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Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients^1,2,3

¹ From the Department of Nutrition and Dietetics (HMK and MAEVB-S), the EMGO Institute (MWVT), the Institute for Health Sciences (JCS), the Department of General Internal Medicine (AT), and the Department of Clinical Epidemiology and Biostatistics (HJA), VU University Medical Center, Amsterdam, Netherlands, and the Institute for Health Sciences, VU University, Amsterdam, Netherlands (MWVT)

Background: About 25-40% of hospital patients are malnourished. With current clinical practices, only 50% of malnourished patients are identified by the medical and nursing staff.

Objective: The objective of this study was to report the cost and effectiveness of early recognition and treatment of malnourished hospital patients with the use of the Short Nutritional Assessment Questionnaire (SNAQ).

Design: The intervention group consisted of 297 patients who were admitted to 2 mixed medical and surgical wards and who received both malnutrition screening at admission and standardized nutritional care. The control group consisted of a comparable group of 291 patients who received the usual hospital clinical care. Outcome measures were weight change, use of supplemental drinks, use of tube feeding, use of parenteral nutrition and in-between meals, number of consultations by the hospital dietitian, and length of hospital stay.

Results: The recognition of malnutrition improved from 50% to 80% with the use of the SNAQ malnutrition screening tool during admission to the hospital. The standardized nutritional care protocol added 600 kcal and 12 g protein to the daily intake of malnourished patients. Early screening and treatment of malnourished patients reduced the length of hospital stay in malnourished patients with low handgrip strength (ie, frail patients). To shorten the mean length of hospital stay by 1 d for all malnourished patients, a mean investment of 76 (US$91) in nutritional screening and treatment was needed. The incremental costs were comparably low in the whole group and in the subgroup of malnourished patients with low handgrip strength.

Conclusions: Screening with the SNAQ and early standardized nutritional care improves the recognition of malnourished patients and provides the opportunity to start treatment at an early stage of hospitalization. The additional costs of early nutritional care are low, especially in frail malnourished patients.

Key Words: Malnutrition • hospital • Short Nutritional Assessment Questionnaire (SNAQ) • screening • undernutrition • effectiveness • cost-effectiveness • length of hospital stay

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