicina Interna, identificar fatores relacionados e avaliar a concordância entre a avaliação do risco nutricional baseada no julgamento médico e no Nutritional Risk Screening 2002.Material e Métodos: Estudo transversal multicêntrico realizado nas enfermarias de Medicina Interna de 24 hospitais portugueses durante 2017. Foram avaliadas características demográficas, internamentos prévios, diagnósticos principais, índice de comorbilidades de Charlson e habilitações literárias. O risco nutricional à admissão foi avaliado usando o Nutritional Risk Screening 2002. A concordância entre o julgamento médico e o Nutritional Risk Screening 2002 foi testado usando o teste kappa de Cohen (k).Resultados: Foram incluídos 729 participantes (idade média 74 ± 14,6 anos, 51% do sexo masculino). A principal causa de admissão foi doença respiratória. O índice de comorbilidades de Charlson médio foi 5,8 ± 2,8. A prevalência de risco nutricional foi 51%. O risco nutricional associou-se a internamento recente (odds ratio = 1,65, 95% intervalo de confiança: 1,22 - 2,24), neoplasia sólida metastizada (odds ratio = 4,73, 95% intervalo de confiança: 2,06 - 10,87), neoplasia não metastizada (odds ratio = 2,04, 95% intervalo de confiança: 1,24 - 3,34), doença renal (odds ratio = 1,83, 95% intervalo de confiança: 1,21 - 2,75), úlcera péptica (odds ratio = 2,17, 95% intervalo de confiança: 1,10 - 4,25), insuficiência cardíaca (odds ratio = 1,51, 95% intervalo de confiança: 1,11 - 2,04), demência (odds ratio = 3,02, 95% intervalo de confiança: 1,96 - 4,64) e doença cerebrovascular (odds ratio = 1,62, 95% intervalo de confiança: 1,12 - 2,35). A concordância entre julgamento médico e Nutritional Risk Screening 2002 foi fraca (kappa de Cohen = 0,415, p < 0,001).Discussão: A prevalência de risco nutricional na enfermaria de Medicina Interna é muito elevada. Admissão recente e múltiplas comorbilidades aumentam a probabilidade de risco nutricional. A avaliação subjetiva do médico não é apropriada para o rastreio nutricional.Conclusão: A elevada prevalência de doentes em risco e baixa precisão da avaliação subjetiva médica sugerem a necessidade de implementar rastreio nutricional obrigatório a nível nacional.Ordem dos Médicos2021-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfapplication/pdfapplication/pdfapplication/pdfapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182oai:ojs.www.actamedicaportuguesa.com:article/13182Acta Médica Portuguesa; Vol. 34 No. 6 (2021): June; 420-427Acta Médica Portuguesa; Vol. 34 N.º 6 (2021): Junho; 420-4271646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/6363https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/12237https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/12634https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/12635https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/12841Direitos de Autor (c) 2021 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessMarinho, RicardoPessoa, AnaLopes, MartaRosinhas, JoãoPinho, JoãoSilveira, JoanaAmado, AnaSilva, SandraOliveira, BrunoMarinho, AnibalJager-Wittenaar, Harriët2022-12-20T11:06:49Zoai:ojs.www.actamedicaportuguesa.com:article/13182Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:20:19.589899Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study
Prevalência de Risco Nutricional à Admissão na Enfermaria de Medicina Interna em Portugal: Estudo Transversal Multicêntrico ANUMEDI
title Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study
spellingShingle Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study
Marinho, Ricardo
Hospitalization
Internal Medicine
Malnutrition
Nutritional Assessment
Avaliação Nutricional
Desnutrição
Hospitalização
Medicina Interna
title_short Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study
title_full Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study
title_fullStr Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study
title_full_unstemmed Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study
title_sort Prevalence of Nutritional Risk at Admission in Internal Medicine Wards in Portugal: The Multicentre Cross-Sectional ANUMEDI Study
author Marinho, Ricardo
author_facet Marinho, Ricardo
Pessoa, Ana
Lopes, Marta
Rosinhas, João
Pinho, João
Silveira, Joana
Amado, Ana
Silva, Sandra
Oliveira, Bruno
Marinho, Anibal
Jager-Wittenaar, Harriët
author_role author
author2 Pessoa, Ana
Lopes, Marta
Rosinhas, João
Pinho, João
Silveira, Joana
Amado, Ana
Silva, Sandra
Oliveira, Bruno
Marinho, Anibal
Jager-Wittenaar, Harriët
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Marinho, Ricardo
Pessoa, Ana
Lopes, Marta
Rosinhas, João
Pinho, João
Silveira, Joana
Amado, Ana
Silva, Sandra
Oliveira, Bruno
Marinho, Anibal
Jager-Wittenaar, Harriët
dc.subject.por.fl_str_mv Hospitalization
Internal Medicine
Malnutrition
Nutritional Assessment
Avaliação Nutricional
Desnutrição
Hospitalização
Medicina Interna
topic Hospitalization
Internal Medicine
Malnutrition
Nutritional Assessment
Avaliação Nutricional
Desnutrição
Hospitalização
Medicina Interna
description Introduction: Disease-related undernutrition is highly prevalent and requires timely intervention. However, identifying undernutrition often relies on physician judgment. As Internal Medicine wards are the backbone of the hospital setting, insight into the prevalence of nutritional risk in this population is essential. We aimed to determine the prevalence of nutritional risk in Internal Medicine wards, to identify its correlates, and to assess the agreement between the physicians’ impression of nutritional risk and evaluation by Nutritional Risk Screening 2002.Material and Methods: A cross-sectional multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Data on demographics, previous hospital admissions, primary diagnosis, and Charlson comorbidity index score were collected. Nutritional risk at admission was assessed using Nutritional Risk Screening 2002. Agreement between physicians’ impression of nutritional risk and Nutritional Risk Screening 2002 was tested by Cohen’s kappa.Results: The study included 729 participants (mean age 74 ± 14.6 years, 51% male). The main reason for admission was respiratory disease. Mean Charlson comorbidity index score was 5.8 ± 2.8. Prevalence of nutritional risk was 51%. Nutritional risk was associated with admission during the previous year (odds ratio = 1.65, 95% confidence interval: 1.22 - 2.24), solid tumour with metastasis (odds ratio = 4.73, 95% confidence interval: 2.06 - 10.87), any tumour without metastasis (odds ratio = 2.04, 95% confidence interval:1.24 - 3.34), kidney disease (odds ratio = 1.83, 95% confidence interval: 1.21 - 2.75), peptic ulcer (odds ratio = 2.17, 95% confidence interval: 1.10 - 4.25), heart failure (odds ratio = 1.51, 95% confidence interval: 1.11 - 2.04), dementia (odds ratio = 3.02, 95% confidence interval: 1.96 - 4.64), and cerebrovascular disease (odds ratio = 1.62, 95% confidence interval: 1.12 - 2.35). Agreement between physicians’ evaluation of nutritional status and Nutritional Risk Screening 2002 was weak (Cohen’s kappa = 0.415, p < 0.001).Discussion: Prevalence of nutritional risk in the Internal Medicine population is very high. Admission during the previous year and multiple comorbidities increase the odds of being at-risk. Subjective physician evaluation is not appropriate for nutritional screening.Conclusion: The high prevalence of at-risk patients and poor subjective physician evaluation suggest the need to implement mandatory nutritional screening.
publishDate 2021
dc.date.none.fl_str_mv 2021-06-01
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/6363
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/12237
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/12634
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/12635
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13182/12841
dc.rights.driver.fl_str_mv Direitos de Autor (c) 2021 Acta Médica Portuguesa
info:eu-repo/semantics/openAccess
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dc.publisher.none.fl_str_mv Ordem dos Médicos
publisher.none.fl_str_mv Ordem dos Médicos
dc.source.none.fl_str_mv Acta Médica Portuguesa; Vol. 34 No. 6 (2021): June; 420-427
Acta Médica Portuguesa; Vol. 34 N.º 6 (2021): Junho; 420-427
1646-0758
0870-399X
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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