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BMC Geriatrics

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Open Access 01-12-2024 | Malnutrition | Research

Geriatric nutritional risk index and adverse medical outcomes among Egyptian patients admitted to a geriatric hospital: a prospective cohort study

Authors: Hebatullah O Mohammed, Azza M. Hassan, Aya Mostafa, Mohamed S. Khater, Aisha Aboelfotoh, Khaled M. Abd Elaziz

Published in: BMC Geriatrics | Issue 1/2024

Abstract

Background

Elderly are one of the most heterogeneous and vulnerable groups who have a higher risk of nutritional problems. Malnutrition is prevalent among hospitalized elderly but underdiagnosed and almost undistinguishable from the changes in the aging process. The Geriatric Nutritional Risk Index (GNRI) is a tool created to predict nutrition-related complications in hospitalized patients. This study aims to measure the prevalence of nutritional risk using the GNRI among hospitalized elderly Egyptian inpatients and to determine the association between the GNRI and selected adverse clinical outcomes.

Methods

A hospital-based prospective cohort study was conducted among 334 elderly patients admitted to a tertiary specialized geriatric university hospital in Cairo, Egypt from August 2021 to June 2022. Within 48 hours after hospital admission, socio-demographic characteristics, blood biomarkers, anthropometric measurements, and nutritional risk assessment by the GNRI score were obtained. Patients were divided into three groups based on their GNRI: high, low, and no nutritional risk (GNRI<92, 92-98, and >98) respectively. Patients were followed up for the occurrence of adverse outcomes during hospital stay (bed sores, Healthcare-Associated Infections (HAIs), hospital Length of Stay (LOS), and hospital mortality) and three months after discharge (non-improvement medical status, appearance of new medical conditions, hospital readmission and 90-day mortality). Multivariable regression and survival analysis were conducted.

Results

The prevalence of high-nutritional risk was 45.5% (95% CI, 40%–51%). Patients with high risk had significantly longer LOS than those with no risk. The high-nutritional risk was significantly associated with the development of bed sores (Adjusted Odds Ratio (AOR) 4.89; 95% CI, 1.37–17.45), HAIs (AOR: 3.18; 95% CI, 1.48–6.83), and hospital mortality (AOR: 4.41; 95% CI, 1.04–18.59). The overall survival rate was significantly lower among patients with high-nutritional risk compared to those with no risk.

Conclusion

GNRI is a simple and easily applicable objective nutritional screening tool with high prognostic value in this Egyptian sample of patients. The findings of this study signal the initiation of the application of this tool to all geriatric hospitals in Egypt.

Mudge AM, Ross LJ, Young AM et al. Helping understand nutritional gaps in the elderly (HUNGER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients. Clin Nutr. 2011;1;30(3):320-5. https://doi.org/10.1016/j.clnu.2010.12.007.

Engel JH, Siewerdt F, Jackson R, et al. Hardiness, depression, and emotional well-being and their association with appetite in older adults. J Am Geriatr Soc. 2011;59(3):482–7. https://doi.org/10.1111/j.1532-5415.2010.03274.x.CrossRefPubMed

Schuetz P, Seres D, Lobo DN, Gomes F, Kaegi-Braun N, Stanga Z. Management of disease-related malnutrition for patients being treated in hospital. Lancet. 2021;398(10314):1927–38. https://doi.org/10.1016/S0140-6736(21)01451-3.CrossRefPubMed

Correia MI. Nutrition screening vs nutrition assessment: what’s the difference? Nutr Clin Pract. 2018;33(1):62–72. https://doi.org/10.1177/0884533617719669.CrossRefPubMed

Volkert D, Saeglitz C, Gueldenzoph H, Sieber CC, Stehle P. Undiagnosed malnutrition and nutrition-related problems in geriatric patients. J Nutr health Aging. 2010;14:387–92. https://doi.org/10.1007/s12603-010-0085-y.CrossRefPubMed

Abd Aziz NA, Teng NI, Abdul Hamid MR, Ismail NH. Assessing the nutritional status of hospitalized elderly. Clin Interv Aging. 2017:1615-25. https://doi.org/10.2147/CIA.S140859.

Zaki DS, Zakaria DM, Abd El-Galil HM. Prevalence of malnutrition among hospitalized medical intensive care unit patients in a university hospital, Cairo, Egypt: Hospital Based Survey. Int J Intern Med. 2018;7(4):54–9. https://doi.org/10.5923/j.ijim.20180704.02.CrossRef

Abd Allah ES, Gad HM, Abdel-Aziz HR. Nutritional status and its contributing factors among older adults with cancer receiving chemotherapy. Clin Nurs Res. 2020;29(8):650–8. https://doi.org/10.1177/1054773820947953.CrossRefPubMed

Abd-El-Gawad WM, Abou-Hashem RM, El Maraghy MO, Amin GE. The validity of Geriatric Nutrition Risk Index: simple tool for prediction of nutritional-related complication of hospitalized elderly patients. Comparison with Mini Nutritional Assessment. Clin Nutr. 2014;33(6):1108-16. https://doi.org/10.1016/j.clnu.2013.12.005.

10.

Nakagawa N, Maruyama K, Hasebe N. Utility of geriatric nutritional risk index in patients with chronic kidney disease: a mini-review. Nutrients. 2021;13(11):3688. https://doi.org/10.3390/nu13113688.CrossRefPubMedPubMedCentral

11.

Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol Series A. 2001;56(6):M366-72. https://doi.org/10.1093/gerona/56.6.M366.CrossRef

12.

Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’(‘MUST’) for adults. Br J Nutr. 2004;92(5):799–808. https://doi.org/10.1079/bjn20041258.CrossRefPubMed

13.

Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition. 1999;15(6):458–64. https://doi.org/10.1016/S0899-9007(99)00084-2.CrossRefPubMed

14.

Reilly HM, Martineau JK, Moran A, Kennedy H. Nutritional screening-evaluation and implementation of a simple nutrition risk score. Clin Nutr. 1995;14(5):269–73. https://doi.org/10.1016/S0261-5614(95)80063-8.CrossRefPubMed

15.

Kondrup JE, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21. https://doi.org/10.1016/S0261-5614(03)00098-0.CrossRefPubMed

16.

Donini LM, Savina C, Rosano A, Cannella C. Systematic review of nutritional status evaluation and screening tools in the elderly. J Nutr Health Aging. 2007;11(5):421. https://doi.org/10.1007/s12603-011-0073-x.CrossRefPubMed

17.

Frew E, Cant R, Sequeira J. Capturing the data: nutrition risk screening of adults in hospital. Nutrients. 2010;2(4):438–48. https://doi.org/10.3390/nu2040438.CrossRefPubMedPubMedCentral

18.

Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777–83. https://doi.org/10.1093/ajcn/82.4.777.CrossRefPubMed

19.

Ahmed N, Shawkat M, Mansour M, Hussien H, Rasheedy D. Comparison of tools for nutritional assessment in elderly patients: A pilot study. Egypt J Geriatr Gerontol. 2014;1(1):53-9. https://doi.org/10.21608/ejgg.2014.5337.

20.

El Gayar NH, Ramadan AM, Tahon M. Study of Geriatric Nutritional Risk Index and Creatinine Index in Elderly Hemodialysis Patients for Nutritional Assessment. Egypt J Hosp Med. 2022;88(1):3582-9. https://doi.org/10.21608/ejhm.2022.249318.

21.

Chumlea WC, Roche AF, Steinbaugh ML. Estimating stature from knee height for persons 60 to 90 years of age. J Am Geriatr Soc. 1985;33(2):116–20. https://doi.org/10.1111/j.1532-5415.1985.tb02276.x.CrossRefPubMed

22.

Nestlé Nutrition Institute. Guide to Completing the Mini Nutritional Assessment MNA– Short Form®. 2023. Available at https://www.mnaelderly.com/sites/default/files/2021-10/mna-guide-english-sf.pdf (Accessed 21 March 2023).

23.

Cereda E, Pedrolli C. The geriatric nutritional risk index. Curr Opin Clin Nutr Metab Care. 2009;12(1):1–7. https://doi.org/10.1097/mco.0b013e3283186f59.CrossRefPubMed

24.

Sikora A, Zahra F. Nosocomial infections. InStatPearl. 2022. StatPearls Publishing; PMID: 32644738. Available at https://www.ncbi.nlm.nih.gov/books/NBK559312 (Accessed 21 March 2023).

25.

Stone K, Zwiggelaar R, Jones P, Mac Parthaláin N. A systematic review of the prediction of hospital length of stay: Towards a unified framework. PLOS Digit Health. 2022;1(4):e0000017. https://doi.org/10.1371/journal.pdig.0000017.CrossRefPubMedPubMedCentral

26.

Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8(2):514–27. https://doi.org/10.3390/ijerph8020514.CrossRefPubMedPubMedCentral

27.

Cereda E, Limonta D, Pusani C, Vanotti A. Geriatric nutritional risk index: a possible indicator of short-term mortality in acutely hospitalized older people. J Am Geriatr Soc. 2006;54(6):1011–2. https://doi.org/10.1111/j.1532-5415.2006.00754.x.CrossRefPubMed

28.

Jia Z, El Moheb M, Nordestgaard A, Lee JM, Meier K, Kongkaewpaisan N, Han K, El Hechi MW, Mendoza A, King D, Fagenholz P. The geriatric nutritional risk index is a powerful predictor of adverse outcome in the elderly emergency surgery patient. J Trauma Acute Care Surg. 2020;89(2):397–404. https://doi.org/10.1097/ta.0000000000002741.CrossRefPubMed

29.

Cereda E, Klersy C, Pedrolli C, et al. The Geriatric Nutritional Risk Index predicts hospital length of stay and in-hospital weight loss in elderly patients. Clin Nutr. 2015;34(1):74–8. https://doi.org/10.1016/j.clnu.2014.01.017.CrossRefPubMed

30.

Wischmeyer PE. Nutrition therapy in sepsis. Crit Care Clin. 2018;34(1):107–25. https://doi.org/10.1016/j.ccc.2017.08.008.CrossRefPubMed

31.

Zhao Y, Xia X, Xie D, Liao Y, Wang Y, Chen L, Ge N, Yue J. Geriatric Nutritional Risk Index can predict postoperative delirium and hospital length of stay in elderly patients undergoing non-cardiac surgery. Geriatr Gerontolo Int. 2020;20(8):759–64. https://doi.org/10.1111/ggi.13963.CrossRef

32.

Ishii H, Takahashi H, Ito Y, et al. The association of ankle brachial index, protein-energy wasting, and inflammation status with cardiovascular mortality in patients on chronic hemodialysis. Nutrients. 2017;9(4):416. https://doi.org/10.3390/nu9040416.CrossRefPubMedPubMedCentral

33.

Fang CJ, Saadat GH, Butler BA, Bokhari F. The geriatric nutritional risk index is an independent predictor of adverse outcomes for total joint arthroplasty patients. J Arthroplasty. 2022;37(8):S836-41. https://doi.org/10.1016/j.arth.2022.01.049.CrossRefPubMed

34.

Gärtner S, Kraft M, Krüger J, Vogt LJ, Fiene M, Mayerle J, Aghdassi AA, Steveling A, Völzke H, Baumeister SE, Lerch MM. Geriatric nutritional risk index correlates with length of hospital stay and inflammatory markers in older inpatients. Clin Nutr. 2017;36(4):1048–53. https://doi.org/10.1016/j.clnu.2016.06.019.CrossRefPubMed

35.

Lee CG, Boyko EJ, Nielson CM, et al. Mortality risk in older men associated with changes in weight, lean mass, and fat mass. J Am Geriatr Soc. 2011;59(2):233–40. https://doi.org/10.1111/j.1532-5415.2010.03245.x.CrossRefPubMedPubMedCentral

36.

Shi X, Shen Y, Yang J, Du W, Yang J. The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study. Heart Lung. 2021;50(6):898–905. https://doi.org/10.1016/j.hrtlng.2021.07.012.CrossRefPubMed

Title: Geriatric nutritional risk index and adverse medical outcomes among Egyptian patients admitted to a geriatric hospital: a prospective cohort study
Authors: Hebatullah O Mohammed
Azza M. Hassan
Aya Mostafa
Mohamed S. Khater
Aisha Aboelfotoh
Khaled M. Abd Elaziz
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Malnutrition
Published in: BMC Geriatrics / Issue 1/2024
Electronic ISSN: 1471-2318
DOI: https://doi.org/10.1186/s12877-024-04671-5

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