New Research Finds U.S. Hospitals Markedly Underreporting Patient Malnutrition

November 20, 2013

While previous studies have suggested that malnutrition is present in between 21% and 54% of hospitalized patients, new research, published in the Journal of Parenteral and Enteral Nutrition, finds that only 3.2% of U.S. hospital patients were given a diagnosis of malnutrition. 

This new study and prior studies do agree, however, that malnutrition is associated with unfavorable outcomes including higher infection rates, poor wound healing, longer length of stay, and higher frequency of readmission of patients. 

“While there is no question that malnutrition can be devastating to a patient’s well-being, many questions remain about how to assure patients are properly diagnosed,” said Mark R. Corkins, MD, CNSC, of University of Tennessee Health Science Center/Le Bonheur Children’s Hospital and lead researcher on the study. 

This new study analyzed 2010 data from the U.S. Department of Health & Human Services sponsored Healthcare Cost and Utilization Project (HCUP), which contains representative data for all U.S. hospitalizations. The HCUP data set contains up to twenty-five ICD-9 diagnosis codes for each discharged patient.  Using these codes, all patients with a diagnosis of malnutrition in their hospital records were identified.  Based on the reported ICD-9 codes a much smaller proportion of malnourished hospital patients were identified than previous studies that used specialized assessment instruments and selected at-risk populations. 

The discrepancy between the new study and prior studies is likely due to inadequate diagnosis and coding of malnutrition in hospitalized patients. There is currently no national benchmarking of malnutrition in acute care hospitals in the U.S. 

The current study’s authors agree that standard malnutrition screening and assessment tools should be used to monitor malnutrition rates.  If implemented, a program of this type not only has the potential to generate much more accurate data on annual rates of malnutrition, but it could also enhance quality of patient care and address pressing public policy issues such as rehospitalization. 

“Until a national benchmarking program of hospital malnutrition is established, annual rates of malnutrition in U.S. hospitals will remain unclear and patient care will suffer,” said Peggi Guenter, PhD, RN, Senior Director of Clinical Practice, Advocacy, and Research Affairs for the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and a researcher and coauthor of the study. 

A.S.P.E.N., which sponsored this new study, has previously called upon the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and National Center for Health Statistics (NCHS) to better address standards, diagnostic codes, and best practice protocols for patient malnutrition in the hospital setting.  It hopes this new research will help bolster its case and promote action to address these issues in a timely manner.                                                     

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The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is dedicated to improving patient care by advancing the science and practice of nutrition support therapy and metabolism. Founded in 1976, A.S.P.E.N. is an interdisciplinary organization whose members are involved in the provision of clinical nutrition therapies, including parenteral and enteral nutrition. With more than 5,500 members from around the world, A.S.P.E.N. is a community of dietitians, nurses, nurse practitioners, pharmacists, physicians, scientists, students and other health professionals from every facet of nutrition support clinical practice, research and education. For more information about A.S.P.E.N., please visit