Information & literature

Malnutrition is a significant problem in hospitalized patients. Prevalence rates of malnutrition in hospitalized patients vary from 25-40%. At the outpatient departments, the prevalence of malnutrition is between 5 and 10%. Still, malnutrition goes by undetected and untreated.

From 2006 until 2009, the Dutch Malnutrition Steering Group coordinated a series of implementation projects on ‘Early recognition and optimal treatment of malnutrition in Dutch hospitals’. The project focussed on implementation of screening and treatment in clinical departments, and involved two pilot projects focussing on screening and treatment in outpatient departments and in children’s departments as well.

The Dutch Health Care Inspectorate established a set of ‘performance indicators’ on which hospitals have to report annually and which are used for benchmarking between hospitals. Since 2007, malnutrition screening at hospital admission has become part of this set of indicators. To date, all Dutch hospitals report on this benchmark (total number of patients per year: 900.000). Last year’s results show that 65% of patients were screened on malnutrition within the first 24 hours of hospital admission, and screening percentages continue to rise.

Since 2008, treatment of malnutrition has become part of this set of indicators as well. Treatment is measured by the percentage of patients with adequate protein intake (1.2-1.5 grams per kg bodyweight) on the fourth day of hospital admission. Last year’s results show that only 41% of malnourished patients achieved this benchmark.

A recent study in hospitalized patients assessed which patients are less susceptible to reach this treatment benchmark, looking at predictors for achieving both protein and energy requirements on the fourth day of hospital admission. It was found that negative predictors for reaching the protein and energy targets are nausea, cancer, acute infections, and higher BMI, whilst higher age, chronic lung disease and receiving tube feeding were positive predictors. Moreover, malnourished patients that achieved the protein and energy targets on day 4 of hospital admission showed a 1.5 to 4 days reduction in length of hospital stay.

The articles below provide evidence and further background information.

Performance Indicators

Leistra 2013. Systematic screening for undernutrition in hospitals: Predictive factors for success

Leistra 2009. Screening on undernutrition is mandatory in Dutch hospitals (ESPEN poster)


Validation studies

Systematic review – Numerous nutrition screening tools for the hospital setting have been developed. The aim of this systematic review is to study construct or criterion validity and predictive validity of nutrition screening tools for the general hospital setting.

Our SNAQ tools have been validated in their respective target populations. The literature describing the development and validation of the tools can be found here:

More studies





PhD Theses