Nutritional status of adult patients in two acute care hospitals: A university hospital and an affiliated Veterans Administration Medical Center

Paired surveys designed to assess the nutritional status of adult inpatients were conducted in two acute care medical centers: University of Maryland Hospital (UMH) and its affiliated Veterans Administrtion Medical Center (VAMC). Nutritional profiles of the patients were determined by anthropometric measurements: measured height and weight, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC), and by a chart review. The criteria used to define severe deficits were less than 80% for ideal body weight (IBW) and MAMC and less than 50% for TSF of sex specific standards. A serum albumin of 2.8g/100ml or less was regarded as a severe deficit. Chart review revealed missing admission weights in UMH and VAMC charts in 40% and 65% and missing heights in 60% and 88%, respectively. The VAMC had a greater percentage of patients that were below standards for IBW (p<.005) and TSF (p<.005). However patients at UMH without insurance were not significantly different from VAMC patients in any measured parameter. Patients with Third Party Payment coverage had significantly better nutrition profiles in all parameters (p<.01) than the VAMC and UMH patients without insurance. Patients from both medical centers were combined to compare the nutritional profiles of medical vs. surgical patients and of various disease classifications. Medical patients were not significantly different from surgical patients in any anthropometric measurement. However, medical patients had more significant deficits in serum albumin (p<.005) than surgical patients. Thirty-six percent of the total medical center population had evidence of protein-calorie malnutrition (PCM) and only 19% of these malnourished patients were receiving physician ordered supplements. Patients diagnosed with cancer, cardiovascular or pulmonary disease were at significant risk for PCM when compared to the rest of the patient populations (p<.01).