Factors Associated with Suboptimal Meal Intake in Older Adults Residing in Nursing Homes - A Nutritionday study

Rationale: Suboptimal food intake is a risk factor of malnutrition in older adults. Malnutrition in hospitals is associated with more complications, prolonged hospital stay and higher health care costs. The aim of this study was to identify factors associated with suboptimal hospital meal intake in older hospital patients across Europe. Methods: The intake of the main hospital meal in 43,603 older adults (≥65 y) in 2311 European hospitals was assessed yearly on one day (nutritionDay) between 2006 and 2013. The association of 53 demographic, disease and nutritional factors and meal intake (<50% or >=50% of main meal) was examined by logistic regression (backward stepwise elimination with P<0.05 as final selection criterion). 
Results: In total 57% of the older patients consumed <50% of their hospital meal. Factors independently associated with suboptimal meal intake included a higher number of: comorbidities (OR=1.1), lines/tubes (OR=1.2) and reasons for eating less (OR=1.2); liver diesease (vs. no)(OR=1.1), recent stroke (OR=1.1), post-surgery (OR=1.1), higher age (OR=1.2), special diet (OR=1.2), protein/energy supplements (OR=1.2), unable to walk without assistance (vs. able)(OR=1.5), swallowing/chewing problems (OR=1.5), female (vs. male)(OR=1.6), loss of appetite (OR=1.6), nausea (OR=1.6), parenteral (OR=1.9) or enteral+parenteral nutrition (OR=3.2). Patients eating normal in the past week (OR=0.4), who were admitted longer (OR=0.9), waiting for operation (OR=0.9) or had diabetes (OR=0.9), stroke (OR=0.9), COPD (OR=0.9) or brain/nerve (OR=0.9), nose/throat (OR=0.9) or lung (OR=0.9) diseases were less likely to have a suboptimal meal intake. 
Conclusion: More than half of older hospital patients consumes less than half of their meal which could predispose them to malnutrition. Understanding of the factors associated with reduced meal intake provides valuable information for preventive interventions.