The Trend of Nutritional Adequacy and Nutritional Routs among Imam Reza Teaching Hospital: A NutritionDay Review in 2019-2021

Document Type : Research Paper


1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Community Medicine and Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad.

5 International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Adequate nutrition is essential for the well-being of hospitalized patients. Assessing nutritional adequacy significantly affects patient-centered care. The nutritionDay (nDay) project, supported by ESPEN, conducts a global audit to evaluate nutritional risks. Imam Reza Teaching Hospital in Mashhad is one of the participating hospitals. This study examined the trend of nutritional adequacy in Imam Reza Teaching Hospital from nDay 2019 to 2021. Method: This cross-sectional study analyzed data collected from the nDay database of Imam Reza Teaching Hospital in Mashhad, Iran, between 2019 and 2021. Written consent was obtained, and the study followed international standards and the nDay questionnaire. Factors such as nutritional routs, energy goals, and energy intake were considered. All statistical analyses were performed using the Statistical Package for Social Sciences version 19.0. The three-year trend of nutritional adequacy was compared using the Chi-Square test. Result: A total of 414 patients from 14 departments of Imam Reza Hospital were included in the study during 2019-2021. There was no significant trend of energy goal among the wards during 2019-2021, except in women's burn, orthopedic surgery, and general surgery wards (P<0.001,<0.001,<0.001, respectively). There was a significant variation in energy intake during 2019-2021 in men’s burn, oncology, cardiac surgery, gynecology surgery, and general surgery wards (P<0.001, <0.001, <0.001, <0.001, <0.001, respectively). Conclusion: This study showed that burn and oncology patients did not achieve their energy goals, indicating the importance of nutritional care.


Main Subjects

  1. World Health Organization. WHO guideline on self-care interventions for health and well-being. World Health Organization. 2021.
  2. Wei X, Day AG, Ouellette-Kuntz H, Heyland DK. The Association Between Nutritional Adequacy and Long-Term Outcomes in Critically Ill Patients Requiring Prolonged Mechanical Ventilation: A Multicenter Cohort Study. Crit Care Med. 2015;43(8):1569-79.
  3. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. The critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. Journal of the Academy of Nutrition and Dietetics. 2013;113(9):1219-37.
  4. Starfield B. Is patient-centered care the same as person-focused care?. The Permanente Journal. 2011;15(2):63.
  5. Ostrowska J, Sulz I, Tarantino S, Hiesmayr M, Szostak-Węgierek D. Hospital Malnutrition, Nutritional Risk Factors, and Elements of Nutritional Care in Europe: Comparison of Polish Results with All European Countries Participating in the nDay Survey. Nutrients. 2021;13(1): 263.
  6. Correia MI, Hegazi RA, Higashiguchi T, Michel JP, Reddy BR, Tappenden KA, et al. Evidence-based recommendations for addressing malnutrition in health care: an updated strategy from the feedM.E. Global Study Group. J Am Med Dir Assoc. 2014;15(8):544-50.
  7. Sanson G, Bertocchi L, Dal Bo E, Di Pasquale CL, Zanetti M. Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study. Int J Nurs Stud. 2018;82:40-8.
  8. Reber E, Gomes F, Bally L, Schuetz P, Stanga Z. Nutritional Management of Medical Inpatients. J Clin Med. 2019;8(8):1130.
  9. Dhonukshe-Rutten RA, Bouwman J, Brown KA, Cavelaars AE, Collings R, Grammatikaki E, et al. EURRECA—an evidence-based methodology for deriving micronutrient recommendations. Critical Reviews in Food Science and Nutrition. 2013;53(10):999-1040.
  10. Román-Vinas B, Serra-Majem L, Ribas-Barba L, Ngo J, García-Álvarez A, Wijnhoven TM, et al. Overview of methods used to evaluate the adequacy of nutrient intakes for individuals and populations. British Journal of Nutrition. 2009;101(S2):S6-S11.
  11. Tarantino S, Hiesmayr M, Sulz I, Group nW. NutritionDay Worldwide Annual Report 2019. Clinical Nutrition ESPEN. 2022;49:560-667.
  12. Sauer AC, Goates S, Malone A, Mogensen KM, Gewirtz G, Sulz I, et al. Prevalence of malnutrition risk and the impact of nutrition risk on hospital outcomes: results from nutritionDay in the US. Journal of parenteral and enteral nutrition. 2019;43(7):918-26.
  13. Sun H, Zhang L, Zhang P, Yu J, Kang W, Guo S, et al. A comprehensive nutritional survey of hospitalized patients: Results from nutritionDay 2016 in China. PLoS One. 2018;13(3):e0194312.
  14. Hiesmayr M, Schindler K, Pernicka E, Schuh C, Schoeniger-Hekele A, Bauer P, et al. Decreased food intake is a risk factor for mortality in hospitalized patients: the NutritionDay survey 2006. Clinical Nutrition. 2009;28(5):484-91.
  15. Cong M, Wang J, Fang Y, Liu Y, Sun M, Wu Q, et al. A multi-center survey on dietary knowledge and behavior among inpatients in the oncology department. Support Care Cancer. 2018;26(7):2285-92.
  16. Bye A, Wesseltoft-Rao N, Iversen PO, Skjegstad G, Holven KB, Ulven S, et al. Alterations in inflammatory biomarkers and energy intake in cancer cachexia: a prospective study in patients with inoperable pancreatic cancer. Medical Oncology. 2016;33(6):54.
  17. Meure CM, Steer B, Porter J. Nutritional Intake, Hospital Readmissions and Length of Stay in Hospitalised Oncology Patients. Cancers. 2023;15(5):1488.
  18. Khorasanchi Z, Beidokhti MS, Rad NM, Dehnavi Z, Arabi SM, Sedaghat A, et al. Nutritional Requirements and Actual Dietary Intake of Adult Burn Patients. Journal of Nutrition, Fasting & Health. 2018;6(3).
  19. Hammad SM, Naser IA, Taleb MH, Abutair AS. Dietary intake and biochemical indicators and their association with wound healing process among adult burned patients in the Gaza strip. Current Research in Nutrition and Food Science Journal. 2019;7(1):169-81.
  20. Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the Nutrition Care Day Survey 2010. Clinical nutrition. 2013;32(5):737-45.
  21. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’(‘MUST’) for adults. British Journal of Nutrition. 2004;92(5):799-808.