Recognizing Disease-Related Malnutrition and its Effects on Patient Outcomes

By: Paul Wischmeyer, M.D., E.D.I.C., Department of Anesthesiology and Duke Clinical Research Institute, Duke University Medical Center

I have a unique perspective on disease-related malnutrition in hospitals, because I am both a physician and an intensive care unit (ICU) survivor who has been in and out of hospitals with inflammatory bowel disease and ulcerative colitis since the age of 15. I know what patients experience when deprived of nutrition during a hospital stay, which for many seriously ill U.S. patients can be as long as seven days. It’s these experiences that have fueled my passion to help physicians understand how assessing and treating at-risk patients with appropriate nutrition therapy improve their chances of recovery.

Until recently, we didn’t know the full consequences of disease-related malnutrition. We now know malnutrition can increase hospital stays by two-times, increase risk of mortality by up to five-times1 and increase hospital readmissions within 30 days of discharge by 54 percent2.

Healthcare providers have several nutrition care options to choose from – oral (food), enteral (tube-feeding) and parenteral (intravenous). In some cases, a combination of therapies is the best option to ensure the patient gets the appropriate amount of calories, proteins, vitamins, micronutrients and trace elements.

What needs to happen to ensure better nutritional care in the hospital?

  • Education – We have to engrain in our healthcare providers during clinical training that evaluating nutrition status is as important as evaluating vital signs.
  • Screening – I teach physicians that every patient’s nutritional needs must be assessed when they arrive at the hospital; the dietitian is their best friend; and at-risk patients should start nutritional care within 24-48 hours of their stay.
  • Treatment – When oral or enteral nutrition are not appropriate or are insufficient, we know patients need parenteral nutrition. And, a patient’s family should feel empowered to talk with their loved one’s healthcare team to ensure nutritional needs are being met daily.

To support better outcomes for our patients, we need to ensure healthcare providers are better educated about malnutrition screening and the safety and value of nutrition care options.