SEQC Spanish Society of Laboratory Medicine

Dysphagia, neurological diseases, oncological pathologies, diabetes and cardiovascular disease are the clinical situations that are most associated with in-hospital malnutrition. In addition, the prevalence of this condition in polymedicated patients is twice that in non-polymedicated patients, according to data from the PREDyCES study (Prevalence of Hospital Malnutrition and Associated Costs in Spain) which evaluated 1,597 patients from 31 representative hospitals of the National Health System. The highest prevalence of malnutrition, both when the patient is admitted to the hospital and at discharge, is concentrated in the age group over 80 years of age. Indeed, one of the symposia of the XV National Clinical Laboratory Congress (LabClin 2021) dealt with the contributions of the clinical laboratory to in-hospital malnutrition.

This congress was held in virtual format from November 7 to 13 and was organized by the three national clinical laboratory societies, the Spanish Society of Laboratory Medicine (SEQC^ML), the Spanish Association of Medical Biopathology-Laboratory Medicine (AEBM -ML) and the Spanish Clinical Laboratory Association (AEFA).

The main consequences of malnutrition associated with the disease are: increased morbidity; increased hospital stay, which leads to increased hospital costs; increased mortality and readmissions; and poorer response to medical and surgical therapies, according to Dr José Ruiz Budría, specialist in Clinical Biochemistry at the Lozano Blesa University Clinical Hospital (Zaragoza) and member of the SEQC^ML Nutrition and Vitamins Commission. In addition, he pointed out that malnutrition associated with the disease includes any deficiency, be it a cause or consequence of the disease, therapeutic procedures, hospitalization, or complications. Now, it would be more correct to speak of clinical malnutrition, since with this concept we understand that nutritional monitoring must be carried out throughout the disease process, whether it occurs in a hospital setting or in primary care.

He also remarked that according to the recommendations of the multidisciplinary consensus document on the approach to in-hospital malnutrition in Spain, some screening method should be carried out to detect malnutrition early in the first 24-48 hours. To do this, each centre should use the most feasible screening method available. There are clinical, automated and mixed screening methods. Clinical methods include subjective and objective data (weight, height, weight changes, etc.). Automated screening methods are based on analytical methods, but also capture other useful data for screening available in the databases of the hospital computer system.

In addition, Dr Ruiz Budría explains that, of the existing screening methods for adults, the most used are the MNA (Mini Nutritional Assessment), MUST (Malnutrition Universal Screening Tool), NRS-2002 (Nutritional Risk Screening 2002), and the SGA (Subjective Global Assessment) -- all of them being clinical screening methods. As to automatic methods, the most widely used is the CONUT (Controlling Nutritional Status), which is based in a first phase on three analytical factors (albumin, cholesterol, and total lymphocytes), which are usually requested in most of the analytical requests upon admission of the patient.

Specifically, the Clinical Biochemistry specialist emphasized that the PREDyCES study concluded that the prevalence of in-hospital malnutrition observed according to the NRS-2002 was 23.7%, reaching values ​​of 37% in patients older than 70 years and up to 45% in those over 85 years of age. The highest prevalence was found in patients with neoplastic, respiratory, and cardiovascular diseases.

Implementation of screening for malnutrition associated with disease in Spain

Dr Ruiz Budría affirmed that at present, most of the hospitals in our country have established screening protocols for clinical malnutrition following the recommendations of the European Society of Clinical Nutrition and Metabolism (ESPEN) using clinical methods (MUST and NRS-2002), although the implementation of automatic methods is increasing.

Likewise, the speaker stressed that the role of clinical laboratory professionals is to implement the CONUT automatic screening method or one of the other existing ones, such as FILNUT (Filter Phase Nutritional Analysis), to identify patients with moderate or severe risk of malnutrition and, with this, alert the clinical professional to take the appropriate nutritional measures in each case.

Finally, Dr Ruiz Budría noted that the SEQC^ML Nutrition and Vitamins Commission has held courses and symposia in past congresses, most recently one related to the approach to clinical malnutrition from the point of view of the laboratory. In addition, the SEQC^ML has a close relationship with the various scientific societies for the joint preparation of documents and recommendations.

Likewise, in LabClin 2021 a nutritional risk calculator (according to CONUT) was presented, which is available on the SEQC ^ML page in the section on the Nutrition and Vitamins Commission.