Associations of in-hospital Global Leadership Initiative on Malnutrition-defined changes in nutritional status with 90-day post-discharge outcomes among patients receiving dietitian-provided nutrition care: A retrospective cohort study
Takeshi Saijo, Daisuke Mori, Kota Taketani, Kiyomi Matsumoto, Hiromi Sate, Kohei Fujino, Hiroki Takeuchi, Ryo Ando, Kayoko RyomotoBackground
Evidence on Global Leadership Initiative on Malnutrition (GLIM)-defined in-hospital trajectories of nutritional status among patients receiving dietitian-provided nutrition care, and on their associations with post-discharge outcomes, remains limited.
Aim
To estimate the incidence of hospital-acquired malnutrition (HAM) and other GLIM-defined changes during hospitalization, and to examine their associations with a 90-day composite endpoint of all-cause mortality or unplanned readmission to the index hospital after discharge.
Methods
We conducted a single-center retrospective observational study in an acute-care hospital. For eligible patients, we performed GLIM-based malnutrition diagnosis at both admission and discharge. Associations between in-hospital changes in nutritional status and the 90-day post-discharge composite endpoint were evaluated using multivariable Cox models, with remained well-nourished as the reference category.
Summary
Among patients not malnourished at admission, HAM occurred in 33.7%. Among those malnourished at admission, 28.5% improved by discharge. In multivariable analyses, the remained malnourished group had a significantly higher risk of the composite endpoint than the remained well-nourished group (hazard ratio, 2.67; 95% confidence interval, 1.64–4.34; p < 0.001). In contrast, the improved and declined groups were not significantly associated with the composite endpoint. Among acute-care hospital patients receiving dietitian-provided nutrition care, persistent GLIM-defined malnutrition from admission to discharge was associated with higher 90-day post-discharge risk. Capturing changes in nutritional status during hospitalization may help identify patients requiring closer post-discharge follow-up. These findings should not be interpreted as evidence of a causal effect of dietitian-provided nutrition care.