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Malnutrition occurs in 30 - 35% of hospitalized patients. Table 1 shows the incidence of malnutrition in some diseases.Geriatrics50%Inflammatory bowel diseases75%Tumours 20 - 80%Pulmonary diseases 45%Malnutrition developed during hospitalization 20 - 25%Total hospital malnutrition30 - 35%Table 38.1. Incidence of malnutrition in selected diseases
38.4.Risks and Impacts of Hospital MalnutritionMalnutrition due to catabolism with increased proteolysis and gluconeogenesis leads to the loss of muscle mass and visceral protein in the body. Reduced protein pool, or reduced functional capacity of the protein system within the body, results in a weaker defensive and reparative immune response. This situation leads to the increased incidence of infectious complications (urinary and respiratory tract infections, early infections) and considerably worse healing of wounds. Another major impact is the loss of muscle mass and strength leading to long-term immobilization, develo-pment of decubitus and respiratory failure with consequent dependence of artificial pulmonary ventilation. All these changes result in a longer stay in hospital, higher morbidity and mortality rates as well as increased cost of treatment. Early diagnosis and treatment of malnutrition may prevent these effects.38.5.Diagnosis of Malnutrition38.5.1.Patient HistoryFrom historical data, the question about weight loss over a certain period of time is essential. Clinically significant weight loss is a loss of 5% in one month or 10% in 2 - 6 months. Another important question is about the amount of food taken in the past ten days. A food intake under ¾ of portions signals a risk of malnutrition. Supplementary ques-tions include analysing dietary habits, questions about indigestion related to food intake, the presence or absence of diarrhoea, social status, or the state of teeth.38.5.2.Anthropometry and Physical ExaminationBasic anthropometric data include weight (kg) and height (cm). However, practice reveals that about 30% of hos-pitalized patients are not weighed and height is measured only very occasionally. This wrong approach contributes to underestimation of malnutrition, which can be corrected by simple organisational measures. Weight and height values are used to compute the body mass indexBMI = weight [kg] / height [m]2, to classify patients (Table 2) and serve to carry out an objective nutritional status. Malnutrition in the population aged 18 - 70 is defined as BMI < 18.5, life-threa-tening malnutrition as BMI < 12.5. The BMI < 20 is considered a malnutrition limit in patients over 70.BMI kg/m2 Higher than 40 Class III obesity35 – 40Class II obesity30 – 35Class I obesity25 – 30Overweight20 – 25Normal rangeLower than 18.5MalnutritionLower than 12.5 Life-threatening malnutritionTable 38.2. BMI ClassificationAnother useful index found from the difference of height (cm) – 100 is the Broca indexto calculate ideal body weight. This simple calculation is used in practice to determine the dose of proteins and calories for enteral and paren-teral nutrition. Example: A patient weighing 120 kg, 160 cm tall has a Broca index of 60, which means that his/her ideal