Protein-energy undernutrition in hospital in-patients

Impaired nutritional status has been frequently reported in surveys estimat ing its prevalence amongst patients in hospital. While there is no doubt th at protein-energy undernutrition has serious implications for health, recov ery from illness or surgery and hospital costs, lack of nationally or inter nationally accepted cut-off points and guidelines for most nutrition-relate d variables make nutritional assessment difficult and proper comparisons be tween studies impossible. In reviewing published work in which the prevalen ce of undernutrition has been assessed, it can be seen that each study defi ned undernutrition, or nutritional risk, using different methodology. This present review aims to highlight the problems which arise when deciphering these studies, and the resulting difficulty in determining the true prevale nce of undernutrition and nutritional risk, amongst both general and specif ic groups of hospital in-patients. It is widely agreed that routine hospita l practices can further adversely affect the nutritional status of sick pat ients in hospital. How this occurs, and the potential effects of impaired n utritional status on clinical outcome are examined. The methods currently a vailable to assess nutritional status are evaluated in the knowledge that s uch assessments are difficult in clinical practice. The review concludes by proposing that if we want the medical and nursing professions to consider the nutritional status of hospital patients seriously, definitions of under nutrition and nutritional risk, and cut-off values for the nutritional vari ables measured must be agreed to allow evidence-based practice. Outcome mea sures which allow clear comparisons between groups and treatments must be u sed in studies assessing the effects of nutritional interventions.