Sammendrag
Background: The prevalence of disease-related malnutrition (DRM) in hospitals is approximately 30%. Reduced physical function and increased length of hospital stay (LOS) are consequences of DRM. Prevention and treatment of DRM can be performed by conducting screening for risk of malnutrition and implementing targeted nutritional measures. Objectives and aims: To assess whether implementation of nutritional measures for patients with risk of DRM will improve physical function in handgrip strength (HGS), and the ability to perform personal activities of daily living (PADL), as well as contribute to shorter LOS. Methods: In a randomized controlled pilot study, 44 patients with nutritional risk screening 2002 (NRS 2002) score equal to or above 3, and with expected LOS equal to or above 3 days from the Medical Clinic, Oslo University Hospital, Ullevål between August, and December 2021, were included in the analysis. Twenty-four patients (intervention group (IG)) received targeted nutritional efforts routinely, 20 patients (control group (CG)) were controls. Weight and height were measured, and body mass index (BMI) were calculated. Physical function and the ability to perform personal activities of daily living were measured using HGS and a PADL form. The LOS was calculated by the difference from inclusion and discharge. Dietary intake was assessed using diet recording forms and 24-hour diet recall. Results: The median (IQR) development in HGS values for the IG through the hospital stay on the right and left hand was 0.3kg (-0.8, 1-8) and -0.5kg (-1.5-2.5), respectively. For the CG, the median (IQR) development on right and left hand was 0.9 kg (-1.3, 2.4) and -0.6 (-0.8, 3.9), respectively. The median LOS was 4.5 and 6.5 days for the IG and CG, respectively. For the IG, it was a positive correlation between increased dietary intake compared to individual requirements and improved HGS values during the hospital stay. Similar correlations were found for the left hand in the CG. Mean energy and protein intake in the IG was 86% and 95% of the calculated individual requirements, respectively (p<0.001). For the CG, it was 51% and 54%, respectively (p<0.001). The number (%) referred to a dietitian was 7 (36.9) and 5 (33.3) in the IG and CG, respectively. Conclusion: An intervention consisting of individualized and targeted nutritional measures did not result in significant improvements of physical function or reduced LOS in the IG, compared to the CG. However, increased energy and protein intake in percent compared to individual requirements was correlated with improvements in HGS during the hospital stay. Increased protein intake was both correlated with a delayed and increase in LOS. Further studies with larger number of participants are needed to verify our findings.