Analysis of predictors of malnutrition in adult hospitalized patients: social determinants and food security

Krystel Ouaijan; Nahla Hwalla; Ngianga-Bakwin Kandala; Joelle Abi Kharma; Emmanuel Kabengele Mpinga

doi:10.3389/fnut.2023.1149579

Analysis of predictors of malnutrition in adult hospitalized patients: social determinants and food security

Front Nutr. 2023 May 9:10:1149579. doi: 10.3389/fnut.2023.1149579. eCollection 2023.

Authors

Krystel Ouaijan^{1

2}, Nahla Hwalla³, Ngianga-Bakwin Kandala^{4

5}, Joelle Abi Kharma⁶, Emmanuel Kabengele Mpinga²

Affiliations

¹ Department of Clinical Nutrition, Saint George Hospital University Medical Center, Beirut, Lebanon.
² Institute of Global Health, University of Geneva, Geneva, Switzerland.
³ Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon.
⁴ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁵ Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Faculty of Arts and Sciences, Lebanese American University, Beirut, Lebanon.

Abstract

Background: Malnutrition in hospitalized patients is becoming a priority during the patient care process due to its implications for worsening health outcomes. It can be the result of numerous social factors beyond clinical ones. This study aimed to evaluate the link between these various risk factors considered social determinants of health, food security levels, and malnutrition and to identify potential predictors.

Methods: A cross-sectional observational study was conducted on a random sample of adult patients in five different hospitals in Lebanon. Malnutrition was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Patients were interviewed to collect social and economic characteristics and were categorized into four criteria: (1) area of residence (urbanization level), (2) level of education, (3) employment status, and (4) source of health coverage. The food security level was screened by a validated two-question tool, adapted from the US Department of Agriculture Household Food Security Survey, targeting both quantity and quality.

Results: In a random sample of 343 patients, the prevalence of malnutrition according to the GLIM criteria was 35.6%. Patients with low levels of food security, mainly low quality of food, had higher odds of being malnourished (OR = 2.93). Unemployed or retired patients and those who have only completed only elementary school had higher odds of being diagnosed with malnutrition as compared to those who were employed or had university degrees, respectively (OR = 4.11 and OR = 2.33, respectively). Employment status, education level, and type of health coverage were identified as predictors of malnutrition in the multiple regression model. Household location (urban vs. rural) was not associated with malnutrition.

Conclusion: The social determinants of health identified in our study, mainly the level of education and income level, in addition to food security, were identified as predictors of malnutrition in hospitalized patients. These findings should guide healthcare professionals and national policies to adopt a broader perspective in targeting malnutrition by including social determinants in their nutrition care.

Keywords: Global Leadership Initiative on Malnutrition GLIM; Right to Health; food security; health coverage; hospital malnutrition; prevalence; social determinants.

Grants and funding

This research study was partially funded by Dietitians in Nutrition Support DNS—Academy of Nutrition and Dietetics in the United States, grant number 104037. Open access funding by American University of Beirut.