Oral health problems are associated with malnutrition in hospitalised adult patients

Ingrid Løvold Mostad; Thomas Kvitvang Reinan; Jostein Halgunset; Lene Thoresen; Astrid Jullumstrø Feuerherm; Marit Kolberg

doi:10.1016/j.clnesp.2023.07.088

Oral health problems are associated with malnutrition in hospitalised adult patients

Clin Nutr ESPEN. 2023 Oct:57:527-536. doi: 10.1016/j.clnesp.2023.07.088. Epub 2023 Jul 31.

Authors

Ingrid Løvold Mostad¹, Thomas Kvitvang Reinan², Jostein Halgunset³, Lene Thoresen⁴, Astrid Jullumstrø Feuerherm⁵, Marit Kolberg⁶

Affiliations

¹ Department of Nutrition and Speech-Language Therapy, Clinic of Rehabilitation, St. Olavs hospital - Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: ingrid.lovold.mostad@stolav.no.
² Clinic of Surgery, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway. Electronic address: thomas_k_r@hotmail.com.
³ Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Biobank1, St. Olavs hospital - Trondheim University Hospital, Trondheim, Norway. Electronic address: jostein.halgunset@ntnu.no.
⁴ Cancer Clinic, St. Olavs hospital - Trondheim University Hospital, Trondheim, Norway. Electronic address: lene.thoresen@stolav.no.
⁵ Center for Oral Health Services and Research Mid-Norway (TkMidt), Trondheim, Norway. Electronic address: astfe@tkmidt.no.
⁶ Center for Oral Health Services and Research Mid-Norway (TkMidt), Trondheim, Norway. Electronic address: marko@tkmidt.no.

PMID: 37739702
DOI: 10.1016/j.clnesp.2023.07.088

Abstract

Background & aims: Hospitalised patients are especially vulnerable to malnutrition, which is associated with an increased risk of complications, leading to longer hospital stays, increased healthcare costs, and with a potentially negative effect on the prognosis. Poor oral health may make food intake difficult and contribute to poor nutritional status. The aim of the present cross-sectional study was to assess the occurrence of poor oral health and malnutrition in adult hospitalised patients, and further to investigate associations between oral health problems and malnutrition.

Methods: The Patient-Generated Subjective Global Assessment (PG-SGA) determined the patients' nutritional status. The oral health condition was evaluated according to the Revised Oral Assessment Guide-Jönköping (ROAG-J) and unstimulated salivary flow rate. Clinical information was collected from medical records.

Results: The study population included 118 patients from 15 somatic and 3 psychiatric wards at a University Hospital in Norway. Nearly half the patients (46%) were categorised as malnourished and in need of symptom alleviation or nutritional intervention. Malnutrition was found in all diagnostic conditions. According to ROAG-J, at least one oral health problem was identified in 93% of the patients. Severe oral health problems were more frequent in malnourished patients. Overall, both the number and total score of oral health problems were associated with malnutrition (OR 1.57, 95% CI 1.20-2.06 and OR 1.47, 95% CI 1.17-1.83, respectively). Of specific oral health items, problems with lips and mucous membranes were significantly associated with malnutrition. One-fifth of all patients had hyposalivation, but this was not associated with malnutrition.

Conclusions: Oral health problems and malnutrition are commonly seen in hospitalised adult patients. The association between the two calls for raised awareness of oral health issues in assessing patients' nutritional status. Further study is required to clarify whether oral health problems constitute a causal factor in malnutrition.

Keywords: Hospitalised patients; Hyposalivation; Malnutrition; Oral health problems; PG-SGA; ROAG-J.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Sectional Studies
Health Care Costs
Humans
Malnutrition* / complications
Malnutrition* / epidemiology
Nutritional Status
Oral Health*