In-hospital malnutrition among adult patients in a national referral hospital in Indonesia

Dyah Purnamasari; Nur Chandra Bunawan; Dwi Suseno; Ikhwan Rinaldi; Drupadi Hs Dillon

doi:10.4162/nrp.2023.17.2.218

In-hospital malnutrition among adult patients in a national referral hospital in Indonesia

Nutr Res Pract. 2023 Apr;17(2):218-227. doi: 10.4162/nrp.2023.17.2.218. Epub 2022 Aug 3.

Authors

Dyah Purnamasari¹, Nur Chandra Bunawan², Dwi Suseno², Ikhwan Rinaldi³, Drupadi Hs Dillon⁴

Affiliations

¹ Endocrinology Metabolism and Diabetes Division, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
² Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
³ Hematology and Oncology Division, Internal Medicine Department, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia.
⁴ Southeast Asian Minister of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON), Universitas Indonesia, Jakarta, Indonesia.

Abstract

Background/objectives: Malnutrition during hospitalization is linked to increased morbidity and mortality, but there are insufficient studies observing clinical factors contributing to weight loss during hospitalization in Indonesia. This study was therefore undertaken to determine the rate of weight loss during hospitalization and the contributing factors.

Subjects/methods: This was a prospective study involving hospitalized adult patients aged 18-59 yrs, conducted between July and September 2019. Body weight measurement was taken at the time of admission and on the last day of hospitalization. The factors studied were malnutrition at admission (body mass index < 18.5 kg/m²), immobilization, depression (Beck Depression Inventory-II Indonesia), polypharmacy, inflammatory status (neutrophil-lymphocytes ratio; NLR), comorbidity status (Charlson Comorbidity Index; CCI), and length of stay.

Results: Totally, 55 patients were included in the final analysis, with a median age of 39 (18-59 yrs) yrs. Of these, 27% had malnutrition at admission, 31% had a CCI score > 2, and 26% had an NLR value of ≥ 9. In all, 62% presented with gastrointestinal symptoms, and depression was documented in one-third of the subjects at admission. Overall, we recorded a mean weight loss of 0.41 kg (P = 0.038) during hospitalization, with significant weight loss observed among patients hospitalized for 7 days or more (P = 0.009). The bivariate analysis revealed that inflammatory status (P = 0.016) was associated with in-hospital weight loss, while the multivariate analysis determined that the contributing factors were length of stay (P < 0.001) and depression (P = 0.019).

Conclusions: We found that inflammatory status of the patient might influence the incidence of weight loss during hospitalization, while depression and length of stay were independent predictors of weight loss during hospitalization.

Keywords: Malnutrition; depression; hospitalization; length of stay; weight loss.