Original articleThe Geriatric Nutritional Risk Index predicts hospital length of stay and in-hospital weight loss in elderly patients
Introduction
The independent role of nutrition in affecting the prognosis of hospitalized patients is well known. Disease-related malnutrition has been shown to be associated with higher mortality and morbidity, prolonged recovery from illness and length of stay (LOS).1, 2, 3 Furthermore, nutritional status may deteriorate during hospitalization.1, 2, 4 Advanced age has been associated with poor adaptation to disease-related metabolic stress5 and is recognized as an independent predictor of nutritional derangements and worse clinical outcome.1, 6
The use of screening procedures to assess nutritional risk before/during hospital admission is recommended so as to identify patients who may benefit from nutritional support.7 To this end, different tools have been introduced in clinical practice; although they provide different information, in theory, they focus on the same issue.7, 8 Nevertheless, the use of a tool should be initially validated against prediction of outcomes. Validation should also specifically take into account the specific setting and population.9 As the numbers of elderly people are growing, and given the intrinsic nutritional needs among this group of patients, the validation of putatively age-specific assessment tools has a rationale.9 Moreover, elderly patients may frequently be unable to take part in nutritional screening procedures.
In accordance with these claims, a specific prognostic index for the elderly, the Geriatric Nutritional Risk Index (GNRI), has been proposed.10, 11 Its use appears to be promising and preliminary studies have suggested a better association with acute care outcomes.12, 13 However, most of the literature on GNRI is focused on long-term care settings. Very little research has been done on use of the GNRI in the acute setting.9, 14, 15, 16
The aim of this study was to investigate the impact of nutritional risk, as assessed by the GNRI, on length of stay (LOS) and nutritional status during hospitalization in elderly patients.
Section snippets
Methods
This was a prospective multicentre cohort study in an acute hospital setting. Assessment procedures were performed in line with principles set down by the Declaration of Helsinki. It was approved by the local Institutional Ethics Committees and all the patients were asked to provide their written informed consent.
From March 2009 to April 2012, all patients over 65 who were admitted to the hospitals were systematically screened to assess whether they met study inclusion criteria. Patients were
Assessment of the study cohort
A total number of 735 patients were assessed; 33 (4%) and 35 (5%) patients were excluded from final analysis due to LOS < 3 days and death, respectively; 667 subjects were included in the final analysis. Table 1 classifies these patients according to their main diagnoses on admission. The prevalence of high nutritional risk (GNRI < 92) was similar in patients who died during hospitalization (36.7% vs. 32.8%; P = 0.811), and no differences were detected in baseline nutritional parameters and
Discussion
Older persons are the fasted growing segment of the population and most frequently hospitalized.21 From a nutritional perspective, ageing is associated with poor adaptation to malnutrition and diminished anabolic response to nutritional repletion.5, 22 These factors are potentially exaggerated during hospitalization. Evidence is accumulating, however, that early nutritional screening and treatment of elderly patients may result in cost savings.19, 20, 23, 24
The current study is one of the
Funding sources
The study was supported by the Fondazione IRCCS Policlinico San Matteo (Pavia, Italy).
Statement of authorship
All the authors significantly contributed to the work, read and approved the final version of the manuscript. Particularly, contributions were as follows:
Study design: R.C., E.C., C.P.
Data collection: R.C., C.P., B.C., C.B., L.Q., S.C., A.B.
Data analyses and interpretation: E.C., R.C., C.K.
Manuscript drafting: E.C., R.C., C.P.
Critical revision of the manuscript: C.K.
Conflict of interest
All authors certify that there are no affiliations with or involvement in any organization with a direct financial interest in the subject matter or materials discussed in the manuscript.
Acknowledgements
The authors wish to thank Jennifer S Hartwig MD for assistance in editing the manuscript.
References (31)
- et al.
Prognostic impact of disease-related malnutrition
Clin Nutr
(2008) - et al.
Does nutritional risk, as assessed by nutritional risk index, increase during hospital stay? A multinational population-based study
Clin Nutr
(2005) - et al.
Lack of adaptation to severe malnutrition in elderly patients
Clin Nutr
(2002) - et al.
EuroOOPS study group. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome
Clin Nutr
(2008) - et al.
Educational and clinical practice committee, European society of parenteral and enteral nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002
Clin Nutr
(2003) - et al.
Comparison of tools for nutritional assessment and screening at hospital admission: a population study
Clin Nutr
(2006) - et al.
Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients
Am J Clin Nutr
(2005) - et al.
The use of the Geriatric Nutritional Risk Index (GNRI) as a simplified nutritional screening tool
Am J Clin Nutr
(2008) - et al.
Nutritional screening and mortality in newly institutionalised elderly: a comparison between the geriatric nutritional risk index and the mini nutritional assessment
Clin Nutr
(2011) - et al.
Nutritional risk as predictor for healthcare-associated infection among hospitalized elderly patients in the acute care setting
J Hosp Infect
(2012)
Geriatric Nutritional Risk Index and overall-cause mortality prediction in institutionalised elderly: a 3-year survival analysis
Clin Nutr
ESPEN guidelines on enteral nutrition: geriatrics
Clin Nutr
ESPEN. ESPEN guidelines on parenteral nutrition: geriatrics
Clin Nutr
Aging is associated with diminished accretion of muscle proteins after the ingestion of a small bolus of essential amino acids
Am J Clin Nutr
Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients
Am J Clin Nutr
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