Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture
Open accessAbstract
Introduction One percent of falls in over-75 years old cause hip fracture (HF). Protein-energy malnutrition (PEM) is associated with falls and fracture. PEM screening and perioperative nutritional management are recommended by the European Society of Parenteral and Enteral Nutrition, yet data on nutritional status in elderly HF patients are sparse. The Mini Nutritional Assessment (MNA) score is presently the most effective screening tool for PEM in over-75 years old.Objective The principal objective of the present study was to determine the prevalence on MNA of PEM in patients aged over 75 years admitted for HF. Secondary objectives were to identify factors associated with PEM and its role as a factor of evolution.Materials and methods A prospective observational epidemiological study included 50 patients aged over 75 years admitted for HF in an 8-bed orthopedic surgery department with a geriatric follow-up unit. PEM was defined by MNA<17/30. Assessment systematically comprised associated comorbidity (Cumulative Illness Rating Scale-Geriatric [CIRS-G]), cognitive status on the Mini Mental State Examination (MMSE), functional status on activities of daily life (ADL), and mean hospital stay (MHS). Scores were compared on quantitative tests (Student t) with the significance threshold set at P<0.05.Results Mean age for the 50 patients was 86.1 years (range, 77-94 years). Prevalence of PEM was 28%; a further 58% of patients were at risk for PEM. PEM was associated with elevated CIRS-G (P<0.006), greater numbers of severe comorbidities (P=0.006), more severe cognitive disorder (P=0.005) and functional dependence (P=0.002), and 8 days' longer MHS (P=0.012).Discussion The present study confirmed the high prevalence of PEM in HF patients aged over 75 years, supporting longer hospital stay. MNA is a diagnostic gold standard, not to be replaced by albuminemia or body-mass index in this perioperative clinical situation. Given the present economic stakes relating to geriatric trauma patients' hospital stay, it is essential to prevent, diagnose and treat PEM in elderly subjects.Level of evidence Level IV; prospective cohort study.
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Energy and protein underfeeding during hospitalization may worsen muscle breakdown.
“Hospitalization is also associated with energy and protein underfeeding that may further exacerbate muscle catabolism (8).”
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- Authors
- Drevet, S., Bioteau, C., Mazière, S., Couturier, P., Merloz, P., Tonetti, J., & Gavazzi, G.
- Affiliations
- Centre Hospitalier Universitaire de Grenoble (FR)
- Corresponding author
- Drevet, S.
- Venue
- Orthopaedics & Traumatology: Surgery & Research
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 100
- Issue
- 6
- Pages
- 669-674
- ISSN
- 1877-0568 (ISSN-L)
- OpenAlex
- W2018254216
- Cited by
- 94
- References
- 31
- Citations by year
- 2025: 4 · 2024: 8 · 2023: 7 · 2022: 3 · 2021: 9 · 2020: 8 · 2019: 6 · 2018: 12 · 2017: 17 · 2016: 10 · 2015: 9 · 2014: 1
- FWCI
- 8.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Orthopaedics & Traumatology Surgery & Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Surgery › Hip and Femur Fractures
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- protein-energy malnutrition, hip fracture, elderly patients, Mini Nutritional Assessment, nutritional screening, comorbidities, cognitive impairment, functional dependence, length of hospital stay, geriatric trauma, perioperative nutritional management
- MeSH terms
- Aged, Aged, 80 and over, Albuminuria, Cognition Disorders, Disability Evaluation, Female, France, Hip Fractures, Hospitalization, Humans, Length of Stay, Male, Prospective Studies, Protein-Energy Malnutrition, Geriatric Assessment, Comorbidity, Body Mass Index, Prevalence
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