Prevalence of malnutrition and risk of malnutrition in complex chronic outpatients

Abstract

Background

The prevalence of disease-related malnutrition (DRM) among Chronic Patients with Complex Needs (CPCN), (a population characterised by multimorbidity, functional decline, and frequent health and social needs), remains poorly established in hospital outpatients settings. These individuals, often older and frail, are presumed to be at higher risk of suffering malnutrition. The Mini Nutritional Assessment (MNA), validated for use in older and frail adults, identifies individuals who are malnourished as well as those at risk of malnutrition (RM).

Objectives

1. To determine the prevalence of DRM and RM in CPCN outpatients. 2. To analyse the association between DRM and RM and a set of clinical, dietary, and social factors relevant to this population.

Methods

Single-centre observational study conducted over a cross-sectional period (June 2022–January 2023). Consecutive sampling was used from the CPCN outpatient registry, a clinical listing used to monitor patients receiving specialised chronic care follow-up. Inclusion criteria: outpatients, ≥18 years, CPCN, life expectancy ≥1 year, living at home. Exclusion criteria: enteral nutrition, dementia GDS ≥5. Variables: gender, age, nutritional status (MNA), education, living alone/accompanied, risk of dysphagia (EAT-10), dental status, adherence to Mediterranean diet (MEDAS), exercise time (walking ≥30 minutes or other similar exercise) and quality of life (EuroQoL).

Results

N=340 patients. Mean age=80.8 years (SD 6.6), 51% female. Ninety percent had only primary education or non, and 23.5% lived alone. Quality of life had a mean score of 61/100 (SD: 17.3). Risk of dysphagia found in 20.6% and 38.2% had missing teeth or teeth in poor condition. While 66.8% adhered correctly to the Mediterranean diet, 55% did not exercise regularly. The prevalence of RM was 31.7% (95% CI: 31.2 to 32.3) with 10.9% being malnourished (95% CI: 10.3 to 11.46). In the multivariate analysis, RM was independently associated with being female (OR: 1.894; 95% CI: 1.102–3.255; P=0.021), the presence of risk of dysphagia (OR: 2.375; 95% CI: 1.241–4.545; P=0.009), teeth in poor condition (OR: 2.897; 95% CI: 1.609–5.217; P<0.001) and non-adherence to the Mediterranean diet (OR: 3.595; 95% CI: 2.034–6.354; P<0.001). The DRM was independently associated with being the presence of risk of dysphagia (OR: 2.722; 95% CI: 1.127–6.573; P=0.026) and non-adherence to the Mediterranean diet (OR: 4.428; 95% CI: 2.005–9.781; P<0.001).

Conclusions

There is a high prevalence of CPCN with DRM and RM in the outpatient setting. The results reinforce the need to establish nutritional strategies aimed at improving eating habits and nutritional status in this vulnerable group of people.