MALNUTRITION IN

H O S P I TA L I Z E D
PAT I E N T

Amelia Eka Damayanty

Dept. GIZI FK UMSU
 DEFENITION

• The World Health Organization (WHO) defines

MALNUTRITION as “the cellular imbalance between
the supply of nutrients and energy and the body’s
demand for them to ensure growth, maintenance and
specific function.
• 277 hospitalized patients;

malnutrition 71.1 %, with similar frequencies between moderate (35.4 %) and

severe malnutrition (35.7 %). In relation to the types of cancer, severe malnutrition
was more prevalent in patients with cancer of the upper gastrointestinal tract
(28.3 %). Of the 126 patients who remembered the usual weight, 80.2 % had %WL ≥5 in
the last 6 months

They showed that more than half of the sample (67.1 %) had symptoms
of nutritional impact, in which the most prevalent were: anorexia
(50.5 %), pain (23.1 %), vomiting (19.4 %), constipation, and dysgeusia (17.7 %).

(Nutr J. 2015; 14:123)

• In hospitalized patients, MALNUTRITION ranges between 30% - 50% is
associated with a higher rate of complications, prolonged
hospitalization and increased cost of helath services

• In hospitalised patients is usually due to:

Difficulties with:
 Chewing
 Swallowing
 Digesting food
 Pain
 Nausea
 Lack of appetite
• In hospitalised patients is usually due to:
Nutrient loss can be accelerated by;
 Bleeding
 Diarrhoea
 Malabsorption disorders
 Other factors
• In hospitalised patients is usually due to:
Increased the amount of nutrition needed by patients:
 Fever
 Infection / inflammation disease
 Sepsis
 Surgery
 Trauma
 Burns
 Some medications
 Benign or malignant tumours
CONSEQUENCES OF MALNUTRITION

 Reduced renal function

 Impaired wound healing
 Constipation, diarrhoea, pain
 Respiratory failure
 Skeletal muscle atrophy
 Increased length of stay
 Delay recovery
 Surgery stress, increased metabolic rate
 Reddish hair, atrophy of tongue papillae
 CALORIC REQUIREMENTS
• The HARRIS-BENEDICT EQUATION is used to calculate BEE in day:
 Male: 66,5 + (13,7 x weight in kg) + (5 x height in cm) – (6,8 x age in
years)
 Female : 65 + (9,6 x weight in kg) + (1,7 x height in cm) – (4,7 x age
in years)

Total Energy Expenditure = BEE X Activity Factor x Stress Factor

In practice:
Stabil condition : 20-25 kkal/kgBB/hari
Acute phase : 25-35 kkal/kgBB/hari or HB X 1,3
Recovery Phase : 35-50 kkal/kgBB/hari (evaluate the patient) or
HB X 1,6
STRESS FACTOR
Pasien Status Stress Factor
• Elective operation / minor surgery 1,0 – 1,2
• Non-stressed on vent 1,0 – 1,2
• CHF 1,1 – 1,2
• Fever 1,13
• Peritonitis 1,05 – 1,25
• Long bone fracture 1,15 – 1,3
• Mild to moderate infection 1,2 – 1,4
• Multiple trauma / mayor surgery 1,3 – 1,55
• Stressed vent dependent 1,4 – 1,6
• Sepsis 1,5 – 1,75
• Liver failure 1,5
• Burns 1,25 – 2,0
A
C • Sedentary.  Little to no regular exercise.  (factor 1.2)
T
I
V • Mild activity level: Intensive exercise for at least 20 minutes 1 to 3 times per
I week. This may include such things as bicycling, jogging, basketball, swimming,
skating, etc.  If you do not exercise regularly, but you maintain a busy life style
T
that requires you to walk frequently for long periods, you meet the
Y
requirements of this level.  (factor 1.375)

F
A • Moderate activity level: Intensive exercise for at least 30 to 60 minutes 3 to
C 4 times per week. Any of the activities listed above will qualify.    (factor 1.55)
T
O
R
A
C
• Heavy or (Labor-intensive) activity level: Intensive exercise for 60
T
I minutes or greater 5 to 7 days per week (see sample activities above). 
V Labor-intensive occupations also qualify for this level.  Labor-intensive
I occupations include construction work (brick laying, carpentry, general
T labor, etc.). Also farming, landscape worker or similar occupations.    
Y (factor 1.7)

• Extreme level: Exceedingly active and/or very demanding activities: 

F Examples include:  (1) athlete with an almost unstoppable training schedule
A with multiple training sessions throughout the day  (2) very demanding job,
C such as shoveling coal or working long hours on an assembly line. Generally,
T this level of activity is very difficult to achieve.  (factor 1.9)
O
R
PROTEIN