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* P 0.05.
ethical committee. The enrolled patients were older than 18 y and Not significant.
had not been hospitalized within the 6 mo before the study.
Obstetric and pediatric patients were excluded. Patients were ran-
domly assigned weekly throughout the study until the completion
of the predetermined sample size for each country. Sample size patients (7.3%); enteral nutrition to 530 (5.6%), and parenteral
was based on the population of each country, although, in some nutrition to 217 (2.3%).
countries such as in Cuba, the number of patients enrolled was Brazil and Costa Rica are the only countries where there are
larger because it was their interest to include more patients. In governmental policies concerning nutritional teams and the prac-
contrast, in Mexico, due to local problems, the number of patients tice of nutritional therapy. In Brazil these policies became man-
evaluated was insufficient to fully reflect the prevalence of mal- datory nationwide in 1998, after the publication of the first results
nutrition in that country. of the Brazilian (Ibranutri) study.1 In the Dominican Republic,
The statistical analyses were performed with SPSS 6.12 (1995; Paraguay, and Uruguay, the government does not pay for the
SPSS, Chicago, IL, USA). The statistical analysis included fre- nutritional therapy used, which is considered the responsibility of
quency distributions of all variables. The odds ratio was calculated the hospitals.
to determine the association between risk factors and malnutrition.
For continuous variables, Students t test was used; for univariate
analysis, the chi-square test was used. Statistical significance was DISCUSSION
defined as P 0.05. The variables identified as risk factors for
malnutrition by the univariate analysis were then entered in a Malnutrition is still highly prevalent among hospitalized patients
multiple regression analysis model. in Latin America in the beginning of the new millennium. Whereas
the Brazilian study1,12 that encompassed 4000 patients was carried
out in 1996, the other surveys showing identical overall rates of
RESULTS malnutrition were carried out between 1998 and 2000. These
results are similar to others reported in the literature, in a different
There were 9348 patients enrolled whose mean age was 52.2 period.11,14 17
18.4 y, and 51% were men. The distribution according to the
country is presented in Table I. Malnutrition was diagnosed in
50.2% of patients, with severe malnutrition in 11.2% of the entire
TABLE III.
sample. The prevalence of malnutrition in each country can be
seen in Table II. Despite the high prevalence of malnutrition,
VARIABLES CONSIDERED RISK FACTORS FOR MALNUTRITION
reference to the nutrition status of the patients was registered in
(UNIVARIATE ANALYSIS)
only 23.1% of the medical records. The usual weight was men-
tioned in only 28.5% of cases. Weight at hospital admission was
obtained in only 26.5% of patients, and height was measured in Malnourished Well nourished
32.9%. Scales were available (within 50 m of the patients bed) in Risk factor (%) (%) Relative risk (CI)
74.9% of cases. Serum albumin was recorded in 26.5% of the
patients medical records. There were no statistically significant Age 60 y 53.0 47.0 1.55* (1.431.73)
differences between countries in terms of these data. Age older Internal medicine 52.1 47.9 1.57* (1.431.73)
than 60 y, the presence of infection or cancer, length of hospital- Infection 60.9 39.9 2.40* (2.162.60)
ization previous to the nutritional assessment, and internal medi- Cancer 65.6 34.4 2.68* (2.393.23)
cine patients were identified in the univariate analysis as signifi- LOS 2 d 33.0 67.0
cant risk factors for malnutrition (Table III). These variables were LOS 27 d 42.7 53.7 1.51* (1.311.73)
entered into the multivariate logistic regression model, which LOS 714 d 49.1 50.9 1.95* (1.682.26)
confirmed the association between these variables and malnutrition LOS 14 d 59.7 40.3 3.00* (2.613.45)
(outcome variable), as shown in Table IV.
Despite this high prevalence of malnutrition, nutritional therapy * P 0.05.
was being prescribed to few patients: oral supplementation to 683 CI, confidence interval; LOS, length of hospital stay
Nutrition Volume 19, Number 10, 2003 Prevalence of Hospital Malnutrition in Latin America 825
TABLE IV. task by using the ELAN results to reinforce the need to face the
challenge of hospital malnutrition and its devastating
VARIABLES CONSIDERED RISK FACTORS FOR MALNUTRITION consequences.
ACCORDING TO MULTIVARIATE ANALYSIS
Variable OR CI
ACKNOWLEDGMENTS
The authors acknowledge the investigation leaders (country na-
Age 60 y 1.38* 1.281.54 tional coordinators) of the ELAN Collaborative Study: Adriana
Internal medicine 1.66* 1.491.86 Crivelli, MD (Argentina), Alfredo Matos, MD (Panama), Gabriela
Presence of infection 2.30* 2.042.59 Parallada, MD (Uruguay), Gertrudis Baptista, RD (Venezuela),
LOS 2.55* 2.193.02 Horacio Massotto, MD (Costa Rica), Jesus Barreto, MD (Cuba),
Presence of cancer 2.94* 2.553.39 Juan Kehr, MD (Chile), Rafael Figueredo, MD (Paraguay), Sergio
Echenique, MD (Peru), Victor Sanchez, MD (Mexico), Victoria
* P 0.05. Sone, MD (Dominican Republic), Zulma Gonzalez, MD (Puerto
CI, confidence interval; LOS, length of hospital stay; OR, odds ratio Rico), and their teams who so promptly accepted the task of
collecting data and interviewing the patients. They thank
FELANPEs affiliate societies that supported the idea and stimu-
Nutrition assessment was performed with the SGA instead of lated the teams to carry out the study. They also thank Ms. Inara
the classic anthropometric measurements.13 This method may be Fonseca for statistical support.
controversial because the SGA is essentially a clinical tool. The
differences we found in the severity of malnutrition in Chile and
Panama might be explained by a bias induced by the observers REFERENCES
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