The Hidden Risk of Missed Nutritional Care in Internal Medicine
Abstract
Background: Malnutrition is highly prevalent among hospitalized patients and is particularly common in Internal Medicine wards. Despite routine screening recommendations, nutritional risk often remains underrecognized and undertreated, potentially contributing to adverse clinical outcomes and increased healthcare costs. This study explored the hidden risks associated with missed opportunities in nutritional care, focusing on mortality and hospital resource utilization.
Methods: A retrospective cohort study was conducted including 1,150 adult admissions to Internal Medicine wards at ULS Santo António, Portugal, during 2022. Nutritional risk was assessed within the first 48 hours of admission using the Nutritional Risk Screening 2002 (NRS-2002). Statistical analysis was designed to quantify the association between nutritional risk and adverse outcomes, treating nutritional status as a clinical risk factor. Descriptive analyses were used to characterize the study population and estimate the prevalence of nutritional risk. Multivariable regression models were applied to evaluate the effect of nutritional risk on in-hospital mortality, post-discharge mortality and healthcare resource utilization while adjusting for relevant demographic and clinical covariates. Effect sizes were expressed as risk measures with corresponding 95% confidence intervals. Survival analysis techniques were used to assess time-dependent mortality outcomes, and model performance was evaluated to determine the discriminative value of nutritional risk as a predictor of adverse clinical events. The analytical framework emphasized risk quantification, predictive modelling and outcome stratification, illustrating how routinely collected hospital data can support evidence-based decision-making and resilience-oriented healthcare planning
Results: Nutritional risk was highly prevalent and was associated with substantially worse clinical outcomes. Patients identified as being at nutritional risk experienced higher mortality rates, greater healthcare utilization, and increased hospital costs compared with those not at risk. The study further highlighted that nutritional interventions were underutilized, suggesting that important opportunities to mitigate risk and improve outcomes were frequently missed.
Conclusions: Nutritional risk represents an important and potentially modifiable predictor of adverse outcomes in Internal Medicine patients. Early identification and appropriate nutritional intervention may reduce mortality and optimize resource utilization. These findings reinforce the need to integrate nutritional assessment and management into routine clinical practice, transforming nutritional care from an often-overlooked aspect of treatment into a key component of risk reduction strategies. Nutritional risk is not merely a nutritional problem; it is a clinical risk factor that influences survival and healthcare resource consumption.