PORTO ALEGRE — Sitting on the bed in her white hospital gown, Jéssica Almeida was devouring a hamburger. But the scene is deceiving. In total, the 17-year-old spent a month in the hospital and lost 10 kilograms (22 pounds).

Such weight loss, which might indicate malnutrition, is common among hospital patients in Brazil, and it increases the risk of complications. Malnutrition affects 40% to 60% of patients in hospitals across Latin America, a study published in June in the specialized journal Clinical Nutrition showed.

"When a patient is admitted to a hospital, he's being treated for his sickness but, unfortunately, concern with the patient's state of nutrition is very rarely part of the diagnosis," says Maria Isabel Correia, a doctor specialized in nutrition at the Federal University of Minas Gerais, who led the study.

This is exactly what happened to Jéssica when she entered a hospital in Porto Alegre with a rheumatic fever. "Nobody asked me anything about food."

There are different ways of checking whether a patient is malnourished. Involuntary weight loss is one of them, but alterations in eating habits can also indicate the patient is at risk, according to Correia.

Brazil's Ministry of Health has released a manual of nutritional therapy that advises specialized support staff at hospitals to give patients their full attention. Nutritional therapy includes screening, assessment of the patients at risk, evaluation of their nutritional needs, therapeutic indications and monitoring. For a patient at risk or already affected by malnutrition, there's either tube or intravenous feeding.

Hospital Suburbio — Photo: Govba

Losing a little weight while in hospital might seem completely unimportant, but a few kilos lost usually means that the condition is worsening, that the treatment is not working and therefore, that the patient will stay longer in hospital. It also significantly increases chances of dying. The study shows that a person with a high level of malnutrition is three times more likely to die (12.8%, but just 4.1% for mid-level malnutrition).

The research also reveals a lack of attention from hospital staff regarding patients' diet, showing a correlation between the number of days spent in hospital and malnutrition. The data shows that the longer a patient stays, the more chances he has of ending up being malnourished, from 40.2% on the first day to 55.2% after seven days, that percentage reaching 64.4% after 14 days.

Maria Isabel Correia says that the international consensus is that 50% of hospital patients are malnourished. "That's why we call it the most widespread disease in hospitals."

Jéssica first received the visit of a nutritionist four days after her admission. The next one came in the second week, after she was seen eating the hamburger. The young girl was losing weight and not eating properly.

Of course, malnutrition can have various causes, including the disease itself or the effects of certain medical procedures. Or, it can simply have to do with the patient's dislike of hospital food.

Hospital haute cuisine

To try and remedy the taste question, some hospitals, like the São Paulo Faculty of Medicine's Clinics Hospital (HC) are trying out new solutions inspired by cooking competitions like Masterchef: making plates more colorful, improve the food's texture and its presentation.

Hospital meal time in Sao Paulo — Photo: Mark Hillary

Beyond illness and long fasting periods to which patients are submitted, the lack of appetite regarding what they're served also plays an important part in malnutrition. "Everybody complains about hospital food," says Maria Carolina Gonçalves Dias, head nutritionist at the HC.

Many patients also need restrictive diets as part of their treatments. But being away from home is also an aggravating factor. "Hospital food is never exactly what you're used to at home," she says. The solution, therefore, is to make hospital food more appealing. And according to the nutritionist, the results are encouraging.

For Gonçalves Dias, the most important factor responsible for malnutrition in hospitals is the lack of a protocol, of knowledge about nutrition therapy. The nutritionist says the problem is not so complicated to solve, and that the fact that it persists is absurd, especially in a place like a hospital. "The patient shouldn't have to say more than just, 'I'm undernourished, you need to treat me.'"


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