Malnutrition in patients admitted to in-hospital cardiac rehabilitation: Clinical correlates and association with mortality

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Submitted: June 1, 2021
Accepted: October 5, 2021
Published: November 24, 2021
Abstract Views: 1389
PDF: 551
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Malnutrition is highly prevalent among hospitalized patients; thus, an accurate identification of malnutrition could improve the outcome of these patients. The aim of the present paper was to apply multiple methods to evaluate the prevalence of malnutrition and clinical correlates in patients admitted to in-hospital cardiac rehabilitation.  We performed a prospective study of 426 patients admitted to in-hospital cardiac rehabilitation: 282 (66.2%) had undergone a major cardiac surgery and 144 (34.8%) had experienced heart failure. The albumin level and Mini Nutritional Assessment (MNA) scores were applied to evaluate the nutritional status of these patients. Serum albumin levels were < 3.5 g/dl in 147 (34.5%) patients, and MNA scores were < 24 in 179 (42.0%) patients. Patients with malnutrition or a risk of malnutrition had lower haemoglobin values, lower EuroQol scores and poorer functional status. Female gender, age, functional status and Cumulative Illness Rating Scale severity were predictors of malnutrition. Over a median follow-up of 47 months, MNA scores <24 were associated with higher mortality, even after correction for confounding variables. In conclusion, in patients admitted to in-hospital cardiac rehabilitation, malnutrition and risk of malnutrition frequently occur and are associated with poor functional status, higher clinical complication rates and long-term mortality.



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Jensen GL, Bistrian B, Roubenoff R, Heimburger DC. Malnutrition syndromes: a conundrum vs continuum. JPEN J Parenter Enteral Nutr 2009;33:710-6. DOI:
ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002;26:1SA-138SA. DOI:
Malone A, Hamilton C. The Academy of Nutrition and Dietetics/the American Society for Parenteral and Enteral Nutrition consensus malnutrition characteristics: application in practice. Nutr Clin Pract 2013;28:639-50. DOI:
Niedert KC, American Dietetic Association. Position of the American Dietetic Association: Liberalization of the diet prescription improves quality of life for older adults in long-term care. J Am Diet Assoc 2005;105:1955-65. DOI:
Dávalos A, Ricart W, Gonzalez-Huix F, et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996;27:1028-32. DOI:
Davis JP, Wong AA, Schluter PJ, et al. Impact of premorbid undernutrition on outcome in stroke patients. Stroke 2004;35:1930-4. DOI:
Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc 2004;104:1258-64. DOI:
Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235-9. DOI:
Guerra RS, Sousa AS, Fonseca I, et al. Comparative analysis of undernutrition screening and diagnostic tools as predictors of hospitalisation costs. J Hum Nutr Diet 2016;29:165-7. DOI:
Guigoz Y, Vallas BJ, Garry PJ. Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol 1994;4:s15-59.
Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med 2002;18:737-57. DOI:
Vellas B. Guigoz Y, Garry PJ, et al. The Mini Nutritional assessment (MAN) and its use in grading the nutritional state to elderly patients. Nutriton 1999;15:116-22. DOI:
Kuzuya M1, Izawa S, Enoki H, et al. Is serum albumin a good marker for malnutrition in the physically impaired elderly? Clin Nutr 2007; 26:84-90. DOI:
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. Available from:
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-7. DOI:
Mahoney FI, Barthel DW. Functional evaluation: the BARTHEL Index. Md State Med J 1965;14:61-5. DOI:
EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199-208. DOI:
Whynes DK, TOMBOLA Group. Correspondence between EQ-5D health state classifications and EQ VAS scores. Health Qual Life Outcomes 2008;6:94. DOI:
Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 1992;41:237–48. DOI:
Louw JA, Werbeck A, Louw ME, et al. Blood vitamin concentrations during the acute-phase response. Crit Care Med.1992; 20:934-41. DOI:
Tevik K, Thürmer H, Husby MI et al. Nutritional risk screening in hospitalized patients with heart failure. Clin Nutr 2015;34:257-64. DOI:
Rahman A1, Jafry S, Jeejeebhoy K et al. Malnutrition and cachexia in heart failure. JPEN J Parenter Enteral Nutr 2016;40:475-86. DOI:
Aziz EF, Javed F, Pratap B, et al. Malnutrition as assessed by nutritional risk index is associated with worse outcome in patients admitted with acute decompensated heart failure: an ACAP-HF data analysis. Heart Int 2011;6:e2. DOI:
Narumi T, Arimoto T, Funayama A, et al.Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 2013;62:307-13. DOI:
Curtis JP, Selter JG, Wang Y, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med 2005;165:55-61. Erratum in Arch Intern Med 2008;168:567. DOI:
Colín-Ramírez E, Orea-Tejeda A, Castillo-Martínez L, et al. Malnutrition syndrome, but not body mass index, is associated to worse prognosis in heart failure patients. Clin Nutr 2011;30:753-8. DOI:
Van Venrooij LM, Visser M, de Vos R, et al. Cardiac surgery-specific screening tool identifies preoperative undernutrition in cardiac surgery. Ann Thorac Surg 2013;95:642-7. DOI:
van Venrooij LM, de Vos R, Borgmeijer-Hoelen M, et al. Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery. Am J Clin Nutr 2008;87:1656-61. DOI:
van Venrooij LM, van Leeuwen PA, Hopmans W, et al. Accuracy of quick and easy undernutrition screening tools--Short Nutritional Assessment Questionnaire, Malnutrition Universal Screening Tool, and modified Malnutrition Universal Screening Tool--in patients undergoing cardiac surgery. J Am Diet Assoc 2011;111:1924-30. DOI:
Chermesh I, Hajos J, Mashiach T, et al. Malnutrition in cardiac surgery: food for thought. Eur J Prev Cardiol 2014;21:475-83. DOI:
Racca V, Castiglioni P, Ripamonti V, et al. Nutrition markers in patients after heart surgery. JPEN J Parenter Enteral Nutr 2010; 34:143-50. DOI:
Lee JL, Oh ES, Lee RW, Finucane TE. Serum albumin and prealbumin in calorically restricted, nondiseased individuals: A systematic review. Am J Med 2015;128:1023.e1-22. DOI:

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How to Cite

Passantino, Andrea, Pietro Guida, Caterina Rizzo, Rosa Carbonara, Roberta Ruggieri, and Domenico Scrutinio. 2021. “Malnutrition in Patients Admitted to in-Hospital Cardiac Rehabilitation: Clinical Correlates and Association With Mortality”. Monaldi Archives for Chest Disease 92 (2).