| Background & Aims: Undernutrition is one of the common problems in hospitalized patients. During the last ten years, reports on the prevalence of undernutrition and nutritional risk in hospitalized patients have ranged from 9% to 48.1%, and from 13% to 48.6%. These wide ranges in the reported prevalence of undernutrition and nutritional risk have been attributed to three factors. First, there is an absence of standardized definitions of undernutrition and nutritional risk. Second, there is a lack of a gold-standard for assessing nutritional status. Third, studies have focused variable populations or types of institutions. Therefore the result from different study is difficulty to be compared.Patients have been showed to lose weight and to reduce their nutritional intake during hospitalization. However, nutritional care is inadequate in most hospitals. Lack of appropriate nutritional support during hospitalization may worsen patient's nutritional status. It is necessary to identify the patients who need nutritional support. Nutritional risk is an indicator for nutritional support, which can be assessed by the Nutritional Risk Screening 2002 (NRS 2002). NRS 2002 is a new screening method based on 128 randomized controlled clinical trials, which has been recommended by European Society for Clinical Nutrition and Metabolism (ESPEN) among hospitalized patients.This study were to test the feasibility of using NRS 2002 and to determine the prevalence of nutritional risk, nutritional support and nutritional risk changes from admission to discharge or over a two-week period in Beijing and Baltimore teaching hospitals.Methods: This study included two parts. The first part of the study: A descriptive design was used to describe data collected at the Respiratory, Nephrology, Gastrointestinal, General surgery and Thoracic surgery at Peking Union Medical College Hospital, Beijing Friendship hospital and People's hospital from April 2006 to July 2007. A total of 1500 consecutive patients, who met the inclusion criteria on admission and provided informed consent were enrolled. The second part of the study: A comparative design was used to compare data collected at Beijing and Baltimore teaching hospitals from April 2006 to April 2007. The study protocol was approved by the Research Ethics Committees of both medical institutions. A total of 500 consecutive patients, 300 from Beijing and 200 from Baltimore who met the inclusion criteria on admission and provided informed consent were enrolled.Statistical analyses were performed with SPSS (Statistical Package for Social Sciences, Chicago, IL, USA), version 12.0. P value < 0.05 was considered statistically significant. Descriptive statistics were used to describe the frequency and percentage of patients able to complete the NRS 2002 screening, the frequency of undernutrition, overweight, obese and nutritional risk in patients, and the frequency of use of EN, PN, and both EN and PN. The Chi-square test was performed to compare the prevalence of nutritional risk between different hospitals and sex. The Fisher's exact test was performed to compare the feasibility of using NRS 2002 and the application rate of PN, EN. Paired t test and Student's t test were used for continuous variables, such as laboratory value, weight loss, length of stay, etc. to determine the difference between the two hospitals and the difference from admission to two weeks after admission or until discharge.Results: The first part of the study: Among the 1500 hospitalized patients, 97.7% were able to complete the NRS 2002. The overall prevalence of nutritional risk was 27.3%, and 28.0% and 26.3% was in medical and surgical patients, respectively. Among the different wards upon admission, the highest prevalence of nutritional risk was in the gastrointestinal ward (36.7%) while the lowest was observed in the nephrology ward (18.5%). The prevalence of nutritional in those patients 65 years or older was 36.0%, which was significantly higher than that of patients younger than 65 years (22.9%) (X~2 = 29.236, P = 0.000). Among allover patients, 167(11.1%) patients were given nutritional support during hospitalization. For the patients who were at nutritional risk, only 24.9% of them were given nutritional support. For the non-risk patients, 6.0% of them were given nutritional support, especially among general surgery patients (12.7%). More parenteral nutritional (PN) (9.3%) was applied comparing to that of enteral nutrition (EN) (0.9%), especially in the surgical department, it was shown 19.8% vs 0.7% of PN vs EN. The average days of nutritional support among the entire sample of patients, medical patients and surgical patients were 6.2 (SD 3.7), 7.5 (SD 4.5) and 5.8 (SD 3.3), respectively. The overall prevalence of nutritional risk changed from 27.3% to 31.7% (X~2 = 6.880, P = 0.009), the prevalence of nutritional risk changed in medical and surgical patients was from 28.0% to 30.5% (X~2 = 1.371, P = 0.242) and 26.3 to 33.5% (X~2 = 7.333, P = 0.007), respectively during hospitalization. The contribution factors for the change of nutritional risk were weight loss: 0.445; food intake: 0.417; severity of disease: 0.374; BMI: 0.323 (descending by coefficients).The second part of the study: Three hundred patients were enrolled from Peking Union Medical College Hospital (PUMCH). Two hundred patients were enrolled from the Johns Hopkins Hospital (JHH). Among the hospitalized patients, 94.0% at Beijing and 99.5% at Baltimore were able to complete the NRS 2002. The prevalence of nutritional risk was 39% and 51.0%, respectively (X~2 = 7.020, P = 0.008). The prevalence of nutritional risk at admission was 38.6% among male patients and 39.4% among female patients in PUMCH (X~2 = 0.017, P = 0.896); 50.9% of male patients and 51.1% of female patients were observed at nutritional risk in JHH (X~2 = 0.000, P = 0.986). Therefore, no significant difference in nutritional risk by sex was shown at either hospital in this study. The prevalence of undernutrition and overweight were not found different, but a significant difference in the prevalence of obesity was observed in the study. Nine percent of patients in PUMCH and 7.5% of patients in JHH were given nutritional support. No significant difference was observed in the application rate of either parenteral nutrition (PN) or enteral nutrition (EN) between Beijing and Baltimore (P > 0.05). For the patients at nutritional risk, only 17.9% at Beijing and 14.7% at Baltimore used either PN or EN (P > 0.05). For non-risk patients, 3.3% used nutritional support at Beijing while no patient used this support at Baltimore (P > 0.05). The prevalence of nutritional risk changed from 39.0% to 38.5% (P > 0.05) during hospitalization at Beijing and from 51.0% to 41.4% at Baltimore (P > 0.05). There were 9.3% of the patients from PUMCH and 11.5% from JHH who changed from at nutritional risk at admission to not at risk upon discharge or two weeks after admission. Nine percent of the patients at PUMCH and 2.5% at JHH developed a state of nutritional risk during hospitalization.Conclusions: NRS 2002 was feasible in both Beijing and Baltimore teaching hospitals. The high prevalence of nutritional risk among hospitalized patients was observed in this study. The prevalence of nutritional risk observed at Baltimore was higher than that at Beijing. The result showed inappropriately used nutritional support in clinical practice. No difference was observed in the application rate of nutritional support and changes in nutritional risk during hospitalization between Beijing and Baltimore teaching two hospitals. The change of the prevalence of nutritional risk during hospitalization was found in surgical department among Beijing teaching hospitals. The results provide baseline information to help measure the application of nutritional support. It could also help to understand the importance of clinical guideline use in the nutrition support for the hospitalized patients.
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