Is the skeleton still in the hospital closet? A review of hospital malnutrition emphasizing health economic aspects

Abstract

Background: Hospital malnutrition used to be a skeleton, a well hidden secret. Compelling studies in the last four decades revealed the width and depth of the problem. It encompasses not only critically ill hospitalized individuals, but many other vulnerable groups. The aim of this review was to assess the effectiveness of current hospital routines in eradicating this historical scourge. Methods: Diagnosis used to rely on clinical impression or anthropometrics only. Fortunately well structured questionnaires, complemented by biochemical tests and body composition studies whenever necessary, allow precise and reproducible assessment of nutritional risk, in most age brackets and disease modalities. Results: Near the end of the XIXth century many scientists believed that anatomical studies were doomed. Everything that needed to be discovered was already known: muscles, bones, joints, nerves, cardiovascular structures and other systems. Then in 1893, Wilhelm His in Switzerland discovered the eponimous His bundle. In 1906 Sunao Tawara in Japan was responsible for the concept of the atrioventricular conduction pathway. Combined with the advent of the electrocardiograph by Willem Einthoven in The Netherlands, in 1903, such advances extraordinarily improved the handling of heart arrhythmias. Addressing hospital malnutrition does not depend on new technologies. All the essential tools exist and have been clinically tested, as here analyzed. A simpler breakthrough is desired, namely the wider adoption of available procedures. Conclusion: Four decades after a historical report, a barrier still remains in many countries, namely more effectively embedding screening and nutritional therapy tools for hospitalized patients, in the professional routine.