Nutritional status of elective gastrointestinal surgery patients pre- and post-operatively

BACKGROUND AND AIMS: Studies have indicated that undernutrition is common on admission to hospital but there is limited data on change in nutritional parameters during the hospital stay. We assessed the nutritional status of elective gastrointestinal surgery patients on admission and documented change in nutritional indices during hospitalisation. METHODS: Two hundred patients aged 18-80 years undergoing elective open gastrointestinal surgery were nutritionally assessed on admission and 150 were reassessed on commencement of oral diet post-surgery. Data were collected on height, weight, upper arm anthropometry and hand-grip dynamometry. RESULTS: On admission BMI <20, 20-24.9 and >25, respectively, were found in 9%, 34% and 57% of patients. Post-surgery, 34% of patients experienced a clinically significant weight loss. Males lost significantly more weight (3.7% vs 1.6%, P<0.001) and tended to lose muscle mass while females preferentially lost subcutaneous fat. CONCLUSIONS: The incidence of undernutrition on admission appears to be lower than previously reported. However, clinically significant weight loss was common and this study highlighted gender differences in the changes in nutritional parameters experienced by gastrointestinal surgery patients. This differential influence of gender warrants further investigation and may have implications for the nutritional management of such patients.     

Increasing malnutrition during hospitalization: documentation by a nutritional screening program.

Nutritional status can change during hospitalization. To evaluate the degree of change, a nutrition screening program (NSP) that included admission and 3-week reassessment was implemented. NSP parameters were weight for height, percentage of weight loss, arm muscle circumference, triceps skinfold, serum albumin, and total lymphocyte count. Nutritional risk factors (NRF) were also recorded: cancer, nothing by mouth (NPO) for 3 or more days, loss of appetite, difficulty chewing or swallowing, persistent fever, and cancer chemotherapy or radiation therapy. Of 15,876 patients admitted during the period of March 1982 through December 1982, 583 (3.67%) were found to be suffering from malnutrition or to have NRFs. Of the 583 patients, 182 received nutritional support and were excluded from the study. The remaining patients were reassessed after 3 weeks and had significant decreases in nutritional parameters; 622 patients with deficits in one parameter (visceral or somatic) on admission had a significant decrease in all parameters (p less than .001) on 3-week assessment. There was a deterioration in nutritional status in those patients entering the hospital with NRFs only or with one low parameter.     

Nutritional status of patients hospitalised in Poland

AIM: Screening and extended assessment of the nutritional status of patients on admission and on discharge from hospital were carried out. DESCRIPTION: The studies were carried out in four teaching hospitals, four provincial hospitals and four county hospitals in Poland. SUBJECTS: Screening examinations were carried out for 3310 randomly selected patients (every 10th patient admitted to hospital, including 1916 female cases aged from 16 to 92 y and 1394 male patients aged from 16 to 100 y). Extended examinations were carried out on 210 patients aged from 16 to 87 y (including 122 female and 88 male). MAIN ASSESSMENT PARAMETERS: Anthropometric (height, weight, body mass index (BMI), waist-to-hip ratio (WHR), arm circumference) and biochemical indices (erythrocyte count, haemoglobin concentration, white blood cell count, blood lymphocyte count and serum albumin serum concentration). The extended examinations included determination of antioxidant vitamins (A, C, E), vitamin B(12) and folic acid. RESULTS: On admission to hospital, 10.43% of the patients surveyed had a BMI below 20 kg/m(2), in 20.74% of patients serum albumin concentration was below 3.5 g/dl, indicating possible protein energy malnutrition. In addition, 21.02% had lymphocyte count below 1.5 x 10(3)/mm(3). During hospitalisation, deterioration in the nutritional status of the patient population occurred. On discharge from hospital, the percentage of patients with BMI < 20 kg/m(2) increased to 11.21% and the percentage with low blood albumin (<3.5 g/dl) increased to 28.57%. On admission, vitamin C deficiency was present in 51.8% of patients, folic acid deficiency in 32%, vitamin E deficiency in 10%, vitamin B(12) deficiency in 6.8% and vitamin A deficiency in 1.4%. Vitamin deficiencies were present equally in malnourished, overweight and obese patients. CONCLUSIONS: In patients admitted to hospitals in Poland, malnutrition risk demonstrated by BMI was observed in 10.43% of patients. On the basis of biochemical indices, increased nutritional risk was demonstrated in 21% of patients. Vitamin malnutrition was seen in the majority of patients. A significant correlation between weight, BMI, arm circumference, blood lymphocyte count and the number of days spent in hospital was observed. SPONSORSHIP: The Committee of Scientific Research and the Ministry of Health-PBZ 012-14.     

Nutritional assessment of drug addicts. Relation with HIV infection in early stages

OBJECTIVE: To assess the nutritional status of drug addicts without acute organic pathology, in order to determine the prevalence of malnutrition and to discern if early HIV infection is associated with a poor nutritional status in this group of patients. DESIGN: Prospective study. SETTING: Detoxication unit of a university hospital. PATIENTS: 140 drug addicts without acute organic pathology. 31 patients were HIV+. No one fulfilled the definition of AIDS. RESULTS: We found that drug addicts were undernourished: 92.4% weighed under the mean populational weight and 55.7% had a weight loss above 5%. The distribution of mid upper arm circumference (MUAC), triceps skinfold (TSF) and mid arm muscle area (MAMA) was lower than a reference normal population. Food intakes were poor; 66.4% of our patients complained of anorexia on admission. The mean caloric intake was 978 +/- 89 kcal/day in females and 1265 +/- 64 kcal/day in males. The mean protein intakes were 39.3 +/- 3.3 g/day in females (0.76 +/- 0.07 g/kg/day) and 49.7 +/- 2.7 g/day in males (0.77 +/- 0.04 g/kg/day). When we compared nutritional parameters between HIV+ and HIV- patients we found no differences. CONCLUSIONS: Nutritional impairment in drugs abusers with early stages of HIV infection should be attributed to drug abuse rather than to HIV infection.     

Physical Assessment and Anthropometric Measures for Use in Clinical Research Conducted in Critically Ill Patient Populations

Background: Accurate assessment of nutrition status is essential in identifying subpopulations of critically ill patients who are malnourished and at higher mortality risk. The aim of this analytic observational study was to assess the performance of physical assessment and anthropometric measures commonly used in clinical research. Methods: A prospective study was undertaken in 31 intensive care units (ICUs) with a focus on patients with short‐term contraindications to enteral nutrition. Within 24 hours of admission to the ICU, the following measures were collected: the Subjective Global Assessment components measuring subcutaneous fat loss and muscle wasting, height, weight, mid‐upper‐arm circumference, and triceps skinfold thickness (TSF). Mid‐arm muscle circumference and body mass index (BMI) were calculated. BMI was assessed as a continuous variable and categorized according to the World Health Organization (WHO) categories. The primary outcome was hospital discharge mortality. Results: In total, 1363 patients were enrolled. BMI, analyzed according to WHO categories (P = .09), and TSF (P = .32) failed to demonstrate statistically significant predictive ability. TSF failed to demonstrate statistically significant clinical utility (area under the receiver operating characteristic curve, 0.52; 95% confidence interval, 0.48–0.56). All other individual measures demonstrated statistically significant predictive ability and statistically significant clinical utility. Conclusions: On the basis of the results of our ICU cohort, we recommend caution when using BMI categorized according to WHO definitions. We cannot recommend collection of TSF. More research is required to understand reliability, performance, and use before our results are able to be generalized to other ICU populations.     

Increasing malnutrition during hospitalization: documentation by a nutritional screening program

Nutritional status can change during hospitalization. To evaluate the degree of change, a nutrition screening program (NSP) that included admission and 3-week reassessment was implemented. NSP parameters were weight for height, percentage of weight loss, arm muscle circumference, triceps skinfold, serum albumin, and total lymphocyte count. Nutritional risk factors (NRF) were also recorded: cancer, nothing by mouth (NPO) for 3 or more days, loss of appetite, difficulty chewing or swallowing, persistent fever, and cancer chemotherapy or radiation therapy. Of 15,876 patients admitted during the period of March 1982 through December 1982, 583 (3.67%) were found to be suffering from malnutrition or to have NRFs. Of the 583 patients, 182 received nutritional support and were excluded from the study. The remaining patients were reassessed after 3 weeks and had significant decreases in nutritional parameters; 622 patients with deficits in one parameter (visceral or somatic) on admission had a significant decrease in all parameters (p less than .001) on 3-week assessment. There was a deterioration in nutritional status in those patients entering the hospital with NRFs only or with one low parameter.     

A longitudinal study of hospital undernutrition in the elderly: Comparison of four validated methods

Background  Undernutrition/nutritional risk were evaluated longitudinally in 531 hospitalized elderly by four validated methods to appraise the most feasible for routine use. Design  Within 48hrs of admission&24hrs before discharge: the following data were collected: clinical data, nutritional status (BMI, %weight loss) & risk (MNA, MUST), energy requirements (Owen et al), diet. Results  Significant changes from admission to discharge in risk/undernutrition prevalence, were not shown by BMI (≈17% vs 22%), ≥5% weight loss (≈53% vs ≈56%) or MNA 83% vs ≈81%; at admission, 93% patients were MUST high risk declining to ≈47% (p=0.001) at discharge, alongside eating resumption. By multivariate analysis comparing all methods&differences between patient groups during hospitalization, only %weight loss clarified nutritional progression: more surgical patients had ≥10% weight loss vs medicine, p<0.01. Only admission ≥5% weight loss was predictive of longer hospitalizations (OR:1.57; 95% CI 1.02–2.40; p<0.003), though MNA&MUST undernourished/high risk had significantly longer stays. MNA and MUST were the most concordant methods, p<0.001. Eating compromising symptoms were prevalent in surgery/medicine with ≥5% weight loss, MNA risk/undernutrition, and MUST high risk, p<0.005. Overall, mean energy requirements/diet were not significantly different between admission/discharge: requirements ≈1400kcal were always lower than on offer ≈2128kcal, p=0.0001. Conclusions  Rigid diets create costly waste which do not counteract nutritional deterioration. Different nutritional risk/status prevalences were unveiled at admission&discharge: >50% patients were at risk/undernourished by significant weight loss, MNA or MUST, all associated with longer stays. Recent weight loss is unarguably essential, comprehensive MNA & MUST similarly reliable; in this study dynamic MUST seemed easier to practise. Quality nutritional care before/during/after hospitalization is mandatory in the elderly.     

A comparison of mid upper arm circumference,body mass index and weight loss as indices of undernutrition in acutely hospitalized patients

A nutritional supplementation trial (Vlaming et al., Clin Nutr 2001; 20: 517) enabled us to assess the nutrition of 1561 patients on emergency admission to hospital. Patients acutely admitted to the 15 relevant medical, surgical and orthopaedic wards were identified. Mid upper arm circumference (MUAC) measurements were obtained in 95% (848 m, 635f) patients. For clinical reasons, Body mass index (BMI) was assessable in only 44% patients (408 m, 285f). Data on three month weight loss were obtainable in 509 patients. These measurements combined to demonstrate that 18.3% of patients were undernourished (At least one of : BMI<20 kg/m(2) or MUAC<25 cm or loss of weight > or =10%). There was a close relationship between BMI and MUAC. Regression equations (excluding age)were for men : BMI=1.01 x MUAC-4.7, (R(2)=0.76), and for women BMI=1.10 x MUAC-6.7, (R(2)=0.76). After adjustment for age, weight loss > or =10% was the most significant of the three as a predictor of mortality. Among patients in whom weight loss was not recorded MUAC was a significant predictor of mortality either alone (P=0.002) or after adjustment for BMI (P=0.007), but BMI was not significant. All three measures, even when adjusted for age and sex, were poor predictors of hospital stay although MUAC was significant in the larger group with a MUAC measure (R(2)=0.7% P<0.001). MUAC correlates closely with BMI, is easier to measure and predicts poor outcome better.     

Nutritional status and clinical outcome in elderly female surgical orthopaedic patients

The possible relationship between nutritional status and clinical outcome following orthopaedic hip surgery was investigated. The nutritional status of 60 elderly female patients admitted for elective total hip replacement (THR) and emergency fractured neck of femur surgery (FNF) was measured over time. Specific measures of clinical outcome, including well-being and functional status, were monitored during hospital stay and at 4, 8 and 26 weeks following discharge. Patients were allocated to a high nutritional risk group where any three of the following were less than the 5th percentile value: serum albumin, haemoglobin, triceps skinfold thickness, mid-upper arm muscle circumference and body weight. Using this definition, malnutrition was present in 4% of THR patients and 41% of FNF patients. It was found that the high risk patients had significantly longer convalescence periods, (median stay 27.5 days compared with 0 days, P < 0.0009), and a greater proportion were dependent upon walking frames at 6 months (46% compared with 11%, P < 0.01). Fifty percent of the high risk patients had been living independently prior to admission, in contrast only 29% had returned to their homes at 6 months after discharge. The results indicate an apparent link between clinical outcome and nutritional status based upon the allocation procedure employed, which has the potential for ensuring cost-effective nutritional intervention.     

Undernutrition in elective colorectal surgery. Implications for post operative morbidity

The nutritional status of 65 patients undergoing elective colorectal surgery was assessed using 5 conventional nutritional indices, percentage ideal weight, mid arm muscle circumference, triceps skin fold thickness, serum albumin and serum total iron binding capacity. Only 9 patients had values for all five indices which are taken to represent normal nutritional status. This survey suggests that many patients undergoing elective colorectal surgery in this country have subnormal values of the indices commonly used for nutritional assessment but only severe depression of serum albumin however appears to adversely affect the outcome of surgery.     

主客观营养评价指标在老年麻风患者中的应用

目的调查麻风患者的营养状况,探讨营养评价方法的可行性。方法采用主观全面营养评定（SGA）和客观指标对60例长期住院晚期老年麻风患者进行营养状态评估。结果SGA评估结果显示,60例患者中,有22例（36．7％）患者存在营养不足,其中5例（8．3％）为严重营养不足。三头肌皮褶厚度（TSF）、前白蛋白（PALB）、上臂肌围（MAMC）、血红蛋白（Hb）和血清白蛋白（ALB）与SGA评价一致性的Kappa值分别为0．619、0．571、0．476、0．454和0．419。除身高和胆固醇外,性别、麻风型别、住院时间和麻风畸残度与所有营养指标无关。年龄和溃疡程度与患者体重指数、TSF、Hb、ALB和PALB明显相关（P〈0．01）。SGA对被筛选客观指标敏感性和特异性不一,TSF和溃疡对SGA的影响最大。结论麻风患者营养风险性不高。客观指标不适合单独应用于老年晚期麻风患者,应结合SGA进行综合评价。     

Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization.

Nutrition status was evaluated in 134 consecutive admissions to a general medical service and throughout hospitalization among patients hospitalized 2 weeks or longer. Likelihood of malnutrition was determined using eight nutrition-related parameters: serum folate and vitamin C, triceps skinfold, weight/height, arm muscle circumference, lymphocyte count, serum albumin, and hematocrit. On admission 48% of patients had a high likelihood of malnutrition, which correlated with a longer hospital stay (20 versus 12 days for patients with a low likelihood of malnutrition) and an increased mortality rate (13 versus 4%). Likelihood of malnutrition increased with hospitalization in 69% of patients with paired determinations. Compared to admission, at final follow-up a greater proportion of patients fell into the depleted range of values for folate, triceps skinfold, weight/height, arm muscle circumference, lymphocyte count, and hematocrit. These parameters worsened in over 75% of patients admitted with normal values. Hematocrit fell in all patients with normal admission levels. These findings demonstrate and association between nutrition status and hospital course and a worsening trend during hospitalization.     

Indices of malnutrition in patients admitted to general medical and chest medicine wards of an Iranian teaching hospital on admission and discharge

The nutritional status of hospitalised patients is generally poor on admission and in some cases declines during their stay in hospital. The aim of this study was to assess the nutritional status of a group of hospitalised patients on admission and at discharge from a large teaching hospital in Northwestern Iran. Male and female patients, who were anticipated to stay in hospital for more than 1 week on the general medical or chest medicine ward, gave informed consent to take part in the study. One hundred and fourteen patients (53.6 ± 17.2 years, body mass index (BMI) 21.0 ± 5.7 kg/m² (mean ± standard error of the mean) were recruited to evaluate the nutritional status. Changes in bioimpedance and anthropometric markers of nutritional status were recorded. The NRS 2002 (nutritional risk screening) method was used to assess nutritional status in patients on admission and prior to discharge. Malnutrition, as assessed using NRS 2002 method, decreased during the stay of patients in hospital (2.8 ± 1.0 versus 1.8 ± 1.0, p < 0.001). This study showed that prevalence of malnutrition was as high as 63.1 % on admission to the general medical and chest wards. The nutritional status of patients was significantly changed over the period of their stay in hospital, as assessed using the NRS 2002 method, although patients lost weight due to the acute care situation.     

Eating problems and nutritional status during hospital stay of patients with severe stroke

Eating problems and nutritional status were studied in a consecutive series of patients who had had strokes. From this cohort, 32 subjects (mean age 73 years) with a hospital stay of 21 days or more are described. Eating problems were identified by direct participant observations of the patients' eating behavior, interviews on admission, inspections of the mouth, and discussions with the patients. Nutritional status was assessed by weight, triceps skinfold thickness (TSF), arm muscular circumference (AMC), plasma albumin, serum transferrin, and plasma prealbumin on admission and then weekly. Eating problems were identified in 27 patients. In a general linear hypothesis program, poor nutritional status 3 weeks after admission was found to be associated with (in decreasing order) low self-care performance, poor nutritional status on admission, male sex, intravenous energy-containing fluids, advanced age, paresis of the right arm, and eating problems. Factors other than eating problems seem to be important for undernutrition in patients with strokes during hospital stay.     

Use of body mass index to evaluate the nutritional status of Xavánte Indigenous adults, Sangradouro-Volta Grande, Mato Grosso State, Central Brazil

This study evaluates the relationship between Body Mass Index (BMI) and anthropometric measurements in Xavánte adults on the Sangradouro-Volta Grande Indian Reservation, Mato Grosso State, Central Brazil. The objective was to analyze the use of BMI as an indicator of nutritional status in this specific population. Fieldwork was conducted in January-February 1999. Data include body mass, height, arm, hip, and waist circumference, and triceps skinfold of 128 adults over 20 years of age. The results indicate high correlations (r > 0.80) between BMI and body mass and waist and mid upper arm circumference for both sexes. For women, fat arm area and total arm area were also highly correlated with BMI, while for men hip circumference and total arm area showed a high correlation with BMI. The results suggest that high BMI values are related to excess fat among the Xavánte. It is important to monitor changes in the nutritional status of indigenous peoples in Brazil, since there is evidence that such populations are undergoing rapid processes of nutritional transition.     

Biosocial Correlates of Nutrition and Chronic Energy Deficiency among Adult Females of two Ecological Zones in Madhya Pradesh and Uttarakhand, India

The paper aims to draw out biosocial correlates of nutrition through body mass index (BMI) and chronic energy deficiency (CED). The findings are based on cross-sectional data of 446 women aged 18-60 years from six different endogamous groups of two ecological zones. The mean age of studied women varied from 31 to 36 years. The mean age at menarche was found to be 14.50±1.32 years. Similarly mean age at menopause was found to be 46.22±4.00 years. The mean of reproductive life span varied from 27 to 35 years. Average number of pregnancies per women was 4.44±2.52, average foetal loss was 0.11, children surviving per women was 3.61, whereas average child loss per women was found to be 0.62 and average family size was 9.51. Variations in mean BMI kg/m2 between populations ranged between 18.56 and 20.71. Prevalence of CED was highest among the Brahmin women of Uttarakhand (58.3%) followed by Ahirwar of Madhya Pradesh (47.1%). Incidence of CED was found lowest among Brahmin women of Madhya Pradesh (24.0%). Linear regression coefficient (b ± standard error) of BMI on Cormic Index for these women was 33.1 ± 8.1 (t=4.0, p=0.001), and correlation coefficient (R) was 0.189. Out of 6 anthropometric variables considered for regression analysis, 5, namely weight, hip circumference, waist circumference, mid arm circumference and sitting height showed significant correlations with BMI. Significant differences in sitting height and Cormic Index of women from the hills and plains indicate the role of ecology in shaping its habitants. Out of 9 demographic variables, only age of respondent and family size were found to have a significant impact on low BMI status. The present study postulates that the nutritional status of women has improved over the last decades.     

Prevalence of patients at nutritional risk in Danish hospitals

BACKGROUND & AIMS: Undernutrition is associated with increased morbidity and mortality and is common in patients admitted to hospital. We examined (1) the prevalence of patients at nutritional risk, (2) whether these patients were identified by the staff, and (3) whether a nutritional plan and monitoring was made for patients at nutritional risk. METHODS: A cross-sectional study in 15 randomly selected departments (>200 beds, departments of internal medicine, gastro- and orthopedic surgery) in Danish hospitals. The patients were characterized by scoring the components 'undernutrition' and 'severity of disease' in 4 categories (absent, mild, moderate or severe). The patient could have a score of 0-3 for each component (undernutrition and severity of disease), and any patient with a total score > or = 3 was considered at nutritional risk. Undernutrition was evaluated by 3 variables (BMI, recent weight loss, recent food intake). RESULTS: Out of 590 patients, 39.9% were nutritionally at risk, with the highest prevalence in departments of gastro-surgery (57%). BMI was <18.5 in 10.9%, and between 18.5 and 20.5 in 16.7% of the patients. In 7.6% the records contained information about nutritional risk, in 14.2% about a nutrition plan of which only 55.2% included a plan for monitoring. Measurements of BMI were found in 3% of the records. Both severity of disease (P < 0.02) and weightloss (P < 0.04) were predictive for making a nutrition plan. CONCLUSIONS: Nearly 40% of patients in departments of internal medicine, gastro- and orthopedic surgery are at nutritional risk, and only a minor part of these patients are identified. As a consequence only few patients at a nutritional risk have a nutrition plan and a plan for monitoring.     

肠内和肠外营养支持方式对胃癌术后营养状况的影响分析

目的：研究胃癌术后肠内肠外营养支持对患者营养况的影响。方法：将需要营养支持的胃癌患者78例,随机分为两组,分别为肠内组（EN）和肠外组（PN）,两组营养支持均等热量、等氮量。记录两组患者手术前和手术后的基本营养状况,及两组患者手术后并发症的情况。结果：（1）EN组体重、上臂围（MAC）、上臂肌围（AMC）、三头肌皮褶厚度（TSF）和、血红蛋白（Hb）均高于PN组,但差异无统计学意义（P〉0.05）;（2）PN组血浆白蛋白（ALB）、总淋巴细胞（LYM）下降较EN组明显（P〈0.05）;（3）术后并发症发生率EN组为10.52%,PN组为23.68%;两组比较差异有统计学意义（P〈0.05）。结论：胃癌术后EN在改善患者营养方面优于PN,并且EN可降低胃癌手术后并发症的发生率,提高手术后的疗效。     

Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure

BACKGROUND: Protein-energy malnutrition is common among infants with congenital heart disease. We hypothesized that infants with hypoplastic left heart syndrome (HLHS) are at risk for malnutrition. OBJECTIVE: To determine the prevalence of and risk factors for malnutrition in infants undergoing palliative surgery for HLHS. METHODS: Retrospective chart review of 50 infants with HLHS who underwent both stage 1 Norwood and bidirectional Glenn (BDG) procedures over 4.5 y. RESULTS: After a median hospital stay of 21 d, median discharge weight was 3.4 kg, unchanged from admission. Adjusting for weight on admission, children with longer length of hospital stay, longer intensive care unit stay, shorter duration of parental nutrition therapy, and higher diuretic dosage at discharge had a lower weight-for-age Z score at discharge (R2=0.85). On admission for BDG, median weight-for-age Z score was -2.0. After adjusting for weight on discharge from the initial hospitalization, children with fewer calories/ounce of their enteral nutrition at discharge, worse right ventricular function, more frequent readmissions, and higher oxygen saturation at discharge had a lower weight-for-age Z score at BDG (R2=0.49). CONCLUSIONS: Malnutrition is common in infants with HLHS after stage 1 palliation. Variables associated with more complex postoperative course and imbalance between systemic and pulmonary blood flow were all associated with poorer nutritional status. When adjusting for these factors, the use of parenteral nutrition and high calorie enteral feeds were associated with improved nutritional status. Aggressive parenteral and enteral nutritional therapy might help reduce the prevalence of growth faltering in infants who have HLHS.     

Apparent low frequency of undernutrition in Dublin hospital in-patients: should we review the anthropometric thresholds for clinical practice?

Protein-energy undernutrition, or the possibility of its development, has been documented to occur frequently in patients on admission to hospital. Deterioration in nutritional status is known to occur in hospital. In a prospective study of 594 sequential hospital admissions, we aimed to assess the prevalence of undernutrition among patients on admission to two acute teaching hospitals in Dublin, Republic of Ireland using the widely-accepted anthropometric criteria applied in a large study from Dundee, Scotland, UK (McWhirter & Pennington, 1994) and to determine changes in nutritional status in hospital. The mean prevalence of undernutrition (11 %) was considerably lower than was reported from Dundee (40 %). Unintentional weight loss before admission and functional impairment on admission occurred to a similar extent in both centres. Weight loss in hospital occurred in the same proportion of patients, but less frequently among those undernourished on admission to hospital, in Dublin compared with Dundee. The patients found to be undernourished on admission in this study had a mortality rate in hospital (6.5 %) over three times that of the adequately nourished group (2 %). The magnitude of the difference in prevalence of undernutrition between the two centres cannot be explained by ethnicity, case-mix or age distribution. With the secular increase in BMI in the population, the thresholds for classifying patients as undernourished or at risk of nutritional deterioration may need to be reviewed. For clinical use, recent weight loss and functional status may be more appropriate variables to use in the evaluation of nutritional status on admission to hospital.