Copyright! Reproduction and dissemination – also partial – applicable to all media only Peer Review | nutritionDay with written permission of Umschau Zeitschriftenverlag GmbH, Wiesbaden. Nutritional situation in German hospitals – Results of the nutritionDay project 20181, 2 Dorothee Volkert, Jasmin Weber, Eva Kiesswetter, Isabella Sulz, Michael Hiesmayr Introduction Abstract The aim of one project for the 14th German Nutrition Society Nutrition Food intake may be difficult or even impos- Report (DGE-Ernährungsbericht) was to describe the nutritional situation sible for people who are ill or in need of care in German hospitals and nursing homes using existing data from the glo- for a variety of reasons including e.g. loss of bal nutritionDay project, and to compare it with the situation in other appetite, swallowing difficulties, or cognitive European countries. In addition, the project aimed to collect current data impairments. In addition, diseases are often on the nutritional situation in German institutions as part of a nationwide accompanied by impaired nutrient utilisation initiative at nutritionDay 2018. The main hospital results of this initiative and/or increased energy and nutrient require- will be presented in this article. ments. Therefore, hospital patients are at an 25 hospitals with 48 wards and 767 patients participated and were subse- increased risk of malnutrition [1], which is as- quently included in the analysis. The results document that malnutrition is sociated with serious consequences not only a relevant health problem among German hospital patients, that required regarding the health of those affected, but also nutritional routines and infrastructures are not always in place, and that there is a clear deficit in terms of nutrition-related medical expertise. in terms of increased costs for the healthcare system [2]. Numerous studies have docu- Actions are urgently needed to improve nutritional care in hospitals, to mented a high prevalence of malnutrition in prevent the development of malnutrition and to adequately treat existing nutritional problems. hospitals [3–6]. In Germany, the nutritional situation of hospital patients was investigated Keywords: nutritionDay, malnutrition, nutritional situation, hospital, nutrition in the German Hospital Malnutrition Study team, nutrition report, food intake around 15 years ago [7]. Signs of malnutri- tion were found in 27% of the participating 1886 patients from 13 hospitals who were examined on the day of admission. Another multicenter study conducted in 15 German hospitals reported a markedly reduced body mass index (BMI) in 8.5% of the included study patients [8]. Besides, there is hardly any data available on this topic. The nutritionDay project nutritionDay is a global project with the core aim to increase awareness of nutritional problems in hospitals and care homes. Start- ing in Austria in 2006 in conjunction with the Council of Europe resolution to improve nutritional care in hospitals [9], meanwhile Citation institutions from 64 countries are taking Volkert D, Weber J, Kiesswetter E, Sulz I, Hiesmayr M (2019) Nu- part. Each year on a pre-defined date, data is tritional situation in German hospitals - Results of the nutritonDay collected on the nutritional situation of hospi- project 2018. Ernahrungs Umschau 66(10): 204–211 tal patients and care home residents with the This article is available online: DOI: 10.4455/eu.2019.045 1 This article is an extract from the relevant chapter of the Peer-reviewed 14th German Nutrition Society nutrition report. It can be Manuscript (original contribution) received: September 16, 2019 downloaded at www.dge.de/14-dge-eb/vvoe/kap2 Evaluated in the course of preparation of the 14th German Nutri- 2 With funding from the Federal Ministry of Food and Agri- tion Society nutrition report culture 204 Ernaehrungs Umschau international | 10/2019 Copyright! Reproduction and dissemination – also partial – applicable to all media only with written permission of Umschau Zeitschriftenverlag GmbH, Wiesbaden. support of staff and patients. Using standardized questionnaires, Recruitment of institutions which are available on the Internet in 30 languages (www.nutri- In addition to the usual advertising efforts of tionday.org), information on nutritional risk factors, nutritional the nutritionDay office in Vienna, nutrition- status and nutritional interventions is obtained at the level of the Day 2018, which took place worldwide on patient or resident and at institutional level. A short follow-up November 15, 2018, was advertised in Ger- data collection is performed 30 days later in the case of hospitals many using a variety of measures. As early as and 6 months later in the case of care homes. Immediately after spring 2018, research was underway to find the data is entered into a central database via the Internet, the the contact details of hospitals in Germany on participating hospital wards and care home sections receive an the Internet. Twenty-five university hospitals, evaluation of their results compared to all other participants, both 50 hospital nutrition teams and 100 other in their own country and worldwide, which can then be used for hospitals were contacted: first by e-mail and benchmarking purposes. The database is also available for sci- then by telephone. In case of interest, infor- entific use, and numerous publications were developed in recent mational material was then sent and support years (including [10–12]). from FAU staff offered regarding data entry. From the beginning of the project, institutions from Germany In addition, the project partners’ existing have also been taking part in the survey and feeding their data personal contacts were utilized: the project into the nutritionDay database online in anonymous form, al- partners got in touch with these contacts by though the number of participants has declined sharply in recent telephone and e-mail and encouraged them years. to participate. Furthermore, advertisements, short reports and more detailed articles in professional journals were used to increase awareness of the project. Over the course of Objectives the year, participation in nutritionDay was promoted at various congresses, at train- The aim of the project for the 14th German Nutrition Society Nu- ing courses for doctors and by Fresenius and trition Report was to describe the nutritional situation in German Nutricia sales representatives. Moreover, the hospitals and nursing homes using existing data from the global nutritionDay website was translated into Ger- nutritionDay project and to compare it with the situation in other man in order to facilitate access to the project European countries. In addition, the project aimed to collect cur- and to the questionnaires. The website was rent data through targeted promotion of the project as part of a also expanded upon with additional informa- Germany-wide initiative for nutritionDay 2018. The results are tion about the initiative in Germany specifi- to be used as the basis for recommendations for action aimed at cally. improving nutritional care in hospitals and nursing homes in Ger- Finally, 44 dietitian and nursing schools were many. contacted by e-mail and alerted to the oppor- This article summarizes a selection of results regarding the nu- tunity to participate in the project, and stu- tritional situation in German hospitals that were obtained as part dents on the masters course in Gerontology at of the Germany-wide nutritionDay 2018 initiative. The full ver- the FAU were offered to support the project in sion of the chapter “Nutritional situation in German hospitals and the context of a project work. nursing homes – results of the nutritionDay project” for the 14th German Nutrition Society Nutrition Report is available at www. Data collection procedure and content dge.de/14-dge-eb/vvoe/kap2. The data collection was carried out on nutri- tionDay, November 15, 2018 by the on-site staff, who were in part supported by pupils or students, as well as by the patients of the par- Methodology ticipating hospitals. A hospital questionnaire and a ward questionnaire were completed by This project was carried out in close co-operation between the doctors and nurses to collect general struc- participating partners: nutritionDay Vienna, the German Society tural information about the facility and about for Nutritional Medicine (Deutsche Gesellschaft für Ernährungs- the organization and structure of nutritional medizin—DGEM), the German Nutrition Society (Deutsche Ge- care. Another questionnaire, which was also sellschaft für Ernährung—DGE) and the Institute for Biomedicine completed by the staff for all patients present, of Aging (Institut für Biomedizin des Alterns—IBA) of the Frie- provided information about the patients (e.g. drich-Alexander University of Erlangen-Nuremberg (Friedrich-Al- weight, height, diagnoses, nutritional status, exander-Universität Erlangen-Nürnberg—FAU). nutritional therapies). In addition, all patients answered questions about themselves (e.g. Ernaehrungs Umschau international | 10/2019 205 Copyright! Reproduction and dissemination – also partial – applicable to all media only Peer Review | nutritionDay with written permission of Umschau Zeitschriftenverlag GmbH, Wiesbaden. Overview 1: Criteria for the recording of malnutrition in telligent Systems of the Medical University of the nutritionDay project Vienna using the statistics program R. The in- clusion criterion for the evaluation of patient • Underweight according to the WHO