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Am J Clin Nutr. 2016 Nov;104(5):1393-1402. Epub 2016 Oct 12.

To eat or not to eat? Indicators for reduced food intake in 91,245 patients hospitalized on nutritionDays 2006-2014 in 56 countries worldwide: a descriptive analysis.

Author information

Department of Internal Medicine III, Division of Endocrinology and Metabolism,
Core Unit for Medical Statistics and Informatics.
Division of Cardiac-, Thoracic-, Vascular Anesthesia and Intensive Care, and.
Departments of Cardiology and.
Research and Education, General Hospital Celje, Celje, Slovenia.
Department of Clinical Medicine, University La Sapienza, Rome, Italy.
Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University; Örebro, Sweden.
Gastroenterology and Nutrition, Archet University Hospital, Nice, France.
Department of Nutrition and Dietetics, Vrije Universiteit, Medical Center, Amsterdam, Netherlands.
Core Unit "Nutrition and Clinical Phenotyping," Integrated Research and Treatment Center AdiposityDiseases, University of Leipzig, Leipzig, Germany.
Section for Medical Expert and Knowledge-Based Systems, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and.
Geneva University Hospital, Geneva, Switzerland.



Inadequate nutrition during hospitalization is strongly associated with poor patient outcome, but ensuring adequate food intake is not a priority in clinical routine worldwide. This lack of priority results in inadequate and unbalanced food intake in patients and huge amounts of wasted food.


We evaluate the main factors that are associated with reduced meal intake in hospitalized patients and the differences between geographical regions.


We conducted a descriptive analysis of data from 9 consecutive, annual, and cross-sectional nutritionDay samples (2006-2014) in a total of 91,245 adult patients in 6668 wards in 2584 hospitals in 56 countries. A general estimation equation methodology was used to develop a model for meal intake, and P-value thresholding was used for model selection.


The proportion of patients who ate a full meal varied widely (24.7-61.5%) across world regions. The factors that were most strongly associated with reduced food intake on nutritionDay were reduced intake during the previous week (OR: 0.20; 95% CI: 0.17, 0.22), confinement to bed (OR: 0.49; 95% CI: 0.44, 0.55), female sex (OR: 0.53; 95% CI: 0.5, 0.56), younger age (OR: 0.74; 95% CI: 0.64, 0.85) and older age (OR: 0.80; 95% CI: 0.74; 0.88), and low body mass index (OR: 0.84; 95% CI: 0.79, 0.90). The pattern of associated factors was homogenous across world regions.


A set of factors that are associated with full meal intake was identified and is applicable to patients hospitalized in any region of the world. Thus, the likelihood for reduced food intake is easily estimated through access to patient characteristics, independent of world regions, and enables the easy personalization of food provision. This trial was registered at as NCT02820246.


disease-related malnutrition; food intake; hospital; mobility; patient sex; undernutrition

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