RSS-Feed abonnieren
DOI: 10.1055/s-2001-15034
Mangelernährung im Krankenhaus - Prävalenz, klinische Folgen, Budgetrelevanz
Malnutrition in hospital: prevalence, clinical consequences and relevant costsPublikationsverlauf
Publikationsdatum:
31. Dezember 2001 (online)

Die Mangelernährung von Patienten stellt auch in den industrialisierten Ländern ein zunehmend relevantes Problem dar. Erstaunlicherweise gibt es im Gegensatz zu anderen westlichen Staaten für die Bundesrepublik Deutschland, mit Ausnahme weniger Studien in der Geriatrie, bisher keine ausreichend systematischen Untersuchungen über die Prävalenz der Mangelernährung in deutschen Kliniken sowie darüber hinaus über den Verlauf des Ernährungsstatus während eines Krankenhausaufenthaltes. Dabei gibt es schon seit den siebziger Jahren eine große Vielfalt von Studien aus anderen westlichen Ländern, die die große klinische Relevanz dieses Themas und seiner erheblichen Folgen für den klinischen Verlauf belegen [Tab. 1] [4] [8] [22] [34] [39] [42] [45]. Die frühzeitige Erfassung einer beginnenden Mangelernährung sowie eine konsekutive adäquate ernährungsmedizinische Basisbetreuung hat aufgrund unseres heutigen Wissensstandes nicht nur einen signifikanten Einfluss auf die individuelle Mortalität, Morbidität, Therapietoleranz, Komplikationsrate und damit die Prognose des Patienten, sondern führt in prospektiven klinischen Studien darüber hinaus auch zu einer hochsignifikanten Verkürzung der Krankenhausliegedauer und zu einer erheblichen Senkung der individuell entstehenden Kosten [8] [34] [35] [42].
Literatur
- 1
Bastow M D, Rawlings J, Allison S P.
Benefits
of supplementary tube feeding after fractured neck of femur: a randomized
controlled trial.
Brit Med J.
1983;
287
1589-1592
MissingFormLabel
- 2
Bernstein L H, Shaw-Stiffel T A, Schorow M, Broullette R.
Financial implications
of malnutrition.
Clin Lab Med.
1993;
13
491-507
MissingFormLabel
- 3
Bistrian B R, Blackburn G L, Vitale J, Cochran D, Naylor J.
Prevalence of
malnutrition in general medical patients.
J Am Med Assoc.
1976;
253
1567-1570
MissingFormLabel
- 4
Brugler L, DiPrinzio M J, Bernstein L.
The
five-year evolution of a malnutrition treatment program in a community
hospital.
J Quality Improvement.
1999;
25
191-206
MissingFormLabel
- 5
Buzby G P, Mullen J L, Matthews D C, Hobbs C L, Rosato E F.
Prognostic
nutritional index in gastrointestinal surgery.
Am J Surg.
1980;
139
160-167
MissingFormLabel
- 6
Calle E E, Thun M J, Petrelli J M, Rodriguez C, Heath C W
Jr.
Body-mass index and mortality in a prospective
cohort of U.S. adults.
New Engl J Med.
1999;
341
1097-1105
MissingFormLabel
- 7
Copeland E M
III, Daly J M, Dudrick S J.
Nutrition
as an adjuvant to cancer treatment in the adult.
Cancer
Res.
1977;
37
2451-2456
MissingFormLabel
- 8
Dempsey D T, Mullen J L, Buzby G.
The
link between nutritional status and clinical outcome: can nutritional
intervention modify it?.
Am J Clin Nutr.
1988;
47
352-356
MissingFormLabel
- 9
Detsky A S, McLaughlin J R, Baker J P, Johnston N, Mendelson R A, Jeejeebhoy K N.
What is
subjective global assessment of nutritional status?.
J
Parenter Enteral Nutr.
1987;
11
8-11
MissingFormLabel
- 10
Dewys W D, Begg C, Lavin P T. et al .
Prognostic effect of weight loss prior
to chemotherapy in cancer patients.
Am J Med.
1980;
69
491-497
MissingFormLabel
- 11
Durazo-Arvizu R, Cooper R S, Luke A, Prewitt T E, Liao Y, McGee D.
Relative weight and mortality
in U.S. blacks and whites: findings from representative national
population samples.
Ann Epidemiol.
1997;
7
383-395
MissingFormLabel
- 12
Edington J, Boorman J, Durrant E R, Perkins A. et al .
Prevalence
of malnutrition on admission to four hospitals in England.
Clin
Nutr.
2000;
19
191-195
MissingFormLabel
- 13
Hall J C.
The
use of internal validity in the construct of an index of undernutrition.
J
Parenter Enteral Nutr.
1990;
14
582-587
MissingFormLabel
- 14
Harris T, Cook E F, Garrison R, Higgins M, Kannel W, Goldman L.
Body mass index and
mortality among nonsmoking older persons.
J Am Med Assoc.
1988;
259
1520-1524
MissingFormLabel
- 15
Harvey K B, Bothe A Jr, Blackburn G L.
Nutritional
assessment and patient outcome during oncological therapy.
Cancer.
1979;
43
2065-2069
MissingFormLabel
- 16
Hoffmans M DA, Kromhout D, Coulander C DL.
The
impact of body mass index of 78.612 18-year old Dutch men on 32-year
mortality from all causes.
J Clin Epidemiol.
1988;
41
749-756
MissingFormLabel
- 17
Jebb S A, Elia M.
Techniques for the measurement
of body composition: a practical guide.
Int J Obesity.
1993;
17
611-621
MissingFormLabel
- 18
Jensen M D.
Research
techniques for body composition assessment.
J Am Diet
Assoc.
1992;
92
454-460
MissingFormLabel
- 19
Kaminski M V.
The
case for nutritional support. Eliminating hospital acquired malnutrition
improves outcomes and reduces cost.
Health Progress.
1992;
73
69-78
MissingFormLabel
- 20
Keele A M, Bray M J, Emery P W, Silk D BA.
Two-phase randomised controlled
clinical trial of oral dietary supplements in surgical patients.
Clin
Nutr.
1995;
14
8
(Suppl 2))
MissingFormLabel
- 21
Keller H H.
Malnutrition
in institutionalized elderly: how and why?.
J Am Geriatr
Soc.
1993;
41
1212-1218
MissingFormLabel
- 22
Klein S, Kinney J, Jeejeebhoy K, Alpers D. et al .
Nutrition support in clinical practice:
review of published data and recommendations for future research
directions.
Am J Clin Nutr.
1997;
66
683-706
MissingFormLabel
- 23
Larsson J, Andersson M, Askelof N, Bark T.
Malnutrition common in Swedish
hospitals. Risk of complications and prolonged care increases.
Nord
Med.
1994;
109
292-295
MissingFormLabel
- 24
Larsson J, Unosson M, Nilsson L, Thorslund S, Bjurulf P.
Effect
of dietary supplement on nutritional status and clinical outcome
in 501 geriatric patients - a randomized study.
Clin
Nutr.
1990;
9
179-184
MissingFormLabel
- 25
Lee I M, Manson J E, Hennekens C H, Paffenbarger R S.
Body
weight and mortality - a 27-year follow-up of middle-aged
men.
J Am Med Assoc.
1993;
270
2823-2828
MissingFormLabel
- 26
Manson J E, Willett W C, Stampfer M J. et al .
Body weight and mortality among women.
New
Engl J Med.
1995;
333
677-685 SE>
MissingFormLabel
- 27
McWhirter J P, Pennington C R.
A comparison
between oral and nasogastric nutritional supplements in malnourished
patients.
Nutrition.
1996;
12
502-506
MissingFormLabel
- 28
McWhirter J P, Pennington C R.
Incidence
and recognition of malnutrition in hospital.
Br Med J.
1994;
308
945-948
MissingFormLabel
- 29
Meguid M M, Debonis D, Meguid V, Hill L R, Terz J J.
Complications
of abdominal operations for malignant disease.
Am J Surg.
1988;
156
341-445
MissingFormLabel
- 30
Mullen J L, Gertner M H, Buzby G P. et al .
Implications of malnutrition in the surgical
patient.
Arch Surg.
1979;
114
121-125
MissingFormLabel
- 31
Müller J M, Dienst D, Brenner U, Pichlmaier H.
Preoperative parenteral
feeding in patients with gastrointestinal carcinoma.
Lancet.
1982;
1
68-71
MissingFormLabel
- 32
Pettigrew R A, Charlesworth P M, Farmilo R W, Hill G L.
Assessment of
nutritional depletion and immune competence: a comparison of clinical
examination and objective measurements.
J Parenter Enteral
Nutr.
1983;
8
21-24
MissingFormLabel
- 33
Pinchcofsky G D, Kaminski M V.
Increasing
malnutrition during hospitalization: documentation by a nutritional
screening program.
J Am Coll Nutr.
1985;
4
471-479
MissingFormLabel
- 34
Reilly H M.
Nutrition
in clinical management: malnutrition in our midst.
Proc
Nutr Soc.
1996;
55
841-853
MissingFormLabel
- 35
Reilly J J, Hull S F, Albert N, Waller A, Bringardener S.
Economic
impact of malnutrition: A model system for hospitalized patients.
J Parenter
Enteral Nutr.
1988;
12
371-376
MissingFormLabel
- 36
Reinhardt G F, Myscofski J W, Wilkens D B. et al .
Incidence and mortality of hypoalbuminemic
patients in hospitalized veterans.
J Parenter Enteral
Nutr.
1980;
4
357-359
MissingFormLabel
- 37
Rissanen A, Heliovaara M, Knekt P, Aromaa A, Reunanen A, Maatela J.
Weight and mortality
in Finnish women.
J Clin Epidemiol.
1991;
44
787-795
MissingFormLabel
- 38
Robinson G, Goldstein M, Levine G M.
Impact
of nutritional status on DRG length of stay.
J Parenter
Enteral Nutr.
1987;
11
49-51
MissingFormLabel
- 39
Roubenoff R, Roubenoff R A, Preto J, Balke W.
Malnutrition among hospitalized
patients.
Arch Intern Med.
1987;
147
1462-1465
MissingFormLabel
- 40
Stevens J, Cai J, Pamuk E R, Williamson D F, Thun M, Wood J L.
The effect of
age on the association between body-mass index and mortality.
New
Engl J Med.
1998;
338
1-7
MissingFormLabel
- 41
Sullivan D B, Carter W J.
Insulin-like
growth factor as an indicator of protein-energy undernutrition among
metabolically stable hospitalized elderly.
J Am Coll Nutr.
1994;
13
184-191
MissingFormLabel
- 42
Tucker H N, Miguel S G.
Cost containment
through nutrition intervention.
Nutr Rev.
1996;
54
111-121
MissingFormLabel
- 43
Valla C, Schneider S M, Stalins S, Hébuterne X.
Food
intake in medical and surgical hospitalized patients.
Clin
Nutr.
2000;
19
(Suppl 1))
MissingFormLabel
- 44
Volkert D, Kruse W, Oster P, Schlierf G.
Malnutrition
in geriatric patients: diagnostic and prognostic significance of
nutritional parameters.
Ann Nutr Metab.
1992;
36
97-112
MissingFormLabel
- 45
Weinsier R L, Edie P H, Hunker R N, Krumdieck C L, Butterworth C E Jr.
Hospital
nutrition: a prospective evaluation of general medical patients
during the course of hospitalization.
Am J Clin Nutr.
1979;
32
418-426
MissingFormLabel
- 46
Wienpahl J R, Sidney S.
Body mass index and 15-year
mortality in a cohort of black men and women.
J Clin Epidemiol.
1990;
43
949-960
MissingFormLabel
- 47
Willard M D, Gilsdorf R B, Price R A.
Protein
calorie malnutrition in a community hospital.
J Am Med
Assoc.
1980;
234
170-172
MissingFormLabel
Korrespondenz
Prof. Dr. med. Christian Löser
Leitender Oberarzt, Leiter der Ambulanz für
Enterale und Parenterale Ernährung, I. Medizinische
Klinik, Christian-Albrechts-Universität
Schittenhelmstraße 12
24105 Kiel
Telefon: 0431/597-1281, -1394
Fax: 0431/597-1302
eMail: chr.loeser@1med.uni-kiel.de