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Malnutrition Diagnoses and Associated Outcomes in Hospitalized Patients: United States, 2018.

ASPEN has been tracking the rates of coded malnutrition diagnoses in hospitalized patients and the associated outcomes over time using Agency for Healthcare Research and Quality databases. This short video reviews the study’s key findings and call to action.

Also download the companion infographic that highlights the key findings from the study.

Malnutrition Diagnoses and Associated Outcomes in Hospitalized Patients: United States, 2018

The Truth about Tube Feeding

Malnutrition Identified by Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Is Associated With More 30-Day Readmissions, Greater Hospital Mortality, and Longer Hospital Stays: A Retrospective Analysis of Nutrition Assessment Data in a Major Medical Center

Lauren Hudson, MS, RD, LDN1; Jesse Chittams, MS2; Cody Griffith, BA3; and Charlene Compher, PhD, RD, CNSC, LDN, FASPEN2

Abstract Background:

Few studies have compared malnutrition identified by the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) consensus criteria with clinical outcomes. Our goal was to compare 30-day readmissions (primary outcome), hospital mortality, length of stay (LOS) in survivors, and time to discharge alive (TDA) in all patients assessed as malnourished or not malnourished using these criteria in fiscal year 2015. We hypothesized more frequent admissions, greater mortality, longer LOS, and less likely shorter TDA in the malnourished patients. Methods: Demographic variables, clinical outcomes, and malnutrition diagnosis for all initial patient admissions were obtained retrospectively from the electronic medical record. Logistic regression was used to compare categorical and Cox proportional hazards for TDA in unadjusted and adjusted (age, sex, race, medical/surgical admission, Charlson Comorbidity Index) models. Results: Of the 3907 patients referred for nutrition assessment, 66.88% met criteria for moderate or severe malnutrition. Malnourished patients were older (61 vs 58 years, P < .0001), and survivors had longer LOS (15 vs 12 days, P = .0067) and were more likely to be readmitted within 30 days (40% vs 23%, P < .0001). In adjusted models, 30-day readmissions (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.82–2.48) and hospital mortality (OR 1.47, 95% CI 1.0–1.99) were increased, and the likelihood of earlier TDA was reduced (hazard ratio [HR] 0.55, 95% CI 0.44–0.77) in those who had >2-day stay. Conclusion: The AND/ASPEN criteria identified malnourished patients in a high-risk population who had more adverse clinical outcomes. Further studies are needed to determine whether optimal provision of nutrition support can improve these outcomes. (JPEN J Parenter Enteral Nutr. 2018;00:1–6)

Read full article here

ASPEN Safe Practices for Enteral Nutrition Therapy

Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

Full publication here

We are pleased to announce the arrival of Improve Patient Outcomes: A.S.P.E.N.’s Step-by-Step Guide to Addressing Malnutrition. 

This interactive guide offers you the tools, care pathways, quality measures, and other important resources you need to address malnutrition. Most importantly, it will help patients, consumers, caregivers, clinicians, and healthcare administrators with the detection, diagnosis, prevention, and treatment of disease-related malnutrition. 

Features of this guide include: 

  • Care pathways for adult and pediatric patients
  • Pocket cards for use at the bedside
  • Reprints of important articles on malnutrition
  • Implementation tools for optimal nutrition care

The book is available in print, eBook, or as a bundle. Visit the A.S.P.E.N. Online Store today to purchase your guide and visit to learn more about all of A.S.P.E.N.’s malnutrition resources.

PN Competencies Paper Now Available

On June 15, A.S.P.E.N.’s highly anticipated paper, “Standardized Competencies for Parenteral Nutrition Prescribing: The American Society for Parenteral and Enteral Nutrition Model,” went live on the NCP website.
Make sure you visit A.S.P.E.N.’s new webpage dedicated to PN information, where you can find all of the resources you need to expand your knowledge base of safe PN practices.

A.S.P.E.N. Calls for National Malnutrition Goal & Innovations in Care Settings

A.S.P.E.N. article titled Addressing Disease-Related Malnutrition in Hospitalized Patients: A Call for a National Goal was published in The Joint Commission Journal on Quality and Patient Safety. The article indicates that the impact and scope of disease-related malnutrition argues for its importance as a serious safety issue and calls for the establishment of a national goal in the United States. “A national goal, combined with a series of specific actions to address disease-related malnutrition, has the potential to improve patient outcomes by reducing readmissions, morbidity, mortality, and costs,” said Gordon Jensen, MD, Ph.D. Professor and Head of Nutritional Sciences at The Pennsylvania State University and one of the article’s authors, all of whom serve on the A.S.P.E.N. Malnutrition Committee. “It is our aim to mobilize health care stakeholders to implement effective, team-based care processes that monitor and improve the nutrition care of hospitalized patients.”


Clinical Guidelines

  • 2010 Nutrition Support of Hospitalized Pediatric Patients with Obesity
  • 2009 Nutrition Support of Children with Human Immunodeficiency Virus Infection
  • 2009 Clinical Guidelines Introduction
  • 2009 Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation
  • 2009 Pediatric Critical Care
  • 2009 Adult Critical Care – In collaboration with the Society of Critical Care Medicine (SCCM)
    1. Preliminary Remarks and Introduction
    2. Section A – Initiate Enteral Feeding
    3. Section B – When to Use Parenteral Nutrition
    4. Section C – Dosing of Enteral Feeding
    5. Section D – Monitoring Tolerance and Adequacy of Enteral Nutrition
    6. Section E – Selection of Appropriate Enteral Formulation
    7. Section F – Adjunctive Therapy
    8. Section G – When Indicated, Maximize Efficacy of Parenteral Nutrition
    9. Section H – Pulmonary Failure
    10. Section I – Renal Failure
    11. Section J – Hepatic Failure
    12. Section K – Acute Pancreatitis
    13. Section L – Nutrition Therapy in End-of-Life Situations
  • 2009 Enteral Nutrition Practice Recommendations
  • 2004 Safe Practices for Parenteral Nutrition


  • 2008 Nutrition Support Pharmacist Standards
  • 2007 Nutrition Support Nurse Standards
  • 2007 Nutrition Support Dietitian Standards
  • 2006 Long Term Care Standards
  • 2005 Home Care Standards
  • 2005 Hospital Patient (Peds) Standards
  • 2003 Nutrition Support Physician Standards
  • 2002 Hospital Patient (Adult) Standards

Position Papers

  • 2008 Statement on Ethics of Withholding and/or Withdrawing Nutrition Support Therapy
  • 2007 Statement on Parenteral Nutrition Standardization
  • 2004 Statement on Aluminum in Parenteral Nutrition

Endorsed Documents

  • Adult Starvation and Disease-Related Malnutrition: A Proposal for Etiology-Based Diagnosis in the Clinical Practice Setting From the International Consensus Guideline Committee
  • AACE/TOS/ASMBS Medical Guidelines for Clinical Practice for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Patient

Click on the links below to view Professional Resources by IrSPEN, ESPEN, ASPEN and INDI available to download free of charge: