It often remains undetected due to lack of awareness, knowledge, and clinical protocols to identify and treat this problem within hospitals. However, malnutrition is preventable and mostly reversible with early adequate nutritional therapy. Malnutrition should be considered and treated as an additional disease, as it has been shown to worsen clinical outcomes and to increase morbidity, mortality, and complication rates, thus causing additional costs. In addition, the fasting periods before many examinations and interventions, as well as inappropriate meal services, inadequate quality and flexibility of hospital catering, and insufficient assistance provided by the health care staff to the most vulnerable patients, lead to further inadequate food intake and deterioration of patients’ nutritional status. The increased metabolism due to the stress of eventual surgical procedures further aggravates the nutritional metabolic risk, and is characterized by activation of the sympathetic nervous system, endocrine responses, and immunological and hematological changes-all leading to a hypermetabolic state, which may further increase patients’ nutritional needs. Malnutrition also influences the efficacy or tolerance of several treatments, such as antibiotic therapy, chemotherapy, radiotherapy, and surgery. A protracted decline in nutritional status results in a catabolic metabolism and chronic low-grade inflammation, potentially leading to several harmful consequences, such as loss of fat-free mass, immune dysfunction, higher complications and mortality rates, reduced quality of life, and prolonged hospital stays. Frequent problems such as chewing and swallowing issues, immobility, and side effects of drugs and polypharmacy should not be underestimated in this regard. The underlying disease may directly impair nutritional intake and may induce metabolic and/or psychological disorders, which increase the nutritional needs or decrease food intake. One in five patients does not consume enough food to cover their energy or protein needs. For various reasons, ill people may struggle to meet their nutritional and hydration requirements, and as a consequence, 20–50% of patients are malnourished or at high risk of malnutrition upon hospital admission. These processes have a strong influence on nutritional status, which in turn depends on nutritional intake, its balanced supply of macro and micronutrients, and fluid intake. Nutritional intake and its controlling mechanisms (e.g., appetite, satiety) are highly complex physiological processes. Nutrition is a basic need of life and thus plays an important role in health promotion and disease prevention. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients’ nutritional condition. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems.
Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support.
Malnutrition is an independent risk factor that negatively influences patients’ clinical outcomes, quality of life, body function, and autonomy.
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