{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:15:13Z","timestamp":1778649313557,"version":"3.51.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malnutrition is a highly prevalent and underdiagnosed condition among hospitalized patients, especially in internal medicine wards. Hospital malnutrition is associated with increased morbidity, mortality, prolonged admissions, and a substantial economic burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to assess the clinical and economic impact of nutritional risk in patients admitted to internal medicine wards, focusing on mortality, hospital resource utilization, and the effectiveness of nutritional interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted at ULS Santo Ant\u00f3nio, Porto, including 1,150 hospital admissions from January to December 2022. All adult patients with nutritional risk screening (NRS-2002) in the first 48\u202fh of admission were included. Data were collected from hospital information systems on demographic, clinical, and economic variables, with outcomes including in-hospital mortality, readmissions at 30, 90, and 180\u202fdays, and one-year post-discharge mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nutritional risk (NRS-2002\u202f\u2265\u202f3) was identified in 42.4% of patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f488), while ICD-10 malnutrition coding at discharge was recorded in only 0.7% of admissions. Of patients at nutritional risk, 74.4% (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f363) received no nutritional supplementation. Nutritional risk was associated with higher in-hospital mortality, longer length of stay, and increased costs across all resource categories. In the time-dependent Cox model, patients at nutritional risk without supplementation showed a markedly higher hazard of in-hospital death at admission (HR 23.32, 95% CI 13.09\u201341.56), with this excess hazard attenuating over time. Patients at nutritional risk who received supplementation also showed elevated early risk (HR 6.15, 95% CI 2.96\u201312.80), though lower than unsupplemented patients. A similar pattern was observed for one-year post-discharge mortality. Total hospitalization costs were approximately 79% higher in at-risk patients, driven mainly by longer length of stay.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nutritional risk affected 42.4% of internal medicine inpatients and was associated with higher mortality and resource use. The finding that 74.4% of at-risk patients received no nutritional intervention represents a substantial missed opportunity. Patients who received nutritional supplementation showed a pattern of lower mortality risk than unsupplemented at-risk patients, consistent with but not proving a beneficial association. These findings support systematic nutritional screening and timely intervention in hospital care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1755750","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T04:50:58Z","timestamp":1778647858000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Missed opportunities in nutritional care: prevalence, mortality, and resource utilization in internal medicine wards"],"prefix":"10.3389","volume":"13","author":[{"given":"Ricardo C.","family":"Marinho","sequence":"first","affiliation":[{"name":"Clinica de Anestesiologia, Medicina Intensiva, Emerg\u00eancia e Urg\u00eancia, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio","place":["Porto, Portugal"]},{"name":"School of Medicine and Biomedical Sciences (ICBAS), University of Porto","place":["Porto, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Craveiro","sequence":"additional","affiliation":[{"name":"Clinica de Anestesiologia, Medicina Intensiva, Emerg\u00eancia e Urg\u00eancia, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio","place":["Porto, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susana","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Dire\u00e7\u00e3o de Planeamento e Controlo de Gest\u00e3o, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio","place":["Porto, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabete","family":"Carolino","sequence":"additional","affiliation":[{"name":"H&TRC \u2013 Health and Technology Research Center, ESSL \u2013 Escola Superior de Sa\u00fade de Lisboa, Instituto Polit\u00e9cnico de Lisboa","place":["Lisbon, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta S.","family":"Lopes","sequence":"additional","affiliation":[{"name":"Hematology Unit, Unidade Local de Sa\u00fade Entre Douro e Vouga","place":["Santa Maria da Feira, Portugal"]},{"name":"Departamento de Ci\u00eancias M\u00e9dicas, Universidade de Aveiro","place":["Aveiro, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o A.","family":"Correia","sequence":"additional","affiliation":[{"name":"School of Medicine and Biomedical Sciences (ICBAS), University of Porto","place":["Porto, Portugal"]},{"name":"Clinica de Medicina, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio","place":["Porto, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anibal","family":"Marinho","sequence":"additional","affiliation":[{"name":"Clinica de Anestesiologia, Medicina Intensiva, Emerg\u00eancia e Urg\u00eancia, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio","place":["Porto, Portugal"]},{"name":"School of Medicine and Biomedical Sciences (ICBAS), University of Porto","place":["Porto, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marisa D.","family":"Santos","sequence":"additional","affiliation":[{"name":"School of Medicine and Biomedical Sciences (ICBAS), University of Porto","place":["Porto, Portugal"]},{"name":"Colorretal Surgery Unit, Clinica de Cirurgia, Centro Hospitalar Universit\u00e1rio de Santo Ant\u00f3nio, Unidade Local de Sa\u00fade de Santo Ant\u00f3nio","place":["Porto, Portugal"]},{"name":"Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), University of Porto","place":["Porto, Portugal"]},{"name":"ITR - Laboratory for Integrative and Translational Research in Population Health","place":["Porto, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.ejim.2020.02.031","article-title":"High prevalence of malnutrition in internal medicine wards - a multicentre ANUMEDI study","volume":"76","author":"Marinho","year":"2020","journal-title":"Eur J Intern Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"918","DOI":"10.1002\/jpen.1499","article-title":"Prevalence of malnutrition risk and the impact of nutrition risk on hospital outcomes: results from nutritionDay in the U.S","volume":"43","author":"Sauer","year":"2019","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1093\/ajcn\/nqab135","article-title":"A multicenter propensity score matched analysis in 73,843 patients of an association of nutritional risk with mortality, length of stay and readmission rates","volume":"114","author":"Meulemans","year":"2021","journal-title":"Am J Clin Nutr"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.amjmed.2020.06.044","article-title":"Impact of malnutrition on hospitalization outcomes for older adults admitted for Sepsis","volume":"134","author":"Abugroun","year":"2021","journal-title":"Am J Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1002\/ncp.10771","article-title":"Malnutrition diagnoses and associated outcomes in hospitalized patients: United States, 2018","volume":"36","author":"Guenter","year":"2021","journal-title":"Nutr Clin Pract"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.ejim.2025.05.025","article-title":"Prevalence of malnutrition and its impact on clinical outcomes in internal medicine wards: the SIMI-NUTRO study","volume":"138","author":"Muscaritoli","year":"2025","journal-title":"Eur J Intern Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1016\/j.clnesp.2022.01.020","article-title":"Economic burden of hospital malnutrition: a cost-of-illness model","volume":"48","author":"Inciong","year":"2022","journal-title":"Clin Nutr ESPEN"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.clnu.2007.04.002","article-title":"The impact of malnutrition on healthcare costs and economic considerations for the use of oral nutritional supplements","volume":"2","author":"Russell","year":"2007","journal-title":"Clin Nutr Suppl"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e046402","DOI":"10.1136\/bmjopen-2020-046402","article-title":"Cost savings associated with nutritional support in medical inpatients: an economic model based on data from a systematic review of randomised trials","volume":"11","author":"Schuetz","year":"2021","journal-title":"BMJ Open"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/S0261-5614(02)00214-5","article-title":"Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials","volume":"22","author":"Kondrup","year":"2003","journal-title":"Clin Nutr"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.clnu.2019.04.011","article-title":"Prediction of early- and long-term mortality in adult patients acutely admitted to internal medicine: NRS-2002 and beyond","volume":"39","author":"Sanson","year":"2020","journal-title":"Clin Nutr"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e1915138","DOI":"10.1001\/jamanetworkopen.2019.15138","article-title":"Association of Nutritional Support with Clinical Outcomes among Medical Inpatients who are Malnourished or at nutritional risk","volume":"2","author":"Gomes","year":"2019","journal-title":"JAMA Netw Open"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.clnu.2025.07.007","article-title":"Patient characteristics associated with the provision of nutritional support to older hospitalised patients at risk of malnutrition: a cohort study","volume":"51","author":"Folven","year":"2025","journal-title":"Clin Nutr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"5684","DOI":"10.1016\/j.clnu.2021.09.039","article-title":"ESPEN guideline on hospital nutrition","volume":"40","author":"Thibault","year":"2021","journal-title":"Clin Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12874-021-01492-7","article-title":"Simple excel and ICD-10 based dataset calculator for the Charlson and Elixhauser comorbidity indices","volume":"22","author":"Prommik","year":"2022","journal-title":"BMC Med Res Methodol"},{"key":"ref16","first-page":"165","article-title":"Nutritional screening and prevalence of hospital malnutrition risk. 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