Hidden hunger in the hospital?:Recognition of malnutrition and malnutrition risk in complex hospital care

Malnutrition often remains overlooked, particularly in overweight patients with complex conditions. This ‘hidden’ malnutrition requires a different approach to screening and assessment: one less reliant on body weight, and more focused on malnutrition risk factors and measurement of muscle mass and muscle strength.The chronic disease burden has increased due to ageing and the overweight epidemic, which poses a great challenge for health care. Much effort is therefore being put into counteracting overweight, but malnutrition also remains a highly prevalent and impactful issue in health care. Since concomitant overweight can hamper the detection of malnutrition, the current approach to the detection of malnutrition in the hospital was evaluated. Using the current screening methods that largely rely on criteria for (under)weight, such as the Malnutrition Universal Screening Tool, risk of malnutrition is hardly detected in overweight hospital patients. In contrast, using the Patient-Generated Subjective Global Assessment (Short Form), which takes into account malnutrition risk factors, increased risk of malnutrition was present in more than one third of these patients. Importantly, this was associated with relevant clinical outcomes, such as hospital readmission. Also, measurement of muscle mass led to better detection of malnutrition, and both low muscle mass and low muscle strength were found to be associated with a higher risk of mortality. In conclusion, malnutrition and risk thereof remain a ‘hidden hunger’ in hospital patients, which is a relevant burden for both the patient and for health care. Better detection of malnutrition (risk), through integration of adequate screening and assessment methods in routine care, is therefore urgently needed