Are nutritional sufficiency of ≥75% energy and protein requirements relevant targets in patients at nutritional risk? - A one month follow-up study. (April 2023)

• Record Type: Journal Article
• Authors: Mikkelsen, Sabina; Frost, Karen Hougaard; Engelbreth, Emma Mølgaard; Nilsson, Lærke; Peilicke, Karen Marie; Tobberup, Randi; Skadhauge, Lotte Boa; Rasmussen, Henrik Højgaard; Holst, Mette
• Is Part Of: Clinical nutrition ESPEN. Volume 54(2023)
• Page Start: 398
• Page End: 405
• Publication Date: 2023-04
• Subjects: Hospitalized patients -- Malnutrition -- Energy requirement -- Protein requirement -- Mortality -- Readmissions; GLIM The Global Leadership Initiative on Malnutrition -- LOS Length of stay -- ONS Oral nutritional supplements -- OR Odds ratio -- 95% CI 95% confidence interval -- BMR Basal metabolic rate -- PAL Physical activity level factor -- P Protein requirement (only in tables) -- E Energy requirement (only in tables); Nutritionally induced diseases -- Periodicals; Metabolism -- Disorders -- Periodicals; 616.39005
• DOI: 10.1016/j.clnesp.2023.02.007
• Languages: English
• ISSNs: 2405-4577

Abstract

Summary: Background & aim: Nutrient intake in patients at nutritional risk was recorded with the aim of reaching at least 75% of estimated requirements for energy and protein. However, the cutoff at 75% has only been sparsely investigated. The aim of this study was to re-evaluate the 75% cutoff of estimated energy and protein requirements among patients at or not at nutritional risk in relation to 30-day mortality and readmissions. Methods: A 30-day follow-up study was performed among hospitalized patients in 31 units at a Danish University Hospital. Data was collected using the nurses' quartile nutrition registration method and electronic patient journals. All patients were screened using the NRS-2002 and classified as either at nutritional risk (NRS-2002, score ≥3) or not at nutritional risk (NRS-2002, score <3). Energy and protein requirements were estimated using weighted Harris–Benedict equation and 1.3 g/kg/day, respectively. Results: In total, 318 patients were included in this study. Patients at nutritional risk were older, lower BMI, male, more comorbidities and a longer primary length of stay compared to patients not at nutritional risk (p < 0.05). After 30-day follow-up, mortality was higher among patients at risk (9.5% vs. 2.0%, p < 0.05). Patients at nutritional risk showed increased risk of mortality if they did not achieve 75% of estimated requirements (energy: OR = 8.08 [1.78; 36.79]; protein: OR = 3.40 [0.74; 15:53]). Furthermore, predicted probability of mortality decreased with increased energy and protein intakes. No significant associations were found for readmissions achieving 75% of estimated energy or protein requirements. A cutoff of 76–81% for energy and 58–62% for protein was equivalent with accepting a 6–8% mortality rate. Conclusion: The results of this study indicate that an energy intake ≥75% of estimated requirement among patients at nutritional risk has a preventative effect regarding mortality within one month, but not for readmissions. Highlights: After 30-day follow-up, mortality was higher among patients at nutritional risk. Mortality was increased in patients at nutritional risk >75% of energy requirements. A cutoff of 76–81% for energy was equivalent with accepting a 6–8% mortality rate. A cutoff of 58–62% for protein was equivalent with accepting a 6–8% mortality rate. Readmissions were not associated with achieving requirements.