PREVALENCE AND CAUSES OF UNDERNUTRITION IN MEDICAL OUTPATIENTS

PURPOSE: To assess the prevalence, common causes, and frequency of rec ognition and treatment of undernutrition in older and younger medical outpatients using a cross-sectional survey design with 2-year follow-u p of undernourished subjects. PATIENTS AND METHODS: Charts of 1017 adu lt patients attending a hospital outpatient department were reviewed f or the presence of undernutrition, and 85 patients meeting inclusion c riteria for undernutrition were evaluated and followed for 2 years. An initial evaluation focused on nutritional, cognitive, and affective s tatus and on nutritional attitudes using two subscales of the EAT-26 e ating disorder inventory. After 2 years, initial data plus outpatient records were evaluated by 2 independent reviewers to determine a prima ry cause of undernutrition and to assess the recognition and treatment of undernutrition by the primary physician. RESULTS: Undernutrition w as identified in 46 (11%) and 44 (7%) of older and younger subjects re spectively; odds ratio (OR) (95% [confidence interval (CI)]) for older versus younger = 1.65 (1.06 to 2.51). The primary cause of undernutri tion differed between age groups but was deemed treatable in nearly 90 % of all subjects. Undernutrition was recognized in 19 (43%) older sub jects and 5 (12%) younger subjects (OR = 5.47 [1.87 to 16.0]), and app ropriate intervention(s) were instituted in 6 (14%) and 2 (5%) of olde r and younger subjects, respectively (OR = 3.08 [0.668 to 14.2]). Olde r subjects scored higher on the EAT-26 oral control subscale than did younger subjects (4.7 versus 2.5, P = 0.004) but similarly on the EAT- 26 dieting subscale (5.2 versus 6.3, P = 0.332); these relationships d id not change with control for potentially confounding variables. CONC LUSIONS: In this study, undernutrition was relatively common, usually amenable to treatment, but frequently undetected and undertreated in b oth older and younger medical outpatients. Older undernourished subjec ts exhibited higher oral control needs than younger persons, which may have implications for the pathophysiology and treatment of their maln utrition. Further improvement in detection and intervention is warrant ed in both younger and older age groups. (C) 1998 by Excerpta Medica, Inc.