Nutrition screening and assessment in hip fracture

Abstract

Protein-energy malnutrition is prevalent in one in two patients admitted with a hip fracture; commonly observed inadequate postoperative protein/energy intake leads to further incident inpatient malnutrition. This condition is reported as the most costly comorbidity in hip fracture. The complex, multimorbid population limits the usefulness of routinely applied malnutrition screening tools. Given the high cost, prevalence, and incidence of malnutrition, and poor sensitivity of most screening tools, routine comprehensive nutrition assessment of all acute hip fracture inpatients is recommended. There is no gold standard for malnutrition diagnosis in the clinical setting in hip fracture. Malnutrition diagnosis is complex in this patient population, and often requires triangulation of multiple nutrition assessment measures from a variety of sources over multiple time periods. Single variable measures should not be relied upon to diagnose malnutrition, and commonly applied index measures may still require a subjective clinical judgment to inform a final diagnosis.