Prevalence and clinical outcomes of malnutrition in hospitalized patients: a real-world study using a stepwise screening-assessment pathway
- 1Department of Clinical Nutrition, Xishan People’s Hospital, Wuxi, 214105 Jiangsu China
- 2Emergency Intensive Care Unit, Suzhou Municipal Hospital (The Affiliated Suzhou Hospital of Nanjing Medical University), Suzhou, 215000 China
Abstract
Background: Hospital malnutrition is associated with adverse clinical outcomes, yet real-world evidence distinguishing nutritional risk screening from diagnostic assessment remains limited. This study evaluated a stepwise NRS2002-based screening and assessment pathway and examined associations between pathway-defined malnutrition and clinical outcomes in hospitalized patients.
Methods: This retrospective cohort study was conducted at Xishan People’s Hospital from January 2022 to June 2025. Adult patients admitted for > = 24 h who completed Nutritional Risk Screening 2002 (NRS2002) within 48 h were included. NRS2002 was the universal screening tool. Patients with NRS2002 > = 3 underwent diagnostic assessment according to a predefined decision tree: oncology patients received Patient-Generated Subjective Global Assessment (PG-SGA), non-oncology patients with BMI < 18.5 kg/m2 received Global Leadership Initiative on Malnutrition (GLIM) evaluation, and remaining at-risk patients received Subjective Global Assessment (SGA). Primary outcomes included hospital-acquired infection (HAI), 30-day readmission among discharged-alive patients, and in-hospital mortality.
Results: Among 2,856 patients (mean age 59.23 +/- 15.47 years; 52.17% male), 1,187 (41.56%) were identified as at nutritional risk by NRS2002. Three pathway groups were identified: NRS2002 < 3 (n = 1,669), NRS2002 > = 3 but not malnourished (n = 335), and malnourished (n = 852). The pathway-defined malnutrition proportion was 29.83% in the total cohort and 71.78% among NRS-positive patients. Malnourished patients had higher rates of HAI (14.67% vs. 5.29%; P < 0.001), 30-day readmission among discharged-alive patients (20.84% vs. 11.18%; P < 0.001), and in-hospital mortality (8.22% vs. 2.30%; P < 0.001). In multivariable models, malnutrition was associated with HAI (aOR = 2.19; 95% CI: 1.57–3.07), 30-day readmission among discharged-alive patients (aOR = 1.81; 95% CI: 1.38–2.37), and in-hospital mortality (aOR = 2.54; 95% CI: 1.59–4.04).
Conclusions: In this single-center retrospective cohort, malnutrition identified through a stepwise NRS2002-based assessment pathway was common and was associated with higher HAI, readmission, mortality, and length of stay. HIS-integrated nutrition software may support standardized documentation and workflow efficiency, but the present observational study did not directly evaluate software effectiveness or interventional care pathways.
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BibTeX
@article{hua2026prevalence,
title = {{Prevalence and clinical outcomes of malnutrition in hospitalized patients: a real-world study using a stepwise screening-assessment pathway}},
author = {Qunfang Hua and Yang Yu and Yun Feng},
journal = {Journal of Health, Population, and Nutrition},
year = {2026},
month = aug,
doi = {10.1186/s41043-026-01366-y},
url = {https://doi.org/10.1186/s41043-026-01366-y},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Prevalence and clinical outcomes of malnutrition in hospitalized patients: a real-world study using a stepwise screening-assessment pathway
AU - Qunfang Hua
AU - Yang Yu
AU - Yun Feng
PY - 2026
DA - 2026/08/01
JO - Journal of Health, Population, and Nutrition
DO - 10.1186/s41043-026-01366-y
UR - https://doi.org/10.1186/s41043-026-01366-y
AB - Background: Hospital malnutrition is associated with adverse clinical outcomes, yet real-world evidence distinguishing nutritional risk screening from diagnostic assessment remains limited. This study evaluated a stepwise NRS2002-based screening and assessment pathway and examined associations between pathway-defined malnutrition and clinical outcomes in hospitalized patients. Methods: This retrospective cohort study was conducted at Xishan People’s Hospital from January 2022 to June 2025. Adult patients admitted for > = 24 h who completed Nutritional Risk Screening 2002 (NRS2002) within 48 h were included. NRS2002 was the universal screening tool. Patients with NRS2002 > = 3 underwent diagnostic assessment according to a predefined decision tree: oncology patients received Patient-Generated Subjective Global Assessment (PG-SGA), non-oncology patients with BMI < 18.5 kg/m2 received Global Leadership Initiative on Malnutrition (GLIM) evaluation, and remaining at-risk patients received Subjective Global Assessment (SGA). Primary outcomes included hospital-acquired infection (HAI), 30-day readmission among discharged-alive patients, and in-hospital mortality. Results: Among 2,856 patients (mean age 59.23 +/- 15.47 years; 52.17% male), 1,187 (41.56%) were identified as at nutritional risk by NRS2002. Three pathway groups were identified: NRS2002 < 3 (n = 1,669), NRS2002 > = 3 but not malnourished (n = 335), and malnourished (n = 852). The pathway-defined malnutrition proportion was 29.83% in the total cohort and 71.78% among NRS-positive patients. Malnourished patients had higher rates of HAI (14.67% vs. 5.29%; P < 0.001), 30-day readmission among discharged-alive patients (20.84% vs. 11.18%; P < 0.001), and in-hospital mortality (8.22% vs. 2.30%; P < 0.001). In multivariable models, malnutrition was associated with HAI (aOR = 2.19; 95% CI: 1.57–3.07), 30-day readmission among discharged-alive patients (aOR = 1.81; 95% CI: 1.38–2.37), and in-hospital mortality (aOR = 2.54; 95% CI: 1.59–4.04). Conclusions: In this single-center retrospective cohort, malnutrition identified through a stepwise NRS2002-based assessment pathway was common and was associated with higher HAI, readmission, mortality, and length of stay. HIS-integrated nutrition software may support standardized documentation and workflow efficiency, but the present observational study did not directly evaluate software effectiveness or interventional care pathways.
SN - 1606-0997
SN - 2072-1315
ER -