Prevalence and factors associated with malnutrition among hospitalised adult patients in a public hospital in Selangor, Malaysia

Hospital malnutrition is common among adult patients, ranging from 14.5% to 91.7% globally. Despite being known to cause several adverse outcomes, hospital malnutrition remains unrecognized and poorly assessed upon admission unless the patient’s medical diagnosis is related to or requires nutritional intervention. This convenient sampling, cross-sectional study aimed to determine the prevalence and factors associated with malnutrition among hospitalized adult patients in Hospital Serdang. Patients (N=259) aged 18 years and above admitted at least 48 hours to the medical wards were recruited. Data recorded were (i) sociodemographic factors, health and medical status, biochemical parameters, and nutrition management; (ii) assessments and measurements containing anthropometric indicators, functional status, and dietary intake; (iii) malnutrition assessment using Patient Generated – Subjective Global Assessment tool (PG-SGA). The PG-SGA helped stratify each participant into the nutritional intervention they belong to, with the SGA categories in this study being either well-nourished or moderately/severely malnourished. The total score of the PG-SGA was also considered, with a higher score indicating a higher malnutrition rate. Data analyses were performed by IBM-SPSS version 23.0. Multivariate analysis tests including binary logistic regression and multiple linear regression were used to test the predictive impact of different variables on malnutrition. The mean age of the patients was 55.07±14.92 years, ranging from 18 to 94 years. Around half of participants (52.9%) were males, 62.6% Malay ethnicity, 49.4% had secondary education, 70% were married, and 57.5% were unemployed. Based on the PG-SGA categories, malnutrition was prevalent among 54.4% of the sample. The overall mean of the PG-SGA score was 7.08±4.32 points, translating to severely malnourished status. Factors that were significantly associated with malnutrition were age (χ2= 26.23), education level (χ2=6.47), employment status (χ2=6.224), hospital stay duration (χ2= 4.68), body mass index (BMI) (χ2= 11.54), handgrip strength (HGS) (χ2=3.98), low-density cholesterol (χ2=4.72), lymphocyte count (χ2=4.68), albumin (χ2=5.56), creatinine (χ2=3.94), haemoglobin (χ2=9.01), and route of feeding (χ2=15.84). Older participants, male gender, unemployment, longer hospital stay, having more than one comorbidity, having renal diseases, having gastrointestinal diseases, and having ONS or enteral feeding significantly correlated to increased malnutrition scores. In Binary Logistic Regression, factors found to remain significantly predicted with malnutrition categories were elderly (OR=4.15, CI:2.15, 8.00), low BMI (OR=3.11, CI:1.25, 7.73), low haemoglobin level (OR=2.14, CI:1.06, 4.30), and ONS/enteral feeding (OR=12.53, CI:2.446, 64.165). Nagelkerke R2 showed that the model explained about 28% of the variation in malnutrition categories. Multiple linear regression analysis showed elderly, male gender, low BMI, low HGS, and having ONS/enteral feeding as malnutrition predictors. Results of this study showed that malnutrition is common among hospitalised adult patients in a public hospital in Selangor, Malaysia. Contributors of malnutrition status of hospitalised Malaysian adults may include various sociodemographic factors, anthropometric factors, functional status, and nutritional management. Early screening for malnutrition upon patient admission is suggested in order to lower the prevalence of malnutrition and begin appropriate management. Further multicentral research would be impactful to understand the importance of nutritional status monitoring and the outcomes of those who have nutritional management versus those who do not.

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