Malnutrition: Low Diagnosis and Treatment Rates in Hospitalized Patients. An Analysis of German Nationwide Health Insurance Data.

Abstract

Background: Malnutrition carries high morbidity and mortality. Until now, there have been no nationwide data on diagnosis and treatment rates of malnutrition among hospitalized patients in Germany. In this study, nationwide data from health insurance companies are analyzed to assess diagnosis rates, nutritional treatment, and treatment results.

Methods: Age- and sex-representative health insurance data (2017–2024) from a German database (InGef) were analyzed to as-certain ICD-coded diagnoses for malnutrition and OPS-coded treatment with enteral and parenteral nutrition. The findings were compared in matched cohorts with and without malnutrition.

Results: From 2017 to 2024, the percentage of hospitalized patients with diagnosed malnutrition varied from 1.16% to 1.30%; among these patients, 2.77% to 4.45% received OPS-coded enteral or parenteral nutritional treatment. The common main diagnoses among the patients who received treatment included malignancies, gastrointestinal diseases, respiratory diseases, and infectious diseases. An analysis of cohorts matched by age, sex, and Charlson Comorbidity Index revealed that the malnourished patients had a higher 90-day mortality than the control group (18.2% vs. 7.3%) and a higher rate of rehospitalization within 90 days (44.9% vs. 37.8%). The malnourished patients had higher mean health-care costs.

Conclusion: This nationwide analysis reveals low diagnosis rates and limited implementation of nutritional treatment among hospitalized patients in Germany, associated with poorer clinical results and higher costs. These findings underscore the need to introduce structured nutritional screening and care pathways in German hospitals.