Prevalence of malnutrition and its impact on clinical outcomes in internal medicine wards: The SIMI-NUTRO study

Introduction: Screening for malnutrition is recommended for all hospitalized patients and can be performed using tools such NRS-2002, MUST, and MNA-SF. Patients at risk should undergo further evaluation for the diagnosis of malnutrition using a validated tool, including the GLIM criteria. This study aimed to evaluate the prevalence of malnutrition and its risk at hospital admission in Internal Medicine Wards, and to assess the impact of malnutrition on the length of stay and on the development of infectious complications. Methods: The SIMI-NUTRO study is a multicenter, observational cohort study conducted in 16 Internal Medicine Wards located in North, Center and South of Italy. Malnutrition risk and diagnosis were assessed by MUST, MNA-SF, and GLIM, respectively. Results: A total of 650 patients were enrolled; 258/610 (42.3 %) were identified as at risk of malnutrition by MUST, while 169/643 (26.3 %) were classified as malnourished by MNA-SF. According to GLIM (n = 625), which requires the presence of at least one etiological and one phenotypic criterion, 233 patients (37.3 %) were considered malnourished. The agreement between MUST and GLIM was moderate (k = 0.55, p < 0.001), as well as between MNA-SF and GLIM (k = 0.49, p < 0.001). Malnourished patients were older and had lower levels of hemoglobin, total cholesterol, and cholinesterase (p < 0.05). Finally, malnutrition was associated with longer hospital stay (p = 0.001) and a higher rate of infectious complications (p = 0.001). Conclusions: The prevalence of malnutrition was high among patients admitted to Internal Medicine Wards distributed in a large national area. Malnutrition was associated with increased number of infections and prolonged hospital stay, underscoring the need for an early identification of nutritional problems.