Apparent low frequency of undernutrition in Dublin hospital in-patients: should we review the anthropometric thresholds for clinical practice?

Protein-energy undernutrition, or the possibility of its development, has b een documented to occur frequently in patients on admission to hospital. De terioration in nutritional status is known to occur in hospital. In a prosp ective study of 594 sequential hospital admissions, we aimed to assess the prevalence of undernutrition among patients on admission to two acute teach ing hospitals in Dublin, Republic of Ireland using the widely-accepted anth ropometric criteria applied in a large study from Dundee, Scotland, UK (McW hirter & Pennington, 1994) and to determine changes in nutritional status i n hospital. The mean prevalence of undernutrition (11 %) was considerably l ower than was reported from Dundee (40 %). Unintentional weight loss before admission and functional impairment on admission occurred to a similar ext ent in both centres. Weight loss in hospital occurred in the same proportio n of patients, but less frequently among those undernourished on admission to hospital, in Dublin compared with Dundee. The patients found to be under nourished on admission in this study had a mortality rate in hospital (6 . 5 %) over three times that of the adequately nourished group (2 %). The mag nitude of the difference in prevalence of undernutrition between the two ce ntres cannot be explained by ethnicity, case-mix or age distribution. With the secular increase in BMI in the population, the thresholds for classifyi ng patients as undernourished or at risk of nutritional deterioration may n eed to be reviewed. For clinical use, recent weight loss and functional sta tus may be more appropriate variables to use in the evaluation of nutrition al status on admission to hospital.