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DOI: 10.1055/s-2001-15034
Mangelernährung im Krankenhaus - Prävalenz, klinische Folgen, Budgetrelevanz
Malnutrition in hospital: prevalence, clinical consequences and relevant costsPublication History
Publication Date:
31 December 2001 (online)
Die Mangelernährung von Patienten stellt auch in den industrialisierten Ländern ein zunehmend relevantes Problem dar. Erstaunlicherweise gibt es im Gegensatz zu anderen westlichen Staaten für die Bundesrepublik Deutschland, mit Ausnahme weniger Studien in der Geriatrie, bisher keine ausreichend systematischen Untersuchungen über die Prävalenz der Mangelernährung in deutschen Kliniken sowie darüber hinaus über den Verlauf des Ernährungsstatus während eines Krankenhausaufenthaltes. Dabei gibt es schon seit den siebziger Jahren eine große Vielfalt von Studien aus anderen westlichen Ländern, die die große klinische Relevanz dieses Themas und seiner erheblichen Folgen für den klinischen Verlauf belegen [Tab. 1] [4] [8] [22] [34] [39] [42] [45]. Die frühzeitige Erfassung einer beginnenden Mangelernährung sowie eine konsekutive adäquate ernährungsmedizinische Basisbetreuung hat aufgrund unseres heutigen Wissensstandes nicht nur einen signifikanten Einfluss auf die individuelle Mortalität, Morbidität, Therapietoleranz, Komplikationsrate und damit die Prognose des Patienten, sondern führt in prospektiven klinischen Studien darüber hinaus auch zu einer hochsignifikanten Verkürzung der Krankenhausliegedauer und zu einer erheblichen Senkung der individuell entstehenden Kosten [8] [34] [35] [42].
Literatur
- 1 Bastow M D, Rawlings J, Allison S P. Benefits of supplementary tube feeding after fractured neck of femur: a randomized controlled trial. Brit Med J. 1983; 287 1589-1592
- 2 Bernstein L H, Shaw-Stiffel T A, Schorow M, Broullette R. Financial implications of malnutrition. Clin Lab Med. 1993; 13 491-507
- 3 Bistrian B R, Blackburn G L, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. J Am Med Assoc. 1976; 253 1567-1570
- 4 Brugler L, DiPrinzio M J, Bernstein L. The five-year evolution of a malnutrition treatment program in a community hospital. J Quality Improvement. 1999; 25 191-206
- 5 Buzby G P, Mullen J L, Matthews D C, Hobbs C L, Rosato E F. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980; 139 160-167
- 6 Calle E E, Thun M J, Petrelli J M, Rodriguez C, Heath C W Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. New Engl J Med. 1999; 341 1097-1105
- 7 Copeland E M III, Daly J M, Dudrick S J. Nutrition as an adjuvant to cancer treatment in the adult. Cancer Res. 1977; 37 2451-2456
- 8 Dempsey D T, Mullen J L, Buzby G. The link between nutritional status and clinical outcome: can nutritional intervention modify it?. Am J Clin Nutr. 1988; 47 352-356
- 9 Detsky A S, McLaughlin J R, Baker J P, Johnston N, Mendelson R A, Jeejeebhoy K N. What is subjective global assessment of nutritional status?. J Parenter Enteral Nutr. 1987; 11 8-11
- 10 Dewys W D, Begg C, Lavin P T. et al . Prognostic effect of weight loss prior to chemotherapy in cancer patients. Am J Med. 1980; 69 491-497
- 11 Durazo-Arvizu R, Cooper R S, Luke A, Prewitt T E, Liao Y, McGee D. Relative weight and mortality in U.S. blacks and whites: findings from representative national population samples. Ann Epidemiol. 1997; 7 383-395
- 12 Edington J, Boorman J, Durrant E R, Perkins A. et al . Prevalence of malnutrition on admission to four hospitals in England. Clin Nutr. 2000; 19 191-195
- 13 Hall J C. The use of internal validity in the construct of an index of undernutrition. J Parenter Enteral Nutr. 1990; 14 582-587
- 14 Harris T, Cook E F, Garrison R, Higgins M, Kannel W, Goldman L. Body mass index and mortality among nonsmoking older persons. J Am Med Assoc. 1988; 259 1520-1524
- 15 Harvey K B, Bothe A Jr, Blackburn G L. Nutritional assessment and patient outcome during oncological therapy. Cancer. 1979; 43 2065-2069
- 16 Hoffmans M DA, Kromhout D, Coulander C DL. The impact of body mass index of 78.612 18-year old Dutch men on 32-year mortality from all causes. J Clin Epidemiol. 1988; 41 749-756
- 17 Jebb S A, Elia M. Techniques for the measurement of body composition: a practical guide. Int J Obesity. 1993; 17 611-621
- 18 Jensen M D. Research techniques for body composition assessment. J Am Diet Assoc. 1992; 92 454-460
- 19 Kaminski M V. The case for nutritional support. Eliminating hospital acquired malnutrition improves outcomes and reduces cost. Health Progress. 1992; 73 69-78
- 20 Keele A M, Bray M J, Emery P W, Silk D BA. Two-phase randomised controlled clinical trial of oral dietary supplements in surgical patients. Clin Nutr. 1995; 14 8 (Suppl 2))
- 21 Keller H H. Malnutrition in institutionalized elderly: how and why?. J Am Geriatr Soc. 1993; 41 1212-1218
- 22 Klein S, Kinney J, Jeejeebhoy K, Alpers D. et al . Nutrition support in clinical practice: review of published data and recommendations for future research directions. Am J Clin Nutr. 1997; 66 683-706
- 23 Larsson J, Andersson M, Askelof N, Bark T. Malnutrition common in Swedish hospitals. Risk of complications and prolonged care increases. Nord Med. 1994; 109 292-295
- 24 Larsson J, Unosson M, Nilsson L, Thorslund S, Bjurulf P. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients - a randomized study. Clin Nutr. 1990; 9 179-184
- 25 Lee I M, Manson J E, Hennekens C H, Paffenbarger R S. Body weight and mortality - a 27-year follow-up of middle-aged men. J Am Med Assoc. 1993; 270 2823-2828
- 26 Manson J E, Willett W C, Stampfer M J. et al . Body weight and mortality among women. New Engl J Med. 1995; 333 677-685 SE>
- 27 McWhirter J P, Pennington C R. A comparison between oral and nasogastric nutritional supplements in malnourished patients. Nutrition. 1996; 12 502-506
- 28 McWhirter J P, Pennington C R. Incidence and recognition of malnutrition in hospital. Br Med J. 1994; 308 945-948
- 29 Meguid M M, Debonis D, Meguid V, Hill L R, Terz J J. Complications of abdominal operations for malignant disease. Am J Surg. 1988; 156 341-445
- 30 Mullen J L, Gertner M H, Buzby G P. et al . Implications of malnutrition in the surgical patient. Arch Surg. 1979; 114 121-125
- 31 Müller J M, Dienst D, Brenner U, Pichlmaier H. Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet. 1982; 1 68-71
- 32 Pettigrew R A, Charlesworth P M, Farmilo R W, Hill G L. Assessment of nutritional depletion and immune competence: a comparison of clinical examination and objective measurements. J Parenter Enteral Nutr. 1983; 8 21-24
- 33 Pinchcofsky G D, Kaminski M V. Increasing malnutrition during hospitalization: documentation by a nutritional screening program. J Am Coll Nutr. 1985; 4 471-479
- 34 Reilly H M. Nutrition in clinical management: malnutrition in our midst. Proc Nutr Soc. 1996; 55 841-853
- 35 Reilly J J, Hull S F, Albert N, Waller A, Bringardener S. Economic impact of malnutrition: A model system for hospitalized patients. J Parenter Enteral Nutr. 1988; 12 371-376
- 36 Reinhardt G F, Myscofski J W, Wilkens D B. et al . Incidence and mortality of hypoalbuminemic patients in hospitalized veterans. J Parenter Enteral Nutr. 1980; 4 357-359
- 37 Rissanen A, Heliovaara M, Knekt P, Aromaa A, Reunanen A, Maatela J. Weight and mortality in Finnish women. J Clin Epidemiol. 1991; 44 787-795
- 38 Robinson G, Goldstein M, Levine G M. Impact of nutritional status on DRG length of stay. J Parenter Enteral Nutr. 1987; 11 49-51
- 39 Roubenoff R, Roubenoff R A, Preto J, Balke W. Malnutrition among hospitalized patients. Arch Intern Med. 1987; 147 1462-1465
- 40 Stevens J, Cai J, Pamuk E R, Williamson D F, Thun M, Wood J L. The effect of age on the association between body-mass index and mortality. New Engl J Med. 1998; 338 1-7
- 41 Sullivan D B, Carter W J. Insulin-like growth factor as an indicator of protein-energy undernutrition among metabolically stable hospitalized elderly. J Am Coll Nutr. 1994; 13 184-191
- 42 Tucker H N, Miguel S G. Cost containment through nutrition intervention. Nutr Rev. 1996; 54 111-121
- 43 Valla C, Schneider S M, Stalins S, Hébuterne X. Food intake in medical and surgical hospitalized patients. Clin Nutr. 2000; 19 (Suppl 1))
- 44 Volkert D, Kruse W, Oster P, Schlierf G. Malnutrition in geriatric patients: diagnostic and prognostic significance of nutritional parameters. Ann Nutr Metab. 1992; 36 97-112
- 45 Weinsier R L, Edie P H, Hunker R N, Krumdieck C L, Butterworth C E Jr. Hospital nutrition: a prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr. 1979; 32 418-426
- 46 Wienpahl J R, Sidney S. Body mass index and 15-year mortality in a cohort of black men and women. J Clin Epidemiol. 1990; 43 949-960
- 47 Willard M D, Gilsdorf R B, Price R A. Protein calorie malnutrition in a community hospital. J Am Med Assoc. 1980; 234 170-172
Korrespondenz
Prof. Dr. med. Christian Löser
Leitender Oberarzt, Leiter der Ambulanz für
Enterale und Parenterale Ernährung, I. Medizinische
Klinik, Christian-Albrechts-Universität
Schittenhelmstraße 12
24105 Kiel
Phone: 0431/597-1281, -1394
Fax: 0431/597-1302
Email: chr.loeser@1med.uni-kiel.de