Undernutrition, risk of malnutrition and obesity in gastroenterological patients: A multicenter study

Table 1 Subscores of the three nutritional risk screening tests used in the study

Test	Subscore				Nutritional risk score
MUST	BMI (score: 0-2)	Unintentional weight loss (score: 0-2)	Acute disease able to significantly reduce nutrient intake in the following 5 d (score: 2)		≥ 2
NRS-2002	Pre-test: BMI < 2 0.5; weight loss, reduced caloric intake, acute disease	Nutritional risk: Weight loss, BMI, caloric intake (score: 0-3)	Severity of disease (score: 0-3)	Age ≥ 70-yr-old (score: 1)	> 3
MNA	First part (six items: Caloric food intake, weight loss, motility, psychological stress, neuropsychological disease, BMI (score: 0-14)	If subscore ≤ 11: Complete second part	Second part (12 items: Home and nutritional autonomy, drugs, bedsores, daily meals, brachial and calf circumference; (maximal score of 16)		17-25

MUST: Malnutrition Universal Screening Tool; NRS: Nutritional Risk Screening; MNA: Mini Nutritional Assessment.

Table 2 Characteristics of the patients in the 19 gastroenterological units participating in the study

Centers	n	M	F	Age (average ± DS)	Ambulatory	DH	Inpatients	MUST	NRS	MNA	Weight (kg)	Weight loss (%)	BMI
Bolzano	21	61.90%	38.10%	67.5 ± 17.2	0.00%	0.00%	100.00%	-	2.2 ± 1.5	16.8 ± 4.3	71.6 ± 16.4	-4.7 ± 6.2	24.8 ± 4.4
Fiemme del Cavalese	17	57.1%	42.9%	56.2 ± 25.1	57.1%	0.0%	42.9%	0.8 ± 1.3	1.7 ± 1.4	19.0 ± 9.9	66.9 ± 5.1	-2.5 ± 6.9	23.1 ± 2.4
Pordenone	14	25.0%	75.0%	48.7 ± 24.0	100.0%	0.0%	0.0%	1.0 ± 1.2	-	22.0 ± 0.0	58.3 ± 12.7	0.0 ± 0.0	21.3 ± 3.6
Udine	10	50.0%	50.0%	51.6 ± 8.7	70.0%	0.0%	30.0%	0.4 ± 0.7	-	13.0 ± 0.0	75.5 ± 16.0	-2.0 ± 5.7	25.9 ± 5.2
Como	12	72.2%	27.8%	65.3 ± 17.9	0.0	22.2%	77.8%	1.7 ± 2.1	2.3 ± 1.5	18.6 ± 5.4	73.5 ± 22.7	-7.6 ± 9.4	25.8 ± 6.7
Milano	17	64.0%	36.0%	64.9 ± 19.2	0.0	0.0%	100.0%	-	1.7 ± 1.4	9.5 ± 3.1	69.4 ± 15.7	-2.8 ± 7.4	25.2 ± 4.7
Torino	38	50.0%	50.0%	58.9 ± 16.1	0.0	55.3%	44.7%	1.6 ± 1.7	2.2 ± 2.2	15.8 ± 4.9	65.3 ± 16.6	-0.9 ± 9.1	23.9 ± 4.5
Alto Vicentino di Santorso	32	40.6%	59.4%	68.2 ± 12.7	97.3	0.0%	2.7%	0.2 ± 0.6	0.5 ± 0.7	15.4± 4.6	71.3 ± 12.8	-2.3 ± 4.9	25.0 ± 3.9
Bassano del Grappa	25	48.0%	52.0%	48.3 ± 17.9	60.0	0.0%	40.0%	0.5 ± 0.9	0.8 ± 1.4	17.6 ± 4.8	68.0 ± 14.5	0.1 ± 9.0	23.9 ± 4.3
Legnano	16	87.5%	12.5%	53.0 ± 16.1	0.0	0.0%	100.0%	-	1.1 ± 1.6	15.2 ± 4.6	66.1 ± 13.5	-4.2 ± 12.3	23.0 ± 2.7
Ravenna	66	41.5%	58.5%	57.4 ± 19.4	52.5	21.9	25.6%	0.8 ± 1.3	1.3 ± 1.4	19.6 ± 2.8	67.7 ± 17.4	-1.5 ± 7.2	24.3 ± 5.4
Ancona	33	39.4	60.6	58.9 ± 19	100.0	0.0	0.0	0.1 ± 0.3	-	13.5 ± 4.8	70.8 ± 13.5	0.5 ± 2.5	25.7 ± 4.8
Napoli	26	53.8	46.1	59.1 ± 15.8	7.7	30.8	61.5	0.5 ± 0.9	1.3 ± 1.2	12.2 ± 2.7	67.9 ± 14.9	-1.2 ± 3.8	24.7 ± 5.6
Foggia	33	39.4	60.6	57.7 ± 18.2	66.6	6,1	27.3	0.3 ± 0.9	0.4 ± 0.8	15.0 ± 3.3	76.5 ± 21.9	-1.5 ± 3.0	28.6 ± 7.6
Trani	53	58.5	41.5	55.5 ± 18.1	62.1	10.3	27.6	0.5 ± 0.9	0.7 ± 1.1	13.4 ± 3.2	71.6 ± 14.5	1.1 ± 5.5	27.1 ± 5.5
Cosenza	58	53.9	46.1	58.8 ± 18.4	38.1	15.9	46.0	1.3 ± 1.7	2.1 ± 1.1	15.3 ± 3.7	67.0 ± 15.9	-3.8 ± 7.9	24.5 ± 4.8
Palermo	15	64.7	35.3	64.2 ± 10.1	0.0	0.0	100.0	-	1.3 ± 0.6	13.0 ± 4.5	77.5 ± 21.3	-1.3 ± 1.6	27.6 ± 6.7
Marsala	17	41.2	58.8	70.4 ± 9.5	88.2	0.0	11.8	0.6 ± 0.8	2.6 ± 0.9	18.0 ± 5.4	72.2 ± 12.4	-2.2 ± 3.5	27.7 ± 3.7
Siracusa	10	60.0	40.0	67.9 ± 1.3	20.0	0.0	80.0	0.8 ± 1.2	2.6 ± 1.5	15.4 ± 4.6	61.8 ± 7.8	-1.6 ± 4.9	23.9 ± 2.6
Total	513	51.4	48.6	59.8 ± 17.8	48.1	12.1	39.8	0.7 ± 0.5	1.5 ± 0.8	15.8 ± 2.9	69.7 ± 16.0	-1.7 ± 6.9	25.3 ± 5.3

M: Male; F: Females; DH: Day Hospital; MUST: Malnutrition Universal Screening Tool; NRS: Nutritional Risk Screening; MNA: Mini Nutritional Assessment; BMI: Body Mass Index.

Table 3 Clinical features of evaluated patients according to age group n (%)

	Total cohort (n = 513)	< 65 yr (n = 289)	≥ 65 yr (n = 218)	P value
Age (yr) (Mean ± SD)	59.8 ± 17.8	47.4 ± 12.8	76.1 ± 6.9	< 0.0011
Male gender,	260 (51.4)	138 (47.8)	122 (56.2)	0.062
Setting				< 0.0012
Inpatient	204 (39.8)	93 (32.2)	110 (50.7)
Outpatient	308 (60.2)	196 (67.8)	107 (49.3)
Disease				< 0.0012
Acute	414 (72.1)	232 (71.8)	177 (72.2)
Chronic	96 (16.7)	73 (22.6)	22 (9.0)
Neoplastic	64 (11.1)	18 (5.6)	46 (18.8)

P value: P < 0.05.

¹Wilcoxon rank-sum (Mann-Whitney) test;

²χ² test. Significant standardized adjusted residual.

Table 4 Prevalence and number of patients with chronic disease, acute disease and cancer according to age group

Chronic disease	%	< 65 yr	≥ 65 yr	P value	Acute disease	%	< 65 yr	≥ 65 yr	P value	Cancer	%	< 65 yr	≥ 65 yr	P value
GERD	8.90	35	18	0.123	Dysphagia	2.7	7	9	0.199	Esophagus	0.7	0	4	0.033
Achalasia	0.20	1	0	0.577	Dyspepsia	9.3	25	30	0.046	Stomach	1.3	3	5	0.219
Chronic gastropathy	5.90	17	18	0.174	Epigastralgia	12.6	44	31	0.44	Small-large intestine	3	5	13	0.01
Chronic viral hepatitis	4.20	17	8	0.194	Other abdominalgia	17.7	53	52	0.78	Pancreas	0.5	1	2	0.394
Chronic alcoholic hepatitis	3.20	14	5	0.113	Acute diarrhea	2.5	8	6	0.602	Liver	3.4	7	13	0.036
NAFLD	4.50	13	14	0.206	Acute constipation	1.5	7	2	0.18	Biliary tree	2	3	9	0.024
Other chronic hepatitis	1.30	3	5	0.211	Digestive bleeding	5.6	13	20	0.027
Compensated cirrhosis	14.70	49	38	0.441	Acute hepatitis	3.4	13	7	0.315
Chronic pancreatitis	1.20	4	3	0.632	Cirrhosis complicated	11.5	39	29	0.478
Non-IBD chronic diarrhea	3.50	11	10	0.391	Hematochezia	3.5	7	14	0.022
Crohn's disease	6.60	33	6	0.0002	IBD exacerbation	6.1	33	3	0.0000033
Ulcerative colitis	4.5	24	3	0.00036	Acute pancreatitis	4.9	17	12	0.515
Chronic constipation	5.2	13	18	0.053
Celiac disease	1.7	10	0	0.004

GERD: Gastricesophagitis reflux diseas; NAFLD: Non-alcoholic fatty liver disease; IBD: Inflammatory bowel disease.

Table 5 Patients with nutritional abnormalities in the 19 gastroenterological centers participating in the study n (%)

	Outpatients		Inpatients		P value
	< 65 yr	> 65 yr	< 65 yr	> 65 yr
Undernutrition	8 (4.2)	6 (5.7)	24 (23.9)1	15 (15.6)2	1P < 0.001
					2P
Risk of Malnutrition	24 (12.2)	43 (40.6)	21 (24.7)	64 (69.2)3	3P
Obesity	34 (18.3)	19 (17.5)	15 (17.2)	10 (10.5)	NS
Overweight	52 (26.5)	46 (42.5)	18 (20.7)	27 (28.4)	NS

¹P < 0.001 out- vs inpatient < 65;

²P = 0.02 out- vs inpatient ≥ 65;

³P < 0.001 out- vs inpatient > 65.

Table 6 Prevalence of risk of malnutrition according to age group

Nutritional risk test	Total cohort (n = 513)	< 65 yr (n = 289)	≥65 yr (n = 218)	P value
MUST				0.45
< 2 (%)	274 (89.0)	172 (87.8)	97 (90.7)
≥ 2 (%)	34 (11.0)	24 (12.2)	10 (9.3)
NRS 2002				0.002
< 3 (%)	112 (63.3)	61 (75.3)	51 (53.1)
≥ 3 (%)	65 (36.7)	20 (24.7)	45 (46.9)
MNA 17%-25%	115 (54.2)	-	115 (54.5)

MUST: Malnutrition Universal Screening Tool; NRS: Nutritional Risk Screening; MNA: Mini Nutritional Assessment.