RT Journal
A1 Sullivan DH, Sun S, Walls RC
T1 Protein-energy undernutrition among elderly hospitalized patients: A prospective study
JF JAMA
JO JAMA
YR 1999
FD June 2
VO 281
IS 21
SP 2013
OP 2019
DO 10.1001/jama.281.21.2013
UL http://dx.doi.org/10.1001/jama.281.21.2013
AB Context 
                  Numerous studies have identified strong correlations
between the severity of nutritional deficits and an increased risk of
subsequent morbid events among the hospitalized elderly, but whether
inadequate nutrient intake during hospitalization contributes to such
nutritional deficits or the risk of adverse outcomes is not known.Objectives 
                  To identify the distribution of average daily nutrient
intake among the nonterminally ill hospitalized elderly, ascertain what
factors contribute to persistently low intakes, and determine whether
the adequacy of nutrient intake correlates with the risk of mortality.Design 
                  Prospective cohort study conducted from 1994 to 1997.Setting 
                  University-affiliated Department of Veterans Affairs
hospital.Patients 
                  A total of 497 patients 65 years or older (mean [SD]
age, 74 [6] years; 97% male; 86% white) with a length of stay of 4
days or more.Main Outcome Measures 
                  Daily in-hospital nutrient intake,
in-hospital mortality, and 90-day mortality.Results 
                  A total of 102 patients (21%) had an average daily
in-hospital nutrient intake of less than 50% of their calculated
maintenance energy requirements. Admission illness severity, average
length of stay, and admission albumin and prealbumin levels for this
low nutrient group did not differ significantly from those of the
remaining patients. However, the low nutrient group had lower mean (SD)
discharge serum total cholesterol (154 [44] mg/dL [4 {1.1}
mmol/L] vs 173 [42] mg/dL [4.5 {1.1} mmol/L];
P=.001), albumin (29.1 [6.7] vs 33.2 [6.1]
g/L, P=.001), and prealbumin (162 [69] vs
205 [68] mg/L; P=.001) concentrations and a
higher rate of in-hospital mortality (relative risk, 8.0; 95%
confidence interval, 2.8-22.6) and 90-day mortality (relative risk,
2.9; 95% confidence interval, 1.4-6.1). Contributing to the problem of
inadequate nutrient intake, patients were frequently ordered to have
nothing by mouth and were not fed by another route. Neither canned
supplements nor nutritional support were used effectively.Conclusions 
                  Throughout their hospitalization, many elderly
patients were maintained on nutrient intakes far less than their
estimated maintenance energy requirements, which may contribute to an
increased risk of mortality. Given the difficulties reversing
established nutritional deficits in the elderly, greater efforts should
be made to prevent the development of such deficits during
hospitalization.