The magnitude of underweight /under nutrition was increased 21.9–24.9% (p > 0.05) and obesity from 5(1.3) to 7(1.8) and waist circumference of ≥ 94 cm for males ≥ 80 cm for female waist circumference increased from 42(10.6%) to 48 (12.1) (p > 0.05).The mean weight 57.7 (SD ± 10.5) at admission decreased to 57.4 (SD ± 10.6) at discharge (P < 0,000). Female in Sex, age > 60 years old, rural in residence and anemia were factors associated underweight/under nourished before admission. Female in sex, age > 60 years old, rural in residence and emergency type of current surgery, length of hospital stay > 15 and anemia were factors associated underweight/under nourished.
Malnutrition is a frequent concomitant of surgical illness. A study reported that up to 40% of patients were malnourished at the time of their admission and majority of these patients continued to be nutritionally depleted throughout their hospital course (18). Similarly, in the current study the magnitude of under nutrient increased from 21.9–24.9%. A similar unintentional weight loss was reported in a study conducted in Netherlands (19). In the current study, there is also significant mean weight depletion after the patients admitted to hospital. A significant weight loss was reported three months before admission in Ethiopian study (9).
The possible reasons for the continued under nutrition and weigh loss might be due diseases specific factors like loss of appetite, inflammation, swallowing difficulties, hyper catabolism; treatment related factors, such as episodes of fasting, side effects of treatment ; psychological factor (anxiety, depression, loneliness) or social factors (such as poverty) (1) and their clinical condition like fistula, malabsorption syndrome, intestinal obstruction and gastric atony (20, 21). The above condition can reduce dietary intake, absorption of macro- and/or micronutrients, increased losses or altered requirements, increased energy expenditure (in specific disease processes) (21, 22). In the current study majority of the patient were admitted for digestive tract surgery. A similar report indicates patients who undergo gastrointestinal surgery are at risk of nutritional depletion from inadequate nutritional intake and the stress of surgery both preoperatively and postoperatively (21).
Malnutrition is associated with poor tolerance to treatment decreased quality of life, and increased health care costs (23). In the current study, there is the longer duration of under nourished patients and septicemia and wound infection are the commonest complications. Malnourished patients have delayed in wound healing and longer length of stay reported in India (7). All the complications developed in the current study seems infectious which might acquire from hospital environment possibly drug resistance. Some studies had shown that infections are a classical complication of malnutrition and under feeding (24, 25).
The magnitude under nutrition before admission was 21.9%. This was similar to study conducted from Brazil (22.2%) (26) and China (17.8%) (27). This was higher than another study conducted in Brazil (14.1%) (3). However, it is lower than similar study from Ethiopia (55.6%) (9) and pre-operative patients report from Albania (65.3%) (2). The magnitude under nutrition in the current study increased to 24.9% during discharge This difference might be due to difference in socio demographic/ economic status ,sample size dietary habits, dietary diversity, types cases (malignant vs nonmalignant ), severity of illness (mild vs severely ill patients), types of surgery (elective vs emergency), hospital set up ,presence nutritional policy/support at hospital ,awareness of health professional about hospital malnutrition, nutritional assessment tool and support.
Despite the high prevalence of malnutrition, nutritional therapy was seldom prescribed to patients, thus reinforcing the fact that nutrition-related issues are not part of the patients’ routine care in the current study. This increase in under nutrition and length of hospital stay after admission which can be possibly due to low awareness on hospital malnutrition among medical staff, low attention to given nutritional support medical staff, less application nutrition course given at 2nd year of medical students training in our country university curriculum. In the current study setting, there is no weight and height scale which might simply use their physical judgment for nutritional assessment.
Routine evaluation of nutritional status was proposed which allows the identification of patients at risk of complications, particularly in the postoperative setting (28, 29). These patients should be targeted for specific nutritional support (30). However, only 16.8% of those with elective surgery before two weeks of admission and 43.5% of those who did surgery obtained nutritional support/counseling from the health professional. There are no official guidelines concerning hospital nutrition and the practice of nutritional therapy in the current study setting which can worsen the condition.
Different factors were identified to be associated with under nutrition. The magnitude malnutrition was significantly higher in the age group > 60 years. Similar significant report of malnutrition were reported among old age/elderly in studies from Albania (2), Spain (10), Taiwan (31), multi centered study from several Latin American countries (32) and Brazil (26, 3). That elder patient might have different condition which can impede or restrict nutritional intake like loose of appetites, co morbidities with chronic diseases. Diabetes mellitus and hyperextension are some of the chronic condition which requires nutritional restriction. Other reasons might be loneliness, depression, poor dentition and impairment of cognitive function, or secondary systemic disease. The magnitude under nutrition continues to increase from 47.1–52.1% among those with age greatest than 60 after surgery in this study. There is a need for nutritional support to elderly patients.
In the current study, males were less likely to undernourished. This is similar to study conducted from Brazil (33). The current study cannot establish cause-effect relationship because it’s cross-sectional nature. However, this fact might be due to the physiology of female aging and the decline of anthropometric variables with age is also considerably higher in women than in men.
Length hospital stay was identified associated with increased under nutrition in the current study. This was similar to studies conducted from Brazil (3, 33), Australia (22) and multi centered study from Latin America (32).
Reducing length of hospital stay (LOS) has the potential to decrease health care cost, risk of infections and other hospital acquired diseases, and to improve patients' quality of life. Prolonged hospital stay may predispose a patient to skin colonization with more virulent hospital-based pathogens. Hospitals with reduced LOS are said to have done better than others with longer stay (22, 34, 35). Reductions in postoperative length of stay may produce cost savings that can be invested in other areas of surgical patient care (36).
Those patients with emergency surgery are possibly under nourished than elective surgery in the current study. However, malnutrition was not related to the type of hospital admission (emergency or elective) or to the gender in other study (2).
This study used some basic nutritional assessment tool and biochemical assessment (hemoglobin). However, it did not include subjective assessment tool and other biochemical tests. This might provide additional information about the magnitude of the problems in the studied hospital.