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.
- Becker P. Consensusstatement of the Academy of nutrition and dietetics/American society for parenteral and enteral nutriton: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutrition in Clinical Practice 2015.
- Joosten K.F.M. Hulst J.M. Malnutrition in pediatric hospital patients: current issues. Nutrition 2011.
- Joosten K.F.M. Hulst J.M. Prevalence of malnutrition in Dutch hospitals. Current Opinion in Pediatrics 2008.
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.
- Schueren 2013. Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the 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:
- Development and validation of SNAQ
- Development and validation of SNAQRC
- Development and validation of SNAQ65+
- Development and validation of MUST
- Leistra 2013. Systematic screening for undernutrition in hospitals: Predictive factors for success
- Leistra 2011. Predictors for achieving protein and energy requirements in undernourished hospital patients
- Freijer 2010. Analysis of the health economic impact of medicalnutrition in the Netherlands
- Neelemaat 2011. Comparison of five malnutrition screening tools in one hospital inpatient sample
- Van Venrooij 2007. Quick-and-easy nutritional screening tools to detect disease-related undernutrition in hospital in- and outpatient settings: A systematic review of sensitivity and specificity
- Kruizenga 2006. Are malnourished patients complex patients? Health status and care complexity of malnourished patients detected by the Short Nutritional Assessment Questionnaire (SNAQ)
- Kruizenga 2005. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients
- Kruizenga 2005. Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ)
- Leistra 2013. Validity of nutritional screening with MUSTand SNAQ in hospital outpatients
- Leistra 2009. Prevalence of malnutrition in Dutch outpatients.
- Neelemaat 2008. Screening malnutrition in hospital outpatients. Can the SNAQ malnutrition screening tool also be applied to this population?
- Joosten K.F.M. Hulst J.M. Nutritional screening tools for hospitalized children: Methodological considerations. Clinical Nutrition 2014.
- Moeeni V. The STRONGkids can be used by paediatric nurses to identify hospitalized patients at risk. Acta Paediatrica 2014.
- Coa J. Nutritional risk screening and its clinical significance in hopsitalized children. Clinical Nutrition 2014.
- Huysentruyt K. Hospital-related undernutrition in children: still an unrecognized problem and untreated problem. Acta Paediatrica 2013.
- Hulst J.M. Dutch national survey to test the STRONGkids nutritional risk screening tool in hospitalized children. Clinical Nutrition 2010.
- Joosten 2011. Malnutrition in pediatric hospital patients: Current issues
- Joosten 2010. National malnutrition screening days in hospitalised children in The Netherlands
- Neelemaat 2012. Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished older adults
- Van Asselt 2012. Assessment and treatment of malnutrition in Dutch geriatric practice: consensus through a modified Delphi study