Determinants of malnutrition in older hospitalized patients: a prospective multicenter study with the DoMAP model.

BACKGROUND

Few studies have assessed the full spectrum of potential causes of malnutrition in older hospitalized patients using a standardized framework. Applying the "Determinants of Malnutrition in Aged Persons" (DoMAP) model, this study aimed to quantify the prevalence of specified determinants and compare their distribution between malnourished and non-malnourished patients, thereby identifying the most important determinants.

METHODS

This multicenter, cross-sectional, prospective, observational study was conducted in three geriatric acute care hospital units. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Potential causes of malnutrition were assessed using the DoMAP model. This study was registered in the German Clinical Trials Register with the DRKS-ID: DRKS00030850 on December 14, 2022.

RESULTS

A total of 556 patients (mean age 82.5 ± 6.6 years; 67% women) were included. Malnourished patients exhibited a significantly higher prevalence of most determinants compared to non-malnourished patients, particularly low intake (89 vs. 49%), poor appetite (68 vs. 25%), inflammation (31 vs. 19%), gastrointestinal disease (29 vs. 11%), inflammatory disease (32 vs. 19%), and hospitalization (62 vs. 47%). The mean total determinants count was significantly higher in malnourished participants (12.5 ± 5.3) than in non-malnourished ones (10.1 ± 4.0; p < 0.001). Regression analysis revealed low intake as the strongest determinant at Level1; poor appetite, at Level2; gastrointestinal disease and oral pain at Level3, and anorexia of aging and hospitalization at Level4.

CONCLUSION

The DoMAP model provides a structured framework for capturing the diverse etiologies of malnutrition in older patients. This study emphasizes the multifactorial nature of malnutrition in hospitalized patients, with low intake and poor appetite emerging as predominant drivers.