
==== Front
Medicine (Baltimore)
Medicine (Baltimore)
MD
Medicine
0025-7974
1536-5964
Lippincott Williams & Wilkins Hagerstown, MD

MD-D-24-06906
00055
10.1097/MD.0000000000039563
3
5500
Research Article
Observational Study
Malnutrition and other associated factors among the hospitalized elderly in Vietnam: A cross-sectional study
Pham Thi Lan Anh MD, PhD ptlanhytcc@ump.edu.vn
a
Le Ngoc Thao Vy BSc lntvy.ddytcc19@ump.edu.vn
a
https://orcid.org/0000-0003-4650-3087
Doan Duy Tan MD, MSc a*
Pham Nhat Tuan MPH phamnhattuan@ump.edu.vn
a
a Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
* Correspondence: Tan Doan Duy, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, 700000, Vietnam (e-mail: doanduytaan@ump.edu.vn).
06 9 2024
06 9 2024
103 36 e3956319 6 2024
12 8 2024
14 8 2024
Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Malnutrition is common among older inpatients and can lead to severe consequences such as disability, assisted living, increased mortality, and prolonged hospital stays. Given the rapidly aging population in Vietnam, limited data is available regarding the nutritional status of the geriatric. This research aimed to determine the prevalence of malnutrition and associated factors among the hospitalized elderly. A prospective observational study with a cross-sectional design was conducted on 108 older inpatients at University Medical Center in Ho Chi Minh City, Vietnam. Patients aged 60 years or older admitted to the hospital were recruited. Malnutrition was assessed using a validated Mini Nutritional Assessment Short Form. Sociodemographic characteristics were measured using interview-administered questionnaires. Data about patients’ biochemical parameters were retrieved from records with the newest results. Among 108 hospitalized patients (mean age 74.6 ± 9.8 years; 50% female), 72.2% of patients had malnutrition (n = 78) while 27.8% had normal nutritional status (n = 30). Age group, education level, cohabitation, serum albumin, hand-drip strength, physical inactivity, and frailty were associated with malnutrition. The prevalence of malnutrition in the elderly accounts for a very high proportion. Nutritional status assessment is essential for the elderly; therefore, more attention should be paid to those risk factors in old age health care in order to improve medical outcomes.

associated factors
elderly
hospitalized
malnutrition
MNA-SF
OPEN-ACCESSTRUE
SDCT
==== Body
pmc1. Introduction

In accordance with the United Nations, the older adults are people who are aged 60 years or older. In the recent years, the number of older adults worldwide has increased rapidly: the figure is expected to double in the next 30 years.[1] Vietnam is one of the countries with the fastest population aging in the world. From 2019 statistical prediction, the number of the elderly is 11.41 million people (accounting for 11.86% of the total population) and will double by 2038.[2] As people age, they are highly susceptible to a wide range of age-related medical conditions, consequently, resulting in many challenges in ensuring medical care for the elderly.[3] Malnutrition, a nutritional disorder, affects the body from both functional and clinical perspectives. It is a general problem in the elderly due to physiological and psychological changes. A retrospective study of elderly people from 12 countries reported that the prevalence of malnutrition ranges from 5.8% in the community to 50.5% in rehabilitation settings.[4] Malnutrition can lead to various adverse issues for hospitalized elderly, listed as morbidity,[5] postoperative complications, prolonged hospital stays, increased rates of re-hospitalization, and mortality.[6] In this respect, the variety of tools has been developed to identify malnutrition.[7] Recommended by The European Society for Clinical Nutrition and Metabolism (ESPEN), the Mini Nutritional Assessment (MNA) has gained worldwide acceptance, relying on anthropometric, medical, lifestyle, dietary, and psychosocial factors.[8] MNA which was designed specifically for use among the elderly population has been validated in many care settings, including communities, hospitals, and nursing homes.[7] A short form of MNA (MNA-SF) has been developed as a time-saving nutritional screening tool that is easy to use in routine practice with comparable diagnostic accuracy to the full MNA.[9] Early detection of malnutrition and personalized nutrition intervention have been proven to improve treatment efficiency and quality of life of older malnourished patients.[10] Therefore, these fundamental tools help to delay or to prevent the associated poor outcomes in geriatric medicine. This indicates the need to assess the nutritional status of elderly people. However, not many studies have been performed on this topic in Vietnam. Some recent studies demonstrate that the malnutrition prevalence is pretty high ranging from 36% to 76,6% by MNA-SF.[11,12] It is crucial to identify patients with malnutrition at an early stage so as to start intervention, which can help improve their nutritional status and to prevent frailty. The purposes of this study are to provide data and to contribute scientific knowledge concerning malnutrition and other associated factors in the hospitalized older adults in Vietnam.

2. Materials and methods

2.1 . Study design

This cross-sectional study was conducted from March to June 2023 at University Medical Center, Ho Chi Minh City, Vietnam. The study sample consisted of the older inpatients who had been admitted to the Department of Geriatrics – Palliative Care.

2.2. Sample size calculation

The inclusion criteria are as follows: aged 60 or older; being mentally alert and able to listen and to give interviews. Participants were not included in this study if they were unable to perform the specific functional test (bedridden people, blind, and hearing loss), unable to communicate effectively (having severe mental or behavioral disorders), or those with motor impairment resulting from acute diseases.

The sample size was estimated using the formula for calculating a prevalence with d = 5% precision, 95% confidence level, and P = 34.6% expected malnourished majority reported by Huynh Trung Son among hospitalized elderly patients in Vietnam.[11] The sample size was determined using WHO Sample Size 2.0. The minimum required sample size was 108 patients.

2.3 . Data collection methods

Data were obtained using a structured questionnaire. Interviews were managed by trained nutritionists. Each interview was conducted through a face-to-face conversation between an interviewer and the participant. Subjects were all newly-admitted patients, in the first 48 hours by random selection.

2.4 . Study variables

2.4.1. Sociodemographic assessment

To acquire sociodemographic information, detailed questionnaires were used (e.g., gender, age, education level, cohabitation, living standard, the elderly patients were asked about their subjective feelings about their current living standard, and whether they have enough to live (average) or are in need (poverty)).

Participants’ comorbid conditions were collected based on medical records (existing diseases, chronic diseases, comorbidities).

Chronic diseases are identify by Centers for Disease Control and Prevention definition: “conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both.” Reference list of chronic diseases according to the List of diseases requiring long-term treatment of the Vietnam Ministry of Health (Circular 46/2016).

Chronic diseases listed in the study as hypertension, diabetes, chronic kidney failure, osteoarthritis, and others (including nephrotic syndrome, coronary artery disease, cirrhosis, liver failure, and chronic obstructive pulmonary disease).

2.4.2. Nutritional questionnaire

The MNA-SF questionnaire, used to assess nutritional status, contained 6 questions including anthropometric measurements (weight, height, and weight loss) and global assessment (questions related to medication, and mobility).[13] The license for using the questionnaire is provided in the Appendix 1, Supplemental Digital Content, http://links.lww.com/MD/N504. The patient’s medication is based on medical record, and dementia is diagnosed by a neurologist.

Based on the total score, people are classified into 3 nutritional statuses: normal nutritional status (score higher than 12), at risk of malnutrition (score from 8–11), and malnutrition (score below 7). This nutritional assessment tool has been validated and used in practice in Vietnam.

2.4.3. Nutritional classification

2.4.3.1. Malnutrition

Yes: MNA-SF score ranges from 0 to 11.

No: MNA-SF score ranges from 12 and above.

The reason why this study merges malnutrition and at risk of malnutrition is that elderly people in hospitals commonly had comorbidities, proportionately, which can change their nutritional status from at risk of malnutrition to malnutrition in a short period. Therefore, this grouping method helps to screen more effectively and to control related factors before reaching the malnutrition milestone.

2.4.4. Frailty assessment

The modified Fried frailty scale determined the level of frailty, including the following 5 criteria[14]:

- Weight loss of more than 5% or 4.5 kg, compared to the weight in the last 12 months.

- Exhaustion: 2 questions in the Centre for Epidemiologic Studies Depression Scale were used: “I felt that everything I did was an effort last week” and “I could not get going last week.” People were defined as having exhaustion if they answered “frequently” or “always,” at least once.

- Low physical activity was evaluated using the Rapid Assessment of Physical Activity. The patient replied “‘I rarely or never do any physical activity’,” considered inactive or low physical activity.[15]

- Slowness: A 15-step (4.57 m) walking time is used to assess physical performance, Walking time was compared to baseline adjusted for gender and height. We used a 15-step (4.75 m) walking time to assess physical performance. The cutoff points established were: (a) in male: height ≤ 173 cm: walking time ≥ 7 seconds; height > 173 cm: walking time ≥ 6 seconds; (b): in female: height ≤ 159 cm: walking time ≥ 7 seconds; height > 159 cm: walking time ≥ 6 seconds.[15,16]

- Weakness was evaluated based on hand-grip strength, using a Digital Hand Dynamometer Grip Strength (Cambry EH: 101). The arm was placed on the side of the body, and a 90° folding elbow held the force meter. The measurements were repeated 3 times, with the most significant value used in the analysis. The measurements were repeated 3 times, with the most significant value used in the analysis. Weakness was defined as a hand-grip strength of less than 17 kg and 29 kg in female and male, respectively.[15]

Those subjects who met 3 criteria or more were classified as frail and those who met from zero to 2 criteria were classified as non-frail (including <frail and robust).

2.4.5. Anthropometric measurements

Anthropometric measurements included: weight, height, and body mass index (BMI). Participants’ height (cm) was measured to the nearest 0.1 cm, using a stadiometer while weight (kg) was measured to the nearest 0.1 kg, using a digital electronic scale. Patients were weighed while wearing light clothing and without shoes, following the guide from Anthropometric Standardization Reference Manual.[17]

2.4.6. Laboratory sampling and examination

All biochemical parameters included in the analysis (listed as hemoglobin, albumin, creatinine, and lymphocyte count) were determined at the latest date of the interview during patients’ respective hospitalizations.[18] The definition of low hemoglobin level, low albumin level, low lymphocyte count and low creatinine level is listed below.

Low hemoglobin level[19]:

Male: hemoglobin < 130 mg/dL

Female: hemoglobin < 120 mg/dL

Low albumin level[19]: albumin < 35 mg/dL

Low lymphocyte count[20]: lymphocyte count < 1500 lympho/mm3

Low creatinine level[21]:

Male: creatinine < 0.9 mg/dL

Female: creatinine < 0.7 mg/dL.

2.5. Ethics approval and consent to participate

Ethical consideration of the study was reviewed and approved by the Biomedical Research Ethics Committees of the University of Medicine and Pharmacy at Ho Chi Minh City (Decision number 144/HĐĐĐ-ĐHYD signed on 07/02/2023). Participants were provided with information regarding the study including purpose, procedure, and risks. The written consent forms were signed and given to all participants. For participants who had difficulties in communication or were not able to read the form, their guardian signed the consent form on their behalf and assisted them during the interview.

2.6. Data management and analysis

Data was entered using Epi Data 3.1 and analyzed using Stata 14.0. Characteristics of participants were described as frequency and percentage, for quantitative variables: report mean or median with their standard deviation or interquartile percentile. The chi-square test (or Fisher tests) was used to assess the factors associated with malnutrition. P value < .05 was considered statistically significant. Prevalence ratios and 95% confidence interval were reported.

3. Results

According to the MNA-SF, nearly ¾ of the subjects (72.2%) belonged to the malnourished group in the study whereas 27.8% of them had normal nutritional status (Table 1). The components of MNA-SF illustrate that 62% of patients had reduced dietary intake. Most of the elderly lost more than 3 kg in the past 3 months (36.1%); 25.9% of patients had limited mobility, more than ½ patients had acute disease or psychological stress in the past 3 months (54.6%); most of the elderly had no neuropsychological problems (95.4%), patients with BMI >23 accounted for the majority (38.9%) (Table 2).

Table 1 Prevalence of malnutrition by MNA-SF.

Variables	Number, n (%)	95% CI	
Malnutrition	
 Yes
 No	78 (72.2)
30 (27.8)	62.8–80.4
19.6–37.2	
Data are presented as number and percentage (%).

CI = confidence interval.

Table 2 Prevalence of nutrition status and components (n = 108).

Variables	Number	Percentage	
Weight	54.6 ± 10.3*	Min: 28.8; Max: 101	
Height	1.58 ± 0.09*	Min: 1.40; Max: 1.83	
BMI	21.9 ± 3.6*	Min: 12.8; Max: 38.5	
BMI WHO classification	
 Underweight	13	12.0	
 Normal weight	80	74.1	
 Overweight/Obese	15	13,9	
Food intake declined over 3 months	
 Severe	24	22.2	
 Moderate	43	39.8	
 No decrease	41	38.0	
Weight loss	
 >3kg	39	36.1	
 Does not know	8	7.4	
 Between 1 and 3kg	24	22.2	
 No weight loss	37	34.3	
Mobility	
 Bed or chair-bound	28	25.9	
 Ability to get out of bed	49	45.4	
 Ability to go out	31	28.7	
Psychological stress or acute disease	
 Yes	59	54.6	
 No	49	45.4	
Neuropsychological problems	
 Severe dementia or depression	4	3.7	
 Mild dementia	1	0.9	
 No psychological problems	103	95.4	
BMI classification	
 BMI <19	18	16.7	
 BMI 19 to <21	28	25.9	
 BMI 21 to <23	20	18.5	
 BMI 23 or greater	42	38.9	
* Mean ± standard deviation.

The study included a total of 108 patients, with a mean age of 74.6 ± 9.8 years. Besides, the majority of patients had, at least, 1 chronic disease (86.1%), 50% of elderly patients had comorbidities. In which, hypertension (74.2%) and diabetes (45.7%) were the 2 most common chronic diseases. Among 93 patients with laboratory test results for hemoglobin and serum creatinine, the majority of patients had decreased hemoglobin (74.2%), for serum creatinine, 36.6% of patients had a decline in serum creatinine. The median hand-grip strength is 14.9 kg. More than 70% of elderly patients had decreased hand-grip strength, and more than 50% of patients had low physical activity. In accordance with Fried criteria, the prevalence of non-frail and frail was 35.2% and 64.8%, respectively (Table 3).

Table 3 Participant characteristics (n = 108).

Variables	Number	Percentage (%)	
Gender
 Male
 Female	54
54	50.0
50.0	
Age	74.6 ± 9.8*	Min: 60; Max: 95	
Age group
 60–69 years
 70–79 years
 80 years and above	41
34
33	38.0
31.5
30.5	
Education level
 Secondary and above
 Unfinished secondary	56
52	51.8
48.2	
Cohabitation
 Living alone
 Living with others	16
92	14.8
85.2	
Living standard
 Poverty
 Average	17
91	15.7
84.3	
Existing disease	5 (4–7)†	
Chronic disease
 Yes
 Hypertension
 Diabetes
 Chronic kidney failure
 Osteoarthritis
 Other	93
69
42
26
18
19	86.1
74.2
45.2
28.0
19.4
17.6	
Comorbidities
 Yes
 No	54
54	50.0
50.0	
Low hemoglobin level (g/dL)
 Yes
 No
Missing: 15	69
24	74.2
25.8	
Low albumin level (g/dL)
 Yes
 No
Missing: 53	46
9	83.6
16.4	
Low creatinine level (g/dL)
 Yes
 No
Missing: 15	34
59	36.6
63.4	
Low lymphocyte count (mm3)
 Yes
 No
Missing: 16	54
38	58.7
41.3	
Hand-grip strength	14.9 (6.5–18.9)†	
Decreased hand-grip strength
 Yes
 No	79
29	73.1
26.9	
Low physical activity
 Yes
 No	59
49	54.6
45.4	
Frailty status
 Frail
 Non-frail	70
38	64.8
35.2	
Other chronic diseases include: nephrotic syndrome, coronary artery disease, cirrhosis, liver failure, and chronic obstructive pulmonary disease.

* Mean ± standard deviation.

† Median (interquartile range).

According to Table 4 in the chi-square test, age group, education level, cohabitation, serum albumin were significantly associated with the prevalence of malnutrition (P < .05). The higher the age group is, the higher the prevalence of malnutrition becomes (PR = 1.35; 95% CI: 1.03–1.76). There was a great difference in the proportions of participants with malnutrition where the level of education was assessed, with more malnourished elderly in the lower education group (PR = 0.72; 95% CI: 0.56–0.91). Individuals living with others had a malnutrition prevalence of 0.73 times compared to that of those living alone (PR = 0.73; 95% CI: 0.61–0.88). Participants with hypoalbuminemia had a higher percentage of malnutrition compared to the group without albumin reduction (PR = 1.80; 95% CI: 1.08–3.04).

Table 4 Association of sociodemographic, clinical characteristics, and biochemical indicators with nutritional status by Mini Nutritional Assessment short form (MNA-SF) of elderly patients (n = 108).

Variables	Malnutrition	Prevalence ratio (95% CI)	P value*	
Yes
n = 78	No
n = 30	
Gender	
 Male
 Female	38 (70.4)
40 (74.1)	16 (29.6)
14 (25.9)	0.95 (0.75–1.20)	.667	
Age group	
 60–69 years
 70–79 years
 80 years and above	22 (53.7)
24 (70.6)
32 (97.0)	19 (46.3)
10 (29.4)
1 (3.0)	1.35 (1.03–1.76)	.032 †	
Education level	
 Secondary and above
 Unfinished secondary	34 (60.7)
44 (84.6)	22 (39.3)
8 (15.4)	0.72 (0.56–0.91)	.006	
Cohabitation	
 Living alone
 Living with others	63 (68.5)
15 (93.7)	29 (31.5)
1 (6.25)	0.73 (0.61–0.88)	.038 ‡	
Living standard	
 Poverty
 Average	65 (71.4)
13 (76.5)	26 (28.6)
4 (23.5)	0.93 (0.70–1.25)	.775‡	
Chronic disease	
 Yes
 No	68 (73.1)
10 (66.7)	25 (26.9)
5 (33.3)	1.09 (0.75–1.60)	.756‡	
Comorbidities	
 Yes
 No	40 (70.4)
38 (74.1)	14 (29.6)
16 (25.9)	0.95 (0.75–1.20)	.667	
Low hemoglobin level (g/dL)	
 Yes
 No	53 (76.8)
16 (66.7)	16 (23.2)
8 (33.3)	1.15 (0.84–1.57)	.328	
Low albumin level (g/dL)	
 Yes
 No	37 (80.4)
4 (44.4)	9 (19.6)
5 (55.6)	1.80 (1.08–3.04)	.037	
Low creatinine level (g/dL)	
 Yes
 No	27 (79.4)
43 (72.9)	7 (20.6)
16 (27.1)	1.09 (0.86–1.37)	.482	
Low lymphocyte count (mm3)	
 Yes
 No	42 (77.8)
26 (68.4)	12 (22.2)
12 (31.6)	0.88 (0.68–1.14)	.314	
CI = confidence interval.

† Trend analysis.

‡ Fisher exact test.

* P value in bold is below the significance level of .05.

According to the chi-square test between malnutrition and frailty (Table 5), frailty was significantly associated with the prevalence of malnutrition. Malnutrition was more common in frail elderly than those without frail (PR = 2.10; 95% CI: 1.44–3.08). While 4 of 5 components (except slowness) associated with the prevalence of malnutrition (P < .05). Patients with weakness had a rate of malnutrition 1.42 times higher than in the other group (PR = 1.42; 95% CI: 1.01–2.01). The proportion of participants with malnutrition was 1.66 times higher in physically inactive groups than in that of the active groups (PR = 1.66; 95% CI: 1.26–2.20). Elderly who lost more than 5% body weight within 12 months had a rate of malnutrition 1.71 times (PR = 1.71; 95% CI: 1.27–2.31) higher than the other group. Participants with exhaustion had a higher percentage of malnutrition compared to the group without (PR = 1.38; 95% CI: 1.10–1.73).

Table 5 Association frailty, the components of frailty with nutritional status by Mini Nutritional Assessment short form (MNA-SF) of elderly patients (n = 108).

Variables	Malnutrition	Prevalence ratio (95% CI)	P value*	
Yes
n = 78	No
n = 30	
Weight loss	
 Yes
 No	55 (87.3)
23 (51.1)	8 (12.7)
22 (48.9)	1.71 (1.27–2.31)	<.001	
Exhaustion	
 Yes
 No	38 (86.4)
40 (62.5)	6 (13.6)
24 (37.5)	1.38 (1.10–1.73)	.007	
Slowness	
 Yes
 No	65 (69.9)
13 (86.7)	28 (30.1)
2 (13.3)	0.80 (0.63–1.02)	.227†	
Weakness (decreased hand-grip strength)	
 Yes
 No	62 (78.5)
16 (55.2)	17 (21.5)
13 (44.8)	1.42 (1.01–2.01)	.017	
Low physical activity	
 Yes
 No	52 (88.1)
26 (53.1)	7 (11.9)
23 (46.9)	1.66 (1.26–2.20)	<.001	
Frailty status	
 Frail
 Non-frail	62 (88.6)
18 (42.1)	8 (11.4)
22 (57.9)	2.10 (1.44–3.08)	<.001	
CI = confidence interval.

† Fisher exact.

* P value in bold is below the significance level of .05.

4. Discussion

The prevalence of malnutrition/at risk of malnutrition among older inpatients was 72.2%, with more than a quarter of the population being at risk of malnutrition. Similar to those results of the prior studies published in 2021 with a malnutrition rate of 71.6%, respectively.[22] In contrast to the earlier findings by Ho Van Hung et al in dementia patients with a malnutrition rate of 66.0%[23] and the study by Xiaoyang Zhang et al with 52.99% malnutrition patients according to MNA-SF.[18] This difference can be explained by the fact that this study was conducted on elderly patients suffering from 1 or more chronic diseases. In addition, the study noted that more than ⅔ of patients had moderate to severe food intake declined, the muscle wasting in aging with a sedentary lifestyle (50% of patients with no exercise) reduces BMI, and leg circumference, resulting in a decrease in MNA-SF score. In comparison to other studies conducted among older persons in other care settings, the Vietnamese older persons in this current study were more likely to be malnourished. Those studies in Turkey and Sweden reported a lower prevalence of malnutrition, approximately ⅓ of the prevalence of malnutrition in this study (18.6%, 17%), respectively.[24,25] A possible reason for this discrepancy may result from the healthcare system in developed countries have better quality than that in Vietnam; consequently, the elderly in these countries are taken better care of.

There was a statistically significant relationship among the following factors: nutritional status and age group, education level, and living status. The fact that age factor has an impact on malnutrition in the elderly is in good agreement with the results from the previous study by Pelin Cin et al.[26] The changes in the aging process including decreased taste, smell, dental health are among the main reasons promoters of malnutrition.[27] Furthermore, geriatric people with lower education years were more malnourished than those with higher periods of education. With a high level of education, they often pay attention to their mental health; at the same time, they tend to have better nutritional practices than patients with less education. Most elderly people living with relatives will be supported both physically and mentally. This helps the elderly to recover from illness and improve their health better than the older people who are living alone without the help of other people. In addition, elderly who live alone often have a habit of skipping meals, increasing the risk of malnutrition. This fits well with the outcomes from these studies in Brazil and Turkey[26,28] and confirms our earlier findings. There was no association between sex, standard of living, chronic diseases, comorbidities with malnutrition. Most of the patients in the study had comorbidities. More than 80% of patients had at least 1 chronic disease; therefore, no correlation was found.

Xiaoyang Zhang study introduced similar results with much lower mean serum albumin in the malnutrition group compared with the normal group. Creatinine stored in muscle mass and older people typically changes body composition, with loss of lean mass and an increase in fat mass. This change is a natural process of aging; on the other hand, in elderly patients, malnutrition process takes place more quickly. However, the study did not find an association between serum creatinine and malnutrition, similar to that conducted by the author Zhang.[18] In addition to the decrease in creatinine due to malnutrition, the creatinine level can decrease in case of a problem with kidney function. To be more specific, one-third of the patients involved have renal failure; as a result, this can affect creatinine results in patients with malnutrition. The study did not find an association between lymphocyte count and serum hemoglobin.

The study found an association between frailty and nutrition, which matched well with the study at the Geriatric Hospital in Finland and in Australia.[29,30] When the diet is not provided enough in response to the increase in energy expenditure related to the metabolic phenomenon, the body will mobilize protein and lipid reserves to compensate for this deficiency. In addition, muscle weakness may be the result of prolonged malnutrition, muscle mass loss, and ultimately, clinical muscle loss. Pelin Cin study and Wong study found an association between physical fitness and exercise, with those people who exercised more often have a lower rate of malnutrition.[26,31]

The study which uses the MNA-SF has high reliability and is a specialized assessment tool for the elderly. The topic includes factors from many aspects revolving around the elderly as follows: society, pathology, geriatric syndrome, physical activity. Frailty and malnutrition usually overlap in hospital settings, the results suggest malnutrition is closely related to frailty. The main limitation is that this study is a cross-sectional design, consequently, there is no statement of causality. Another limitation is that the study samples are from 1 medical center, therefore, the results are limited in universality. Additionally, most older patients were admitted to the hospital due to acute conditions, which potentially affect their walking speed and muscle strength. To address this bias, when recruiting participants, we excluded patients who were unable to perform functional tests. Walking speed was measured only in those who could stand and walk, and muscle strength was assessed only in those who could perform a hand grip. Data collection occurred within 2 days of admission, excluding patients with prolonged stays typically due to severe illness and long-term muscle mass loss. Furthermore, the MNA-SF section inquired about acute illnesses in the past 3 months, not at the time of hospitalization. We selected an appropriate baseline for hospitalized patients according to Vu HTT et al and provided clear instructions for the functional tests to ensure patients performed to the best of their abilities.[16] On the other hand, the result can be a reference for other hospital-based studies in Vietnam and provides evidence for screening malnutrition in the older adult population. In conclusion, more prospective cohort studies in the elderly are needed to further understand the potential action in preventing, delaying or reversing malnutrition.

5. Conclusions

Hospital malnutrition is a significant health problem in Ho Chi Minh City. Sociodemographic characteristics and physical inactiveness are significant risk factors besides other clinical risk factors. The improvement of education and physical activities along with dietetics services is crucial to optimize patient outcomes.

Author contributions

Conceptualization: Anh Pham Thi Lan, Tan Doan Duy.

Data curation: Anh Pham Thi Lan, Vy Le Ngoc Thao, Tuan Pham Nhat, Tan Doan Duy.

Formal analysis: Anh Pham Thi Lan, Tan Doan Duy.

Investigation: Anh Pham Thi Lan, Vy Le Ngoc Thao, Tuan Pham Nhat, Tan Doan Duy.

Methodology: Anh Pham Thi Lan, Tan Doan Duy.

Supervision: Tan Doan Duy.

Writing – original draft: Anh Pham Thi Lan, Tan Doan Duy.

Writing – review & editing: Anh Pham Thi Lan, Vy Le Ngoc Thao, Tuan Pham Nhat, Tan Doan Duy.

Supplementary Material

Abbreviations:

BMI body mass index

MNA Mini Nutritional Assessment

MNA-SF Mini Nutritional Assessment Short Form

The written consent forms were signed and given to all participants. For participants who had difficulties in communication or were not able to read the form, their guardian signed the consent form on their behalf and assisted them during the interview.

The research proposal was accepted ethically in research by the Biomedical Research Ethics Committees at the University of Medicine and Pharmacy in Ho Chi Minh City, Vietnam number 144/HĐĐĐ- ĐHYD signed on 07/02/2023. Participants were provided with information regarding the study including purpose, procedure, and risks.

The authors have no funding and conflicts of interest to disclose.

The datasets generated during and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

Supplemental Digital Content is available for this article.

How to cite this article: Pham Thi Lan A, Le Ngoc Thao V, Doan Duy T, Pham Nhat T. Malnutrition and other associated factors among the hospitalized elderly in Vietnam: A cross-sectional study. Medicine 2024;103:36(e39563).
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