NutritionDay: effective strategy for understanding nutritional risk factors and facilitating the implementation of nutritional care protocols - an analysis over the years

NutritionDay: effective strategy for understanding nutritional risk factors and facilitating the implementation of nutritional care protocols - an analysis over the years | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article NutritionDay: effective strategy for understanding nutritional risk factors and facilitating the implementation of nutritional care protocols - an analysis over the years Grasiela Konkolisc Pina de Andrade, Ana Lucia Chalhoub Chediac Rodrigues, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4823607/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hospital malnutrition is a global debilitating problem; therefore, the implementation of nutritional monitoring protocols is essential for its early diagnosis and translates into better care. NutritionDay emerged from the need to document the global malnutrition scenario to improve patient safety and the quality of nutritional care. Our objective was to analyze nutritional care data from a high-complexity hospital obtained through the NutritionDay and to compare these data between years and with the results of other institutions in order to identify areas for nutritional care improvement. Methods A one-day cross-sectional retrospective study was conducted at the NutritionDay global data collection date. The data were analyzed by comparing the nutritional care provided at the hospital in 2019 with national and global scenarios. Additionally, data on nutritional care in our hospital from 2017 to 2020 was compared. Quantitative variable groups were compared by the Student’s t-test. Relationships were analyzed using the Pearson’s chi-square test or the Fisher’s exact test for categorical data. The significance level was set at 10. Results Weighing on admission is a point of improvement for all groups. In our hospital it led to the creation of an institutional indicator for its monitoring. From 2017 to 2020, nutritional screening and assessment used the body mass index (BMI) and a non-validated tool until 2018. After 2019, we adopted nutritional risk screening (NRS2002) and a tool based on the Global Leadership Initiative on Malnutrition (GLIM) to improve nutritional care. We found a trend towards improvement in satisfaction with the diet provided, which was associated with a significant increase in meal consumption and which is due to the monthly monitoring of meal satisfaction that generate action plans. We notice an increase in dietary restrictions reported by patients associated with adhering to a healthier diet. Thus, the composition of the meals changed over the years, with a decreased use of processed products. Conclusion The analysis of NutritionDay data is an effective strategy for better understanding nutritional risk factors, enabling comparisons with other services and facilitating the implementation of enhanced nutritional care protocols. Health sciences/Health care Health sciences/Risk factors NutritionDay hospital malnutrition nutritional care Figures Figure 1 Figure 2 Figure 3 1. BACKGROUND Hospital malnutrition is a global debilitating problem despite a significant body of research and established best practice guidelines 1 , 2 . Approximately one in four inpatients is malnourished on admission or will become malnourished during hospitalization due to disease-related loss of appetite, medication-related side effects, the need for fasting before tests, diseases impairing gastrointestinal functioning, and general hospital nutrition management deficits 3 . Impaired nutritional status is associated with increased morbidity and mortality, prolonged hospital stay, higher readmission probabilities, and increased hospital costs 4 . Therefore, the implementation of nutritional monitoring protocols and guidelines is essential for an early diagnosis and translates into better nutritional care, contributing to assertive interventions and reducing unfavorable clinical outcomes 2 , 5 , 6 . NutritionDay is a project of ESPEN (the European society for clinical nutrition and metabolism) and of the Medical University of Vienna and emerged from the need to survey and document the global malnutrition scenario in order to improve patient safety, nutritional risk factors, and factors related to the nutritional care process, increasing awareness and knowledge about hospital malnutrition 6 , 7 . Data analyses are the basis for identifying best practice models, benchmarking across institutions, and comparing regions worldwide 8 . In Brazil the data collection is organized by BRASPEN (sociedade brasileite de nutrição parenteral e enteral) and the local national NutritionDay coordinator Cristina Gonzales and her team. 2. METHODS Our objective was to analyze nutritional care data collected at the Hospital Sírio Libanês (HSL), located in the city of São Paulo – Brazil on the NutritionDay and to compare these data between years and with the results obtained by other national and international institutions to identify areas for nutritional care improvement. Study design A one-day cross-sectional retrospective study was conducted in the inpatient and intensive care units of Hospital Sírio-Libanês, São Paulo, SP, Brazil. The data were collected by anonymously completing the NutritionDay standard online questionnaire 9 between 2017 and 2020. The NutritionDay study consists of a one-day cross-sectional audit. It is carried out by filling out a questionnaire that has a part that the patient or caregiver fills out themselves and a part that a properly trained health professional asks questions and collects data from the medical record. Data security and anonymity are given particular attention through a randomly generated hospital and ward code, and a consecutive numbering of patients on the administrative sheet available on a ward. Upon participation, units receive a comprehensive unit report on their data with regional and worldwide comparison to units from the same specialty. The nutritionDay reports provide information about organisation and structures, disease specific information of patients or residentes, weight monitoring, mobility and social contacts, nutritional habits and apetite and food intake. Repeated participation allows benchmarking as well as monitoring of the nutrition care and its structure elements in the unit. Units are thus empowered, by available data, to determine local needs, to bring attention to specific area which need changes as well as to allow unit data comparison at a local and international level. The inclusion criteria were patients admitted between 7:00 a.m. and 7:00 p.m. on the NutritionDay data collection date who agreed to answer the questionnaire (including admissions and discharges during the period). Exclusion criteria included patients under 18 years old, those unable to answer the questions, or with incomplete medical records. Research procedures The patients underwent bedside interviews regarding physiological aspects that interfered with their diet and the characteristics of the meals served in the hospital. In addition, data such as weight, height, hospitalization diagnosis, health history, calculated nutritional needs, and possible in-hospital nutritional therapy complications were collected from the medical records. The previously trained multidisciplinary team (nutritionists, nurses, pharmacists, and physiotherapists) administered the questionnaires. Then, the data was directly entered on the NutritionDay website to be analyzed according to the reports issued, and data on the nutritional care provided at the hospital in 2019 were compared with data from national and international health institutions. The nutritional care provided between 2017 and 2020 was also compared. Ethical aspects We confirm that all research was performed in accordance with relevant guidelines and regulations. This study was approved by the Research Ethics Committee of Sírio Libanês Hospital. The Research Ethics Committee waived the Informed Consent Form because this is a retrospective study with secondary data collection. The research subjects’ privacy was guaranteed, and the collected data was solely and exclusively used for the presented project. The research project was submitted to the NutritionDay platform to obtain approval for the use of data for scientific production. Statistical analysis In descriptive analysis, simple and crossed tables were used for qualitative or categorized variables. Quantitative variables were represented by central tendency and dispersion measures, such as the mean and standard deviation. Normality was verified by the Shapiro-Wilk test, and a parametric or non-parametric test was chosen. Quantitative variable groups were compared by the Student’s t-test, and the non-parametric Mann-Whitney test was used when normality was not proven. Relationships were analyzed using the Pearson’s chi-square test or the Fisher’s exact test for categorical data, when necessary. The significance level was set at 10%, and the R packages 4.0.3 and SPSS software 22.0 were used. 3. RESULTS Tables 1 – 4 contain data obtained from the 2019 audit carried out on clinical patients. The patients were separated into three groups: HSL (n = 107), hospitals in Brazil (n = 45), and hospitals worldwide (n = 8,333). Table 1 shows the characteristics of the study population. At HSL the total number of beds is 220 and hospitalized patients were predominantly men (60.7%) with a mean age of 71.5 years (SD = 18.4), which was significantly higher than in the other groups. The mean body mass index (BMI) was 26.5 kg/m 2 (SD = 5.5), with no statistical difference compared to the other groups. At the HSL and other Brazilian hospitals, the main participating wards were neoplasms, pneumology and gastroenterology, while in other hospitals around the world there was participation mainly by cardiology and gastroenterology followed by pneumology and neoplasms. Regarding feeding routes, in the HSL group, all patients using supplementation also received meals (consumes oral food), and some of them were using mixed feeding routes - oral and enteral or oral and parenteral. This can also be observed in the other groups in the Brazil and world study. In Brazil, the mortality rate is lower than in the rest of the country but significantly higher than in the rest of the world. Table 1 Inpatient units - social, clinical, and nutritional characteristics of participants in the NutritionDay. Variable HSL Brazil World p Classification Men (n, %) 65 (60.7) 18 (40.0) 4,530 (50.0) 0.035 Age (mean, SD) 71.5 (18.4) 68.5 (18.8) 61.9 (20.5) 0.003 BMI (mean, SD) 26.5 (5.5) 24.2 (5.2) 25.7 (6.0) 0.051 Main participating wards (n, %) Neoplasms 24 (22.4) 25 (55.6) 1,432 (15.7) 0.000 Cardiology 16 (15.0) 5 (11.1) 2,038 (22.3) 0.036 Pneumology 27 (25.2) 6 (13.3) 1,457 (16.0) 0.031 Gastroenterology 24 (22.4) 9 (20.0) 2,166 (23.7) 0.796 Comorbidities (n, %) Diabetes 27 (25.7) 9 (20.0) 1,954 (22.3) 0.676 Cancer 40 (37.7) 30 (66.7) 1,765 (20.1) 0.000 Infection 23 (21.5) 18 (40.0) 1,303 (14.9) 0.000 Heart failure 22 (21.0) 3 (6.7) 1,685 (19.2) 0.125 Liver diseases 14 (13.3) 5 (11.1) 1,027 (11.8) 0.748 Feeding routes (n, %) Consumes oral food 85 (79.4) 38 (84.4) 5,724 (62.7) 0.000 Use of supplementation 28 (26.2) 14 (31.1) 1,547 (17.0) 0.005 Enteral nutrition 14 (13.1) 6 (13.3) 411 (4.5) 0.000 Parenteral nutrition 6 (5.6) 1 (2.2) 351 (3.8) 0.264 Dietary restrictions (n, %) Avoids sugar 26 (24.3) 11 (24.4) 1,511 (16.6) 0.040 Avoids carbohydrates 12 (11.2) 4 (8.9) 569 (6.2) 0.075 Low fat content 15 (14.0) 7 (15.6) 909 (10.0) 0.171 Lactose intolerance 1 (0.9) 3 (6.7) 290 (3.2) 0.155 Outcome (n, %) Death 6 (5.6) 6 (13.3) 260 (3.3) 0.003 Tables 2 and 3 show the nutritional care protocols adopted and the patients’ perception of their involvement in nutritional care. Weight at the time of admission is a point of improvement to be considered in all groups, with a frequency of weighing of 66.4% at the HSL, 63.6% in hospitals in Brazil, and 57.7% in hospitals around the world. As for the patients’ involvement in their nutritional care, the HSL has a significantly higher percentage than other hospitals in Brazil and worldwide, both regarding diagnostic information and planned nutritional treatment. Table 2 Inpatient units - nutrition-related protocols and care used with participants in the NutritionDay. Variable (n, %) HSL Brazil World p Nutritional support team 107 (100.0) 45 (100.0) 6,551 (79.5) 0.000 Nutritional care strategy 107 (100.0) 45 (100.0) 6,586 (79.9) 0.000 Nutritionist available for nutritional care 107 (100.0) 45 (100.0) 7,435 (89.2) 0.000 Use of nutritional care guidelines 107 (100.0) 45 (100.0) 6,863 (85.5) 0.000 Weight on admission 71 (66.4) 28 (63.6) 5,040 (57.7) 0.332 Individual nutritional care plan 107 (100.0) 0 (0.0) 1,488 (16.3) 0.000 Use of nutritional screening criteria 107 (100.0) 45 (100.0) 7,163 (86.0) 0.000 Use of nutritional assessment criteria 107 (100.0) 45 (100.0) 6,770 (81.2) 0.000 Energy requirement calculation 107 (100.0) 9 (20.0) 4,601 (50.4) 0.000 Protein requirement calculation 107 (100.0) 45 (100.0) 8,342 (91.4) 0.002 Table 3 Inpatient units - nutritional treatment perception and involvement by participants in the NutritionDay. Variable (n, %) HSL Brazil World p Patient informed about the nutritional diagnosis 89 (84.0) 30 (68.2) 3,318 (38.2) 0.000 Patient informed about the nutritional treatment 91 (85.0) 30 (68.2) 2,973 (34.3) 0.000 Table 4 and Fig. 1 address specific patient nutrition questions. No statistical difference between groups was observed regarding patient satisfaction or meal consumption. The HSL has virtually implemented all actions aimed at supporting patient meals, such as meal presentation, meal options, and respect for cultural/religious preferences. The only item in which the HSL is below the other groups is the standardization of different portion sizes offered to patients. As for the reasons mentioned for lower food consumption, only 4.7% of patients reported not liking the meal, a percentage similar to that found in other hospitals in Brazil (4.5%) but about half of that found in the rest of the world (9.5%). Table 4 Inpatient units - questions related to the diet of the participants in the NutritionDay. Variable (n, %) HSL Brazil World p Satisfaction with hospital meals 65 (83.3) 28 (80.0) 5,098 (82.2) 0.921 Consumes the whole meal 51 (56.7) 18 (45.0) 4,123 (48.2) 0.270 Supports adequate food intake Offers additional meals or between-meal snacks 107 (100.0) 45 (100.0) 6,280 (68.8) 0.000 Offers meal options 107 (100.0) 28 (62.2) 5,788 (63.5) 0.000 Offers different meal sizes 0 (0.0) 28 (62.2) 4,931 (54.1) 0.000 Considers food presentation 107 (100.0) 19 (42.2) 3,348 (36.7) 0.000 Changes food texture/consistency 107 (100.0) 45 (100.0) 7,037 (77.1) 0.000 Considers the patient’s issues with eating and drinking 107 (100.0) 36 (80.0) 7,385 (81.0) 0.000 Considers cultural/religious preferences 107 (100.0) 28 (62.2) 5,888 (64.5) 0.000 Considers allergy/intolerance 107 (100.0) 45 (100.0) 7,227 (79.2) 0.000 Tables 5 to 6 contain data obtained from the 2019 audit carried out on ICU patients. The patients were also separated into three groups: HSL (n = 36), hospitals in Brazil (n = 37), and hospitals around the world (n = 1,024). ICU patients were predominantly men (55.6%) with a mean age of 70.5 years (SD = 14.9), which was significantly higher than in the other groups. The mean BMI was 26.6 kg/m 2 (SD = 4.7), with no statistical difference compared to the other groups. At the HSL, the main reasons for hospitalization were heart disease and sepsis, whereas lung diseases and sepsis predominated in other hospitals in Brazil. In the rest of the world, hospitalization was mainly due to heart and lung diseases. Regarding the feeding routes in ICU patients, the same applies to that described for ward patients, that is, in the HSL group, all patients using supplementation also received meals (they consume food orally), and some of them used mixed feeding routes - oral and enteral or oral and parenteral. This can also be observed in the other groups in the Brazil and world study. In Brazil, the mortality rate is lower than in the rest of the country, but significantly higher than in the rest of the world. In Brazil, the mortality rate (14.3%) was significantly lower than in the other groups (24.3% in hospitals in Brazil and 24.8% in hospitals around the world). Table 5 Intensive care units - social, clinical, and nutritional characteristics of participants in the NutritionDay. Variable HSL Brazil World p Classification Men (n, %) 20 (55.6) 18 (48.6) 560 (54.9) 0.763 Age (mean, SD) 70.5 (14.9) 69.1 (17.7) 61.5 (17.4) 0.000 BMI (mean, SD) 26.6 (4.7) 26.2 (6.3) 26.8 (6.7) 0.864 SAPS (mean, SD) 42.3 (17.0) 51.8 (15.0) 39.9 (17.6) 0.000 Main diagnoses on admission (n, %) Cardiac 8 (22.2) 7 (18.9) 255 (24.9) 0.666 Neurologic 7 (19.4) 4 (10.8) 185 (18.1) 0.516 Abdominal 3 (8.3) 5 (13.5) 136 (13.3) 0.822 Pulmonary 5 (13.9) 8 (21.6) 229 (22.4) 0.497 Sepsis 7 (19.4) 11 (29.7) 127 (12.4) 0.007 Feeding routes (n, %) Consumes normal food 20 (58.8) 15 (45.5) 484 (48.6) 0.468 Use of supplementation 7 (20.0) 2 (5.7) 87 (8.6) 0.074 Use of enteral nutrition 10 (28.6) 21 (60.0) 490 (48.5) 0.025 Use of parenteral nutrition 5 (14.3) 10 (28.6) 182 (18.0) 0.219 Enteral nutrition therapy (mean, SD) Planned calories 1,108.0 (566.5) 1,423.5 (478.5) 1,393.7 (617.7) 0.467 Calories administered 999.5 (603.7) 1,462.5 (701.8) 1,127.4 (611.8) 0.090 Outcome (n, %) Death 5 (13.9) 9 (24.3) 207 (24.8) 0.000 Table 6 shows the nutritional care protocols and guidelines implemented at the HSL and compares them to those implemented in the other groups, showing a significantly higher number, especially compared to hospitals around the world. Table 6 Intensive care units - nutritional care protocols used with participants in the NutritionDay. Variable (n, %) HSL Brazil World p Nutritional support team 36 (100.0) 37 (100.0) 913 (89.8) 0.007 ICU nutrition protocol 36 (100.0) 28 (80.0) 672 (77.8) 0.006 Professional available for nutritional care 36 (100.0) 37 (100.0) 869 (85.4) 0.003 Written nutritional care procedures 36 (100.0) 37 (100.0) 944 (92.8) 0.061 Weight/height 36 (100.0) 37 (100.0) 904 (90.2) 0.011 Verification of laboratory parameters 36 (100.0) 37 (100.0) 826 (85.9) 0.000 Table 7 and Figs. 2 and 3 compare the data collected on the NutritionDay between 2017–2020 and analyze the evolution of nutritional care at the HSL. Women predominated in 2017 and 2020 (61.9% and 56.4% of the sample, respectively), with a mean age of 52.2 years (SD = 16.3) and 58.2 years (SD = 21.1), respectively; but an inversion occurred in 2018 and 2019, with a predominance of older men (53.6% and 60.7%, respectively), with a mean age of 65.8 (SD = 21.8) and 71.5 (SD = 18.4) years. BMI showed no statistical difference between years. As for screening and nutritional assessment, until 2018, they used the BMI and an assessment tool that, despite considering nutritional aspects, disease, and treatment, was not validated. After 2019, the HSL adopted the NRS 2002 screening 10 and a tool based on the GLIM 11 for nutritional assessment according to international guidelines. Regarding eating habits and satisfaction with meals, a tendency toward improved satisfaction with the diet served has been observed, which was associated with significantly increased meal consumption (Fig. 2 ) and increased patient-reported dietary restrictions (Fig. 3 ). Table 7 Nutritional care evolution at HSL (2017–2020). Variable 2017 n = 21 2018 n = 56 2019 n = 107 2022 n = 39 p Classification Men (n, %) 8 (38.1) 30 (53.6) 65 (60.7) 17 (43.6) 0.123 Age (mean, SD) 52.2 (16.3) 65.8 (21.8) 71.5 (18.4) 58.2 (21.1) 0.000 BMI (mean, SD) 25.2 (5.8) 24.8 (5.0) 26.5 (5.5) 26.7 (5.1) 0.139 Nutritional screening (n, %) BMI 21 (100.0) 56 (100.0) 0 (0.0) 0 (0.0) 0.000 NRS 0 (0.0) 0 (0.0) 107 (100.0) 31 (100.0) 0.000 Weight on admission 7 (33.3) 31 (55.4) 71 (66.4) 31 (79.5) 0.000 Nutritional assessment (n, %) BMI/ Visual assessment 21 (100.0) 56 (100.0) 0 (0.0) 0 (0.0) 0.000 Other tools (GLIM) 0 (0.0) 0 (0.0) 107 (100.0) 31 (100.0) 0.000 Main reasons for reducing food consumption (n, %) Type of food offered 1 (4.8) 7 (12.5) 5 (4.7) 0 (0.0) 0.065 Food smell/taste 9 (42.9) 5 (8.9) 1 (0.9) 0 (0.0) 0.000 Was not hungry 3 (14.3) 8 (14.3) 2 (1.9) 0 (0.0) 0.001 Did not have the usual appetite 11 (52.4) 14 (25.0) 11 (10.3) 1 (2.6) 0.000 Chewing/swallowing problems 3 (14.3) 2 (3.6) 0 (0.0) 0 (0.0) 0.002 Usually eats less 7 (33.3) 4 (7.1) 3 (2.8) 0 (0.0) 0.000 Nausea and vomiting 7 (33.3) 5 (8.9) 2 (1.9) 1 (2.6) 0.050 4. DISCUSSION Similar BMI values ​​from the present study (Tables 1 and 5 ) were reported in other studies, such as the one carried out in Brazil with ward inpatients with a BMI of 24.85 Kg/m 2 (SD = 4.25) and ICU patients with a BMI of 25.1 kg/m 2 (SD = 5.41) 7 ; in Colombia with a BMI of 26.2 Kg/m 2 (SD = 4.3) 12 ; and in Europe with a mean BMI of 26 kg/m 13 all using NutritionDay data, which corroborates our results and also does not report a statistical BMI differences compared to the other study groups. The HSL uses oral supplementation and enteral nutrition (EN) in clinical units similarly to other hospitals in Brazil but significantly more than in the rest of the world (Table 1 ) and in other studies also using the NutritionDay database 8 , 14 . This can be explained by the greater complexity of the patients treated at the HSL, since in the clinical units both inpatient and semi-intensive units were evaluated, and also because in some countries the insurance companies do not reimburse supplementation costs 15 . In ICUs, the use of oral supplementation is also higher at the HSL than in other groups, which can be explained by the greater number of patients consuming an oral diet (Table 5 ). Oral supplements are considered a key nutritional intervention approach for patients who can eat orally but do not meet the recommended amount 14 , 16 . Therefore, at the HSL, patients consuming less than 60% are indicated for oral supplementation, which would also justify the greater use of these products in the hospital. Adherence to the consumption of oral supplements in our hospital is checked at the time of the bedside visit (at least 3 times a week) and is asked whether the patient is consuming the entire supplement, more than half, half, less than half or not joined. Additionally, we look in the room for leftover or unopened jars. If there is no adherence to the use of supplementation, we offer alternatives such as flavorless supplements or those included in preparations and reinforce the importance of their consumption for nutritional restoration. Regarding the outcome, the mortality rate in clinical units (5.6%) exceeded the world rate (3.3%) (Table 1 ), which can be explained by the Brazil status as a developing country where patients are in general hospitalized in more severe conditions. However, compared to other hospitals in Brazil (13.3%) and to other studies such as the one by Pearcy et al. 2 and Tatsch et al. 7 , the HSL mortality rate is lower and can be justified because, despite being in a developing country, it is a private hospital with more resources than the average in the country and in some regions of the world. The implementation of processes for patients at nutritional risk is associated with decreased mortality 11 , decreased length of hospital stay, and better outcomes 15 . As for nutritional care protocols (Table 2 ), the HSL has standardized nutritional care with a specialized nutrition team and well-established protocols. The most relevant point of improvement is weight on admission. Although it is higher than the world mean (57.7%), in 2019 it reached 66.4% of patients, which is below the percentage reported in other studies such as that by Ostrowska (72.9%) 13 . However, continuous data analysis over the years (Table 7 ) helped implement new procedures, such as an institutional indicator with a goal of weighing at least 70% of patients on admission and educational actions involving the multidisciplinary team, which significantly increased this measurement between 2017 and 2020, from 33.3% to 79.5, respectively (p = 0.000). Studies have shown that patient involvement in health care actions improves service quality. For example, decreased appetite can be a barrier to adequate nutrition; however, it can be reduced by informing the patient about the importance of eating enough 8 . Over the years, HSL has prioritized patient involvement, with several actions implemented, such as initiating discharge guidelines at the beginning of hospitalization so that the patient has time to assimilate the information and clarify doubts, and using a whiteboard in the room with the main information about the patient’s care plan. These measures significantly increased the perception of patient involvement in their treatment compared to other hospitals in Brazil and worldwide (Table 3 ). Appropriate nutritional care, including meal quality control, has shown beneficial effects on patient outcomes 7 . The HSL has shown a tendency toward increased food satisfaction and a significant increase in total meal consumption (Fig. 2 ). This percentage is higher than the one seen in other studies, such as Hiesmayr et al., who reported that less than 50% of hospitalized patients ate the entire meal offered, with a negative impact on their clinical outcomes 8 . Additionally, the number of reports of patients who did not eat well due to meal quality decreased (not liking the diet or finding the taste and odor unpleasant) (Table 7 ), which is due to the monthly monitoring of meal satisfaction through indicators that generate action plans at critical points. Although patient satisfaction and total meal consumption showed no significant differences at the HSL compared to other hospitals in Brazil and the world (Table 4 ), only 4.5% of the patients reported not liking the food served, a result well below that found in the study by Varella et al. 12 , which showed that 22.2% of patients reported not consuming the whole meal because they did not like the food. Other reasons for lower consumption at the HSL are related to disease symptoms, not to the quality of the meals (Fig. 1 ), corroborating the main reasons mentioned in other studies that used the NutritionDay 5 , 8 . A multidisciplinary team's commitment to the nutritional care process is essential for obtaining positive results 5 , 8 . In this context, a positive point was the reduced number of patients mentioning chewing and swallowing difficulties as a reason for inadequate consumption over the years, which is mainly due to joint multidisciplinary actions, mainly involving speech therapists (Table 7 ). Some studies highlight that patients reduce intake not only due to disease or lack of appetite, but also due to changing habits or dissatisfaction with food preparation and service 5 , and that this situation can be reversed with simple interventions such as protected mealtimes, more meal options, and additional snacks 8 . As for the questions regarding the institution’s support for food intake, standardized procedures exist for adapting the dietary regimen both in terms of preferences and adapting meals to the clinical conditions of the patient (Table 4 ). However, we saw an opportunity for improvement in meal sizes. Although we have two meal sizes (whole or half meal), this is a dietary adaptation and not a standardization; in addition, we can be more flexible in adapting meal sizes to patients with certain symptoms such as nausea and vomiting. Tables 5 and 6 show the results for ICU patients. Some studies show that inpatients receive suboptimal EN 17 , reaching a mean adequacy of 60% 18 . Protocols addressing common factors that delay EN help avoid them before they become a problem 2 . As for the calorie offer in relation to calorie estimate, the HSL has a mean adequacy of 90.2% (which reaches the institutional target of 80%). This adequacy reaches 102.7% in other Brazilian hospitals, dropping to 80.8% around the world. The Simplified Acute Physiology Score (SAPS) is one of the most extensively validated scores for critically ill patients 19 . Although our mean SAPS (42.3 points) exceeded the rest (39.9 points) (Table 5 ), it remains lower than that of other hospitals in Brazil (51.8 points), as HSL follows the international patient care standards. This may explain the lower mortality rate in ICU patients than in the rest of Brazil and the world (p = 0.000). This standardization also includes the nutritional care provided at the ICUs (Table 6 ). Implementing a screening routine is positively associated with providing specialized nutrition to patients at risk of malnutrition 8 . As for screening and nutritional assessment (Table 7 ), until 2018, the HSL used the BMI and a nutritional assessment tool that considered food intake, diagnosis, and clinical conditions but was not validated. Aiming at better nutritional care and in accordance with international guidelines 2 , after 2019, the HSL adopted the NRS2002 screening 10 for screening and developed a tool based on the GLIM guidelines for nutritional assessment that considers both phenotypic and etiological patient information 11 . In addition, body composition is also systematically evaluated in cases of nutritional risk 20 . The frequency of some dietary restrictions has increased over the years (Fig. 3 ), which is also reported for the other groups (Table 1 ). These restrictions appear to be associated with adhering to a healthier diet, with reduced consumption of simple sugars or fats, which are positive changes as they aim for a healthy diet that reduces malnutrition and reverses unfavorable chronic disease tendencies 21 , 22 . Thus, the composition of the meals served in the hospital changed over the years, with a decreased use of processed products. In addition, some diets were standardized, such as gluten- or lactose-free and vegetarian diets. However, educational activities are important to discourage unnecessary restrictions, always aiming for a balanced diet that contributes to a full recovery. To this end, we provide a healthy eating guide and recipe books for patients 23 . Some limitations of the present study are the voluntary participation in the NutritionDay and the extensive databases, which may lead to missing data and non-homogeneous reports. Finally, data collection was affected by the COVID-19 pandemic in 2020, which may have interfered with the results obtained. 5. CONCLUSION The analysis of the data provided by the NutritionDay is an effective strategy to better understand the structures and factors associated with nutritional risks in inpatients, both in clinical units and in ICUs. This allows a comparison with other health services, enhances the implementation of effective nutritional care protocols and actions, and leads to improved clinical outcomes. Abbreviations Intensive care units (ICU) Body mass index (BMI) Nutritional risk screening (NRS2002) Global Leadership Initiative on Malnutrition (GLIM) Hospital Sírio Libanês (HSL) Enteral nutrition (EN) Simplified Acute Physiology Score (SAPS) Declarations Ethics approval and consent to participate This study was approved by the institution’s Research Ethics Committee. The Research Ethics Committee waived the Informed Consent Form because this is a retrospective study with secondary data collection. The research subjects’ privacy was guaranteed, and the collected data was solely and exclusively used for the presented project. The research project was submitted to the NutritionDay platform to obtain approval for the use of data for scientific production. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions GKPA: conceptualization, methodology, investigation, resources, data curation, writing - original draft, visualization, project administration. ALCCR: conceptualization, methodology, resources, writing - review & editing, supervision. ES : conceptualization, methodology, resources, writing - review & editing, supervision. LMY : conceptualization, methodology, investigation. JM : conceptualization, methodology, investigation. JBC: conceptualization, methodology, investigation. AY : resources, writing - review & editing, supervision. SNB : conceptualization, methodology. ANS: resources, writing - review & editing, supervision. SRM : writing - review & editing, supervision Acknowledgements We would like to thank everyone who contributed to holding NutritionDay in our hospital. References Heyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, Day A. Nutrition support in the critical care setting: current practice in Canadian ICUs–opportunities for improvement? JPEN J Parenter Enteral Nutr. 2003 Jan-Feb;27(1):74–83. Pearcy J, Agarwal E, Isenring E, Somani A, Wright C, Shankar B. Ward-based nutrition care practices and a snapshot of patient care: Results from NutritioNutritionDay in the ICU. Clinical Nutrition ESPEN. 2021:41;340–345. Gressies C, Tribolet P, Schuetz P. Nutrition issues in the general medical ward patient: From general screening to specific diagnosis and individualized treatment. JPEN J Parenter Enteral Nutr. 2023;47 Suppl 1:S16-S23. doi: 10.1002/jpen.2423 . Epub 2022 Dec 5. Barazzoni R, Sulz I, Schindler K, Bischoff SC, Cappellari GC, Hiesmayr M. A negative impact of recent weight loss on in-hospital mortality is not modified by overweight and obesity. Clinical Nutrition. 2020;39:2510–2516. Sampaio EJ, Meirelles ARN, Gusmão MHL, Cruz IS, Luedy A. Participação do Hospital Universitário no NUTRIDIA Brasil 2012: estratégia para a assistência segura ao paciente. Rev Acred. 2015;5(9):21–29. Schindler K, Pichard C, Sulz I, Volkert D, Streicher M, Singer P, Ljungqvist O, Van Gossum A, Bauer P, Hiesmayr M. NutritioNutritionDay: 10 years of growth. Clin Nutr. 2017;36(5):1207–1214. Tatsch CG, Fischer MQ, Dalmonte KS, Baelz K, Poll FA, Antunes CT. NutriDia Brasil: a atuação de um hospital de ensino nos anos de 2015 e 2016. Revista Saúde. 2018;44(2):2–8. Hiesmayr M, Schindler K, Pernicka E, Schuh C, Schoeniger-Hekele A, Bauer P, Laviano A, Lovell AD, Mouhieddine M, Schuetz T, Schneider SM, Singer P, Pichard C, Howard P, Jonkers C, Grecu I, Ljungqvist O; NutritioNutritionDay Audit Team. Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritioNutritionDay survey 2006. Clin Nutr. 2009;28(5):484–91. doi: 10.1016/j.clnu.2009.05.013 . NutritioNutritionDay. ICU questionnaires. (Accessed August 2, 2023, at https://www.nutritioNutritionDay.org/en/hospitals-intensive-care-units-.nursing-homes/intensive-care-units/questionaires/index.html. ) Kondrup J, Rasmussen HH, Hamberg O Stang Z, ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–36 Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. Clin Nutr. 2019;38:1–9 Varela ALV, Delgado EMG. Riesgo de malnutrición asociado a baja ingesta alimentaria, estancia hospitalaria prolongada y reingreso en un hospital de alto nivel de complejidad en Colombia. Nutr Hosp. 2015;32(3):1308–1314. Ostrowska J, Sulz I, Tarantino S, Hiesmayr M, Szostak-Węgierek D. Hospital Malnutrition, Nutritional Risk Factors, and Elements of Nutritional Care in Europe: Comparison of Polish Results with All European Countries Participating in the NutritionDay Survey. Nutrients. 2021;13(1):263. Rattanachaiwong S, Warodomwichit D, Yamwong P, Keawtanom S, Hiesmayr M, Sulz I, Singer P. Characteristics of hospitalized patients prescribed oral nutrition supplements in Thailand: A cross-sectional NutitioNutritionDay survey. Clin Nutr ESPEN. 2019;33:294–300. Hiesmayr M, Tarantino S, Moick S, Laviano A, Sulz I, Mouhieddine M, Schuh C, Volkert D, Simon J, Schindler K. Hospital Malnutrition, a Call for Political Action: A Public Health and NutritioNutritionDay Perspective. J Clin Med. 2019;8(12):2048. doi: 10.3390/jcm8122048 . Jobse I, Liao Y, Bartram M, Delantonio K, Uter W, Stehle P, Sieber CC, Volkert D. Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status. J Nutr Health Aging. 2015;19(3):356–64. doi: 10.1007/s12603-014-0544-y . Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: what is "best achievable" practice? An international multicenter observational study. Crit Care Med. 2010;38(2):395–401. doi: 10.1097/CCM.0b013e3181c0263d . Bendavid I, Singer P, Theill:a M, Themessl-Huber M, Sulz I, Mouhieddine M, Schuh C, Mora B, Hiesmayr M. NutritioNutritionDay ICU: A 7 year worldwide prevalence study of nutrition practice in intensive care. Clin Nutr. 2017;36(4):1122–1129. doi: 10.1016/j.clnu.2016.07.012. Epub 2016 Aug 9. Jahn M, Rekowski J, Jánosi RA, Kribben A, Canbay A, Katsounas A. Score performance of SAPS 2 and SAPS 3 in combination with biomarkers IL-6, PCT or CRP. PLoS One. 2020;15(9). doi: 10.1371/journal.pone.0238587 . PMID: 32881963. Andrade GKP, Carvalho JB, Nascimento LA, Rodrigues ALCC, Severine AN. Nutritional assessment team: body composition assessment protocol in hospitalized patients. Clinical Nutrition Open Science. 2022 Apr 42:119–129. Ministério da Saúde. Guia alimentar da população brasileira. Brasilia, 2014. (Accessed July 23, 2023, at https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf) . Frank Hu, MD, Lilian Cheung, ScD, Brett Otis Nancy Oliveira, Healthy Living Guide. Department of Nutrition at the Harvard, 2022–2023. Accessed July 12, 2023, at https://www.hsph.harvard.edu/nutritionsource/2023/01/04/healthy-living-guide-2022-2023 ). Hospital Sírio Libanês. Guia de receitas. (Accessed August 2, 2023, https://www.hospitalsiriolibanes.org.br/receitas ). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4823607","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":347980467,"identity":"44158ddf-4549-4662-9472-3431563111ad","order_by":0,"name":"Grasiela Konkolisc Pina de Andrade","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYLCCBAYLBgkGBsYHQDYPH5FaJEBamA1AWtiItAeshU0CxCSoRT768OMPDyok5CVnNz+r/JpjJ8PGwPzw0Q08WgzPpZlJJJyRMJwtc8zstuy2ZKDD2IyNc/Bp6WEwY0hsk2CcJ5FgdltyGzNQCw+bNH4t7J8/JP6TsJ8nkf6tWHJbPWEt8jw8BhKJDRKJsyVyzBg/bjtMWIsBD0+ZRMIxieSZc84USzNuO87DxkzAL/I97Js//qixsZ1xu33jx5/bqu352ZsfPsZrywEYCxSXPCAGMx7lYFsakLQw/iCgehSMglEwCkYmAACyCEJCxn2e2gAAAABJRU5ErkJggg==","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":true,"prefix":"","firstName":"Grasiela","middleName":"Konkolisc Pina","lastName":"de Andrade","suffix":""},{"id":347980470,"identity":"abf7c272-39e4-4972-a81a-099528ae8f8a","order_by":1,"name":"Ana Lucia Chalhoub Chediac Rodrigues","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Lucia Chalhoub Chediac","lastName":"Rodrigues","suffix":""},{"id":347980472,"identity":"5d984dd5-341d-4326-b611-3fe48c9cb26b","order_by":2,"name":"Erika Suiter","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Erika","middleName":"","lastName":"Suiter","suffix":""},{"id":347980474,"identity":"1312bc4e-aa9c-44c4-957e-a3f6a4e99481","order_by":3,"name":"Luciana Miyuki Yamashita","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Luciana","middleName":"Miyuki","lastName":"Yamashita","suffix":""},{"id":347980475,"identity":"9c8a504a-ba8e-4729-bb56-6f0bef7666bd","order_by":4,"name":"Jessica Madeira","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"","lastName":"Madeira","suffix":""},{"id":347980476,"identity":"9d491287-8a78-415a-b1f8-aa198fa1d2c0","order_by":5,"name":"Juliana Bonfleur Carvalho","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Juliana","middleName":"Bonfleur","lastName":"Carvalho","suffix":""},{"id":347980477,"identity":"2f74d8d8-1ec0-4b5e-88d0-62d493ebd3dc","order_by":6,"name":"Adriana Yamaguti","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Adriana","middleName":"","lastName":"Yamaguti","suffix":""},{"id":347980478,"identity":"5a5ee09e-b5f8-4291-b5df-8ea722c90823","order_by":7,"name":"Sabine Nunes Boilesen","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Sabine","middleName":"Nunes","lastName":"Boilesen","suffix":""},{"id":347980479,"identity":"aa1456e6-e165-49bd-987d-29484146965f","order_by":8,"name":"Ariane Nadolskis Severine","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Ariane","middleName":"Nadolskis","lastName":"Severine","suffix":""},{"id":347980480,"identity":"391c288b-2c86-4e28-9f5b-9574b77419f2","order_by":9,"name":"Silmara Rodrigues Machado","email":"","orcid":"","institution":"Hospital Sírio-Libanês","correspondingAuthor":false,"prefix":"","firstName":"Silmara","middleName":"Rodrigues","lastName":"Machado","suffix":""}],"badges":[],"createdAt":"2024-07-29 17:00:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4823607/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4823607/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64569835,"identity":"2e296c87-35e8-4061-af08-542496490ce2","added_by":"auto","created_at":"2024-09-16 00:54:45","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":189741,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReasons mentioned for reduced food consumption at the HSL compared to Brazil and the world (%). *p \u0026lt; 0.05, **p \u0026lt; 0.01.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4823607/v1/1d4914b6a74a8ff3536f3e8a.jpeg"},{"id":64569239,"identity":"04e9e7de-d8e9-41e3-ad81-ac081b5fea32","added_by":"auto","created_at":"2024-09-16 00:46:45","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":88340,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSatisfaction and total consumption of the meal served in the hospital (%). * p = 0.000.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4823607/v1/19202018ddf501ea29f4425d.jpeg"},{"id":64569240,"identity":"5fb5de59-4ebb-426e-b495-b28489301564","added_by":"auto","created_at":"2024-09-16 00:46:45","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":106250,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDietary restrictions reported over the years (%). *p \u0026lt; 0.0001, **p \u0026lt; 0.001, ***p \u0026lt; 0.005.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4823607/v1/81c498ce0e180a991e5fd135.jpeg"},{"id":65563901,"identity":"2067db8c-694b-4368-ab28-0c93779f2d74","added_by":"auto","created_at":"2024-09-30 04:46:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1222079,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4823607/v1/075d85d2-e4af-4ff6-9e1a-0418c9fc7848.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"NutritionDay: effective strategy for understanding nutritional risk factors and facilitating the implementation of nutritional care protocols - an analysis over the years","fulltext":[{"header":"1. BACKGROUND","content":"\u003cp\u003eHospital malnutrition is a global debilitating problem despite a significant body of research and established best practice guidelines\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Approximately one in four inpatients is malnourished on admission or will become malnourished during hospitalization due to disease-related loss of appetite, medication-related side effects, the need for fasting before tests, diseases impairing gastrointestinal functioning, and general hospital nutrition management deficits\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eImpaired nutritional status is associated with increased morbidity and mortality, prolonged hospital stay, higher readmission probabilities, and increased hospital costs\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Therefore, the implementation of nutritional monitoring protocols and guidelines is essential for an early diagnosis and translates into better nutritional care, contributing to assertive interventions and reducing unfavorable clinical outcomes\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNutritionDay is a project of ESPEN (the European society for clinical nutrition and metabolism) and of the Medical University of Vienna and emerged from the need to survey and document the global malnutrition scenario in order to improve patient safety, nutritional risk factors, and factors related to the nutritional care process, increasing awareness and knowledge about hospital malnutrition\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Data analyses are the basis for identifying best practice models, benchmarking across institutions, and comparing regions worldwide\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. In Brazil the data collection is organized by BRASPEN (sociedade brasileite de nutri\u0026ccedil;\u0026atilde;o parenteral e enteral) and the local national NutritionDay coordinator Cristina Gonzales and her team.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cp\u003e Our objective was to analyze nutritional care data collected at the Hospital S\u0026iacute;rio Liban\u0026ecirc;s (HSL), located in the city of S\u0026atilde;o Paulo \u0026ndash; Brazil on the NutritionDay and to compare these data between years and with the results obtained by other national and international institutions to identify areas for nutritional care improvement.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eStudy design\u003c/span\u003e \u003c/p\u003e \u003cp\u003e A one-day cross-sectional retrospective study was conducted in the inpatient and intensive care units of Hospital S\u0026iacute;rio-Liban\u0026ecirc;s, S\u0026atilde;o Paulo, SP, Brazil. The data were collected by anonymously completing the NutritionDay standard online questionnaire\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e between 2017 and 2020.\u003c/p\u003e \u003cp\u003eThe NutritionDay study consists of a one-day cross-sectional audit. It is carried out by filling out a questionnaire that has a part that the patient or caregiver fills out themselves and a part that a properly trained health professional asks questions and collects data from the medical record. Data security and anonymity are given particular attention through a randomly generated hospital and ward code, and a consecutive numbering of patients on the administrative sheet available on a ward. Upon participation, units receive a comprehensive unit report on their data with regional and worldwide comparison to units from the same specialty. The nutritionDay reports provide information about organisation and structures, disease specific information of patients or residentes, weight monitoring, mobility and social contacts, nutritional habits and apetite and food intake. Repeated participation allows benchmarking as well as monitoring of the nutrition care and its structure elements in the unit. Units are thus empowered, by available data, to determine local needs, to bring attention to specific area which need changes as well as to allow unit data comparison at a local and international level.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were patients admitted between 7:00 a.m. and 7:00 p.m. on the NutritionDay data collection date who agreed to answer the questionnaire (including admissions and discharges during the period). Exclusion criteria included patients under 18 years old, those unable to answer the questions, or with incomplete medical records.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eResearch procedures\u003c/span\u003e \u003c/p\u003e \u003cp\u003eThe patients underwent bedside interviews regarding physiological aspects that interfered with their diet and the characteristics of the meals served in the hospital. In addition, data such as weight, height, hospitalization diagnosis, health history, calculated nutritional needs, and possible in-hospital nutritional therapy complications were collected from the medical records.\u003c/p\u003e \u003cp\u003eThe previously trained multidisciplinary team (nutritionists, nurses, pharmacists, and physiotherapists) administered the questionnaires. Then, the data was directly entered on the NutritionDay website to be analyzed according to the reports issued, and data on the nutritional care provided at the hospital in 2019 were compared with data from national and international health institutions. The nutritional care provided between 2017 and 2020 was also compared.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eEthical aspects\u003c/span\u003e \u003c/p\u003e \u003cp\u003e We confirm that all research was performed in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003cp\u003e This study was approved by the Research Ethics Committee of S\u0026iacute;rio Liban\u0026ecirc;s Hospital. The Research Ethics Committee waived the Informed Consent Form because this is a retrospective study with secondary data collection. The research subjects\u0026rsquo; privacy was guaranteed, and the collected data was solely and exclusively used for the presented project.\u003c/p\u003e \u003cp\u003e The research project was submitted to the NutritionDay platform to obtain approval for the use of data for scientific production.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eStatistical analysis\u003c/span\u003e \u003c/p\u003e \u003cp\u003eIn descriptive analysis, simple and crossed tables were used for qualitative or categorized variables. Quantitative variables were represented by central tendency and dispersion measures, such as the mean and standard deviation. Normality was verified by the Shapiro-Wilk test, and a parametric or non-parametric test was chosen. Quantitative variable groups were compared by the Student\u0026rsquo;s t-test, and the non-parametric Mann-Whitney test was used when normality was not proven. Relationships were analyzed using the Pearson\u0026rsquo;s chi-square test or the Fisher\u0026rsquo;s exact test for categorical data, when necessary. The significance level was set at 10%, and the R packages 4.0.3 and SPSS software 22.0 were used.\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e contain data obtained from the 2019 audit carried out on clinical patients. The patients were separated into three groups: HSL (n\u0026thinsp;=\u0026thinsp;107), hospitals in Brazil (n\u0026thinsp;=\u0026thinsp;45), and hospitals worldwide (n\u0026thinsp;=\u0026thinsp;8,333).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the characteristics of the study population. At HSL the total number of beds is 220 and hospitalized patients were predominantly men (60.7%) with a mean age of 71.5 years (SD\u0026thinsp;=\u0026thinsp;18.4), which was significantly higher than in the other groups. The mean body mass index (BMI) was 26.5 kg/m\u003csup\u003e2\u003c/sup\u003e (SD\u0026thinsp;=\u0026thinsp;5.5), with no statistical difference compared to the other groups. At the HSL and other Brazilian hospitals, the main participating wards were neoplasms, pneumology and gastroenterology, while in other hospitals around the world there was participation mainly by cardiology and gastroenterology followed by pneumology and neoplasms.\u003c/p\u003e \u003cp\u003e Regarding feeding routes, in the HSL group, all patients using supplementation also received meals (consumes oral food), and some of them were using mixed feeding routes - oral and enteral or oral and parenteral. This can also be observed in the other groups in the Brazil and world study. In Brazil, the mortality rate is lower than in the rest of the country but significantly higher than in the rest of the world.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInpatient units - social, clinical, and nutritional characteristics of participants in the NutritionDay.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHSL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorld\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,530 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (mean, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.5 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.5 (18.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.9 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (mean, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.5 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.2 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.7 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMain participating wards (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoplasms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,432 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,038 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,457 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastroenterology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,166 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.796\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eComorbidities (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (25.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,954 (22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,765 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (21.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,303 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,685 (19.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,027 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eFeeding routes (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsumes oral food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (84.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,724 (62.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of supplementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (31.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,547 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnteral nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e411 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParenteral nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e351 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDietary restrictions (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoids sugar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (24.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,511 (16.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvoids carbohydrates\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e569 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow fat content\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e909 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLactose intolerance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e290 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eOutcome (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e260 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e show the nutritional care protocols adopted and the patients\u0026rsquo; perception of their involvement in nutritional care. Weight at the time of admission is a point of improvement to be considered in all groups, with a frequency of weighing of 66.4% at the HSL, 63.6% in hospitals in Brazil, and 57.7% in hospitals around the world. As for the patients\u0026rsquo; involvement in their nutritional care, the HSL has a significantly higher percentage than other hospitals in Brazil and worldwide, both regarding diagnostic information and planned nutritional treatment.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInpatient units - nutrition-related protocols and care used with participants in the NutritionDay.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHSL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorld\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional support team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,551 (79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional care strategy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,586 (79.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritionist available for nutritional care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,435 (89.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of nutritional care guidelines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,863 (85.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight on admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71 (66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,040 (57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndividual nutritional care plan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,488 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of nutritional screening criteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,163 (86.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of nutritional assessment criteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,770 (81.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnergy requirement calculation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,601 (50.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtein requirement calculation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8,342 (91.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInpatient units - nutritional treatment perception and involvement by participants in the NutritionDay.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHSL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorld\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient informed about the nutritional diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89 (84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,318 (38.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient informed about the nutritional treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91 (85.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (68.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,973 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e address specific patient nutrition questions. No statistical difference between groups was observed regarding patient satisfaction or meal consumption. The HSL has virtually implemented all actions aimed at supporting patient meals, such as meal presentation, meal options, and respect for cultural/religious preferences. The only item in which the HSL is below the other groups is the standardization of different portion sizes offered to patients. As for the reasons mentioned for lower food consumption, only 4.7% of patients reported not liking the meal, a percentage similar to that found in other hospitals in Brazil (4.5%) but about half of that found in the rest of the world (9.5%).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInpatient units - questions related to the diet of the participants in the NutritionDay.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHSL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorld\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction with hospital meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,098 (82.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsumes the whole meal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,123 (48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eSupports adequate food intake\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOffers additional meals or between-meal snacks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,280 (68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOffers meal options\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,788 (63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOffers different meal sizes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,931 (54.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsiders food presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,348 (36.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChanges food texture/consistency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,037 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsiders the patient\u0026rsquo;s issues with eating and drinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,385 (81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsiders cultural/religious preferences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,888 (64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsiders allergy/intolerance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,227 (79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e to \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e contain data obtained from the 2019 audit carried out on ICU patients. The patients were also separated into three groups: HSL (n\u0026thinsp;=\u0026thinsp;36), hospitals in Brazil (n\u0026thinsp;=\u0026thinsp;37), and hospitals around the world (n\u0026thinsp;=\u0026thinsp;1,024).\u003c/p\u003e \u003cp\u003eICU patients were predominantly men (55.6%) with a mean age of 70.5 years (SD\u0026thinsp;=\u0026thinsp;14.9), which was significantly higher than in the other groups. The mean BMI was 26.6 kg/m\u003csup\u003e2\u003c/sup\u003e (SD\u0026thinsp;=\u0026thinsp;4.7), with no statistical difference compared to the other groups. At the HSL, the main reasons for hospitalization were heart disease and sepsis, whereas lung diseases and sepsis predominated in other hospitals in Brazil. In the rest of the world, hospitalization was mainly due to heart and lung diseases.\u003c/p\u003e \u003cp\u003e Regarding the feeding routes in ICU patients, the same applies to that described for ward patients, that is, in the HSL group, all patients using supplementation also received meals (they consume food orally), and some of them used mixed feeding routes - oral and enteral or oral and parenteral. This can also be observed in the other groups in the Brazil and world study. In Brazil, the mortality rate is lower than in the rest of the country, but significantly higher than in the rest of the world. In Brazil, the mortality rate (14.3%) was significantly lower than in the other groups (24.3% in hospitals in Brazil and 24.8% in hospitals around the world).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntensive care units - social, clinical, and nutritional characteristics of participants in the NutritionDay.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHSL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorld\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e560 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (mean, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.5 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.1 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.5 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (mean, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.6 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.2 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.8 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAPS (mean, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.3 (17.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.8 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.9 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eMain diagnoses on admission (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e255 (24.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurologic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e185 (18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.516\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e229 (22.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.497\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127 (12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eFeeding routes (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsumes normal food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e484 (48.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of supplementation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of enteral nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e490 (48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of parenteral nutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e182 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eEnteral nutrition therapy (mean, SD)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlanned calories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,108.0 (566.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,423.5 (478.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,393.7 (617.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalories administered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e999.5 (603.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,462.5 (701.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,127.4 (611.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eOutcome (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e207 (24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows the nutritional care protocols and guidelines implemented at the HSL and compares them to those implemented in the other groups, showing a significantly higher number, especially compared to hospitals around the world.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntensive care units - nutritional care protocols used with participants in the NutritionDay.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable (n, %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHSL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorld\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional support team\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e913 (89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU nutrition protocol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e672 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional available for nutritional care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e869 (85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWritten nutritional care procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e944 (92.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight/height\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e904 (90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVerification of laboratory parameters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e826 (85.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e compare the data collected on the NutritionDay between 2017\u0026ndash;2020 and analyze the evolution of nutritional care at the HSL.\u003c/p\u003e \u003cp\u003eWomen predominated in 2017 and 2020 (61.9% and 56.4% of the sample, respectively), with a mean age of 52.2 years (SD\u0026thinsp;=\u0026thinsp;16.3) and 58.2 years (SD\u0026thinsp;=\u0026thinsp;21.1), respectively; but an inversion occurred in 2018 and 2019, with a predominance of older men (53.6% and 60.7%, respectively), with a mean age of 65.8 (SD\u0026thinsp;=\u0026thinsp;21.8) and 71.5 (SD\u0026thinsp;=\u0026thinsp;18.4) years. BMI showed no statistical difference between years.\u003c/p\u003e \u003cp\u003eAs for screening and nutritional assessment, until 2018, they used the BMI and an assessment tool that, despite considering nutritional aspects, disease, and treatment, was not validated. After 2019, the HSL adopted the NRS 2002 screening\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e and a tool based on the GLIM\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e for nutritional assessment according to international guidelines.\u003c/p\u003e \u003cp\u003eRegarding eating habits and satisfaction with meals, a tendency toward improved satisfaction with the diet served has been observed, which was associated with significantly increased meal consumption (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and increased patient-reported dietary restrictions (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNutritional care evolution at HSL (2017\u0026ndash;2020).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;21\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;56\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;107\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;39\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eClassification\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e8 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e30 (53.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e65 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e17 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (mean, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e52.2 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e65.8 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e71.5 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e58.2 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (mean, SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e25.2 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e24.8 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e26.5 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e26.7 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional screening (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e21 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e56 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e31 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight on admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e31 (55.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e71 (66.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e31 (79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eNutritional assessment (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI/ Visual assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e21 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e56 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther tools (GLIM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e107 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e31 (100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e \u003cp\u003eMain reasons for reducing food consumption (n, %)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of food offered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e5 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFood smell/taste\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e9 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWas not hungry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e8 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDid not have the usual appetite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e11 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChewing/swallowing problems\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2 (3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUsually eats less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea and vomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eSimilar BMI values ​​from the present study (Tables \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) were reported in other studies, such as the one carried out in Brazil with ward inpatients with a BMI of 24.85 Kg/m\u003csup\u003e2\u003c/sup\u003e (SD\u0026thinsp;=\u0026thinsp;4.25) and ICU patients with a BMI of 25.1 kg/m\u003csup\u003e2\u003c/sup\u003e (SD\u0026thinsp;=\u0026thinsp;5.41)\u003csup\u003e7\u003c/sup\u003e; in Colombia with a BMI of 26.2 Kg/m\u003csup\u003e2\u003c/sup\u003e (SD\u0026thinsp;=\u0026thinsp;4.3)\u003csup\u003e12\u003c/sup\u003e; and in Europe with a mean BMI of 26 kg/m\u003csup\u003e13\u003c/sup\u003e all using NutritionDay data, which corroborates our results and also does not report a statistical BMI differences compared to the other study groups.\u003c/p\u003e \u003cp\u003eThe HSL uses oral supplementation and enteral nutrition (EN) in clinical units similarly to other hospitals in Brazil but significantly more than in the rest of the world (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and in other studies also using the NutritionDay database\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. This can be explained by the greater complexity of the patients treated at the HSL, since in the clinical units both inpatient and semi-intensive units were evaluated, and also because in some countries the insurance companies do not reimburse supplementation costs\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. In ICUs, the use of oral supplementation is also higher at the HSL than in other groups, which can be explained by the greater number of patients consuming an oral diet (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOral supplements are considered a key nutritional intervention approach for patients who can eat orally but do not meet the recommended amount\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Therefore, at the HSL, patients consuming less than 60% are indicated for oral supplementation, which would also justify the greater use of these products in the hospital. Adherence to the consumption of oral supplements in our hospital is checked at the time of the bedside visit (at least 3 times a week) and is asked whether the patient is consuming the entire supplement, more than half, half, less than half or not joined. Additionally, we look in the room for leftover or unopened jars. If there is no adherence to the use of supplementation, we offer alternatives such as flavorless supplements or those included in preparations and reinforce the importance of their consumption for nutritional restoration.\u003c/p\u003e \u003cp\u003eRegarding the outcome, the mortality rate in clinical units (5.6%) exceeded the world rate (3.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), which can be explained by the Brazil status as a developing country where patients are in general hospitalized in more severe conditions. However, compared to other hospitals in Brazil (13.3%) and to other studies such as the one by Pearcy et al.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e and Tatsch et al.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, the HSL mortality rate is lower and can be justified because, despite being in a developing country, it is a private hospital with more resources than the average in the country and in some regions of the world.\u003c/p\u003e \u003cp\u003eThe implementation of processes for patients at nutritional risk is associated with decreased mortality\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, decreased length of hospital stay, and better outcomes\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. As for nutritional care protocols (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), the HSL has standardized nutritional care with a specialized nutrition team and well-established protocols. The most relevant point of improvement is weight on admission. Although it is higher than the world mean (57.7%), in 2019 it reached 66.4% of patients, which is below the percentage reported in other studies such as that by Ostrowska (72.9%)\u003csup\u003e13\u003c/sup\u003e. However, continuous data analysis over the years (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e) helped implement new procedures, such as an institutional indicator with a goal of weighing at least 70% of patients on admission and educational actions involving the multidisciplinary team, which significantly increased this measurement between 2017 and 2020, from 33.3% to 79.5, respectively (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cp\u003eStudies have shown that patient involvement in health care actions improves service quality. For example, decreased appetite can be a barrier to adequate nutrition; however, it can be reduced by informing the patient about the importance of eating enough\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Over the years, HSL has prioritized patient involvement, with several actions implemented, such as initiating discharge guidelines at the beginning of hospitalization so that the patient has time to assimilate the information and clarify doubts, and using a whiteboard in the room with the main information about the patient\u0026rsquo;s care plan. These measures significantly increased the perception of patient involvement in their treatment compared to other hospitals in Brazil and worldwide (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAppropriate nutritional care, including meal quality control, has shown beneficial effects on patient outcomes\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The HSL has shown a tendency toward increased food satisfaction and a significant increase in total meal consumption (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This percentage is higher than the one seen in other studies, such as Hiesmayr et al., who reported that less than 50% of hospitalized patients ate the entire meal offered, with a negative impact on their clinical outcomes\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Additionally, the number of reports of patients who did not eat well due to meal quality decreased (not liking the diet or finding the taste and odor unpleasant) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e), which is due to the monthly monitoring of meal satisfaction through indicators that generate action plans at critical points.\u003c/p\u003e \u003cp\u003eAlthough patient satisfaction and total meal consumption showed no significant differences at the HSL compared to other hospitals in Brazil and the world (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), only 4.5% of the patients reported not liking the food served, a result well below that found in the study by Varella et al.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, which showed that 22.2% of patients reported not consuming the whole meal because they did not like the food. Other reasons for lower consumption at the HSL are related to disease symptoms, not to the quality of the meals (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), corroborating the main reasons mentioned in other studies that used the NutritionDay\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA multidisciplinary team's commitment to the nutritional care process is essential for obtaining positive results\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. In this context, a positive point was the reduced number of patients mentioning chewing and swallowing difficulties as a reason for inadequate consumption over the years, which is mainly due to joint multidisciplinary actions, mainly involving speech therapists (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome studies highlight that patients reduce intake not only due to disease or lack of appetite, but also due to changing habits or dissatisfaction with food preparation and service\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, and that this situation can be reversed with simple interventions such as protected mealtimes, more meal options, and additional snacks\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. As for the questions regarding the institution\u0026rsquo;s support for food intake, standardized procedures exist for adapting the dietary regimen both in terms of preferences and adapting meals to the clinical conditions of the patient (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). However, we saw an opportunity for improvement in meal sizes. Although we have two meal sizes (whole or half meal), this is a dietary adaptation and not a standardization; in addition, we can be more flexible in adapting meal sizes to patients with certain symptoms such as nausea and vomiting.\u003c/p\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e show the results for ICU patients. Some studies show that inpatients receive suboptimal EN\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e, reaching a mean adequacy of 60%\u003csup\u003e18\u003c/sup\u003e. Protocols addressing common factors that delay EN help avoid them before they become a problem\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. As for the calorie offer in relation to calorie estimate, the HSL has a mean adequacy of 90.2% (which reaches the institutional target of 80%). This adequacy reaches 102.7% in other Brazilian hospitals, dropping to 80.8% around the world.\u003c/p\u003e \u003cp\u003eThe Simplified Acute Physiology Score (SAPS) is one of the most extensively validated scores for critically ill patients\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. Although our mean SAPS (42.3 points) exceeded the rest (39.9 points) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), it remains lower than that of other hospitals in Brazil (51.8 points), as HSL follows the international patient care standards. This may explain the lower mortality rate in ICU patients than in the rest of Brazil and the world (p\u0026thinsp;=\u0026thinsp;0.000). This standardization also includes the nutritional care provided at the ICUs (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImplementing a screening routine is positively associated with providing specialized nutrition to patients at risk of malnutrition\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. As for screening and nutritional assessment (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e), until 2018, the HSL used the BMI and a nutritional assessment tool that considered food intake, diagnosis, and clinical conditions but was not validated. Aiming at better nutritional care and in accordance with international guidelines\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, after 2019, the HSL adopted the NRS2002 screening\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e for screening and developed a tool based on the GLIM guidelines for nutritional assessment that considers both phenotypic and etiological patient information\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. In addition, body composition is also systematically evaluated in cases of nutritional risk\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe frequency of some dietary restrictions has increased over the years (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), which is also reported for the other groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). These restrictions appear to be associated with adhering to a healthier diet, with reduced consumption of simple sugars or fats, which are positive changes as they aim for a healthy diet that reduces malnutrition and reverses unfavorable chronic disease tendencies\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Thus, the composition of the meals served in the hospital changed over the years, with a decreased use of processed products. In addition, some diets were standardized, such as gluten- or lactose-free and vegetarian diets. However, educational activities are important to discourage unnecessary restrictions, always aiming for a balanced diet that contributes to a full recovery. To this end, we provide a healthy eating guide and recipe books for patients\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSome limitations of the present study are the voluntary participation in the NutritionDay and the extensive databases, which may lead to missing data and non-homogeneous reports. Finally, data collection was affected by the COVID-19 pandemic in 2020, which may have interfered with the results obtained.\u003c/p\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003e The analysis of the data provided by the NutritionDay is an effective strategy to better understand the structures and factors associated with nutritional risks in inpatients, both in clinical units and in ICUs. This allows a comparison with other health services, enhances the implementation of effective nutritional care protocols and actions, and leads to improved clinical outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIntensive care units (ICU)\u003c/p\u003e\n\u003cp\u003eBody mass index (BMI)\u003c/p\u003e\n\u003cp\u003eNutritional risk screening (NRS2002)\u003c/p\u003e\n\u003cp\u003eGlobal Leadership Initiative on Malnutrition (GLIM)\u003c/p\u003e\n\u003cp\u003eHospital S\u0026iacute;rio Liban\u0026ecirc;s (HSL)\u003c/p\u003e\n\u003cp\u003eEnteral nutrition (EN)\u003c/p\u003e\n\u003cp\u003eSimplified Acute Physiology Score (SAPS)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institution\u0026rsquo;s Research Ethics Committee. The Research Ethics Committee waived the Informed Consent Form because this is a retrospective study with secondary data collection. The research subjects\u0026rsquo; privacy was guaranteed, and the collected data was solely and exclusively used for the presented project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe research project was submitted to the NutritionDay platform to obtain approval for the use of data for scientific production.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGKPA:\u003c/strong\u003e conceptualization, methodology, investigation, resources, data curation, writing - original draft, visualization, project administration. \u003cstrong\u003eALCCR:\u0026nbsp;\u003c/strong\u003econceptualization, methodology, resources, writing - review \u0026amp; editing, supervision.\u0026nbsp;\u003cstrong\u003eES\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e conceptualization, methodology, resources, writing - review \u0026amp; editing, supervision.\u0026nbsp;\u003cstrong\u003eLMY\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e conceptualization, methodology, investigation.\u0026nbsp;\u003cstrong\u003eJM\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e conceptualization, methodology, investigation.\u0026nbsp;\u003cstrong\u003eJBC:\u003c/strong\u003e conceptualization, methodology, investigation.\u0026nbsp;\u003cstrong\u003eAY\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e resources, writing - review \u0026amp; editing, supervision.\u0026nbsp;\u003cstrong\u003eSNB\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003econceptualization, methodology. \u003cstrong\u003eANS:\u003c/strong\u003e resources, writing - review \u0026amp; editing, supervision.\u0026nbsp;\u003cstrong\u003eSRM\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e writing - review \u0026amp; editing, supervision\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank everyone who contributed to holding NutritionDay in our hospital.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHeyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, Day A. 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Accessed July 12, 2023, at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hsph.harvard.edu/nutritionsource/2023/01/04/healthy-living-guide-2022-2023\u003c/span\u003e\u003cspan address=\"https://www.hsph.harvard.edu/nutritionsource/2023/01/04/healthy-living-guide-2022-2023\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHospital S\u0026iacute;rio Liban\u0026ecirc;s. Guia de receitas. (Accessed August 2, 2023, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hospitalsiriolibanes.org.br/receitas\u003c/span\u003e\u003cspan address=\"https://www.hospitalsiriolibanes.org.br/receitas\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"NutritionDay, hospital malnutrition, nutritional care","lastPublishedDoi":"10.21203/rs.3.rs-4823607/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4823607/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHospital malnutrition is a global debilitating problem; therefore, the implementation of nutritional monitoring protocols is essential for its early diagnosis and translates into better care. NutritionDay emerged from the need to document the global malnutrition scenario to improve patient safety and the quality of nutritional care. Our objective was to analyze nutritional care data from a high-complexity hospital obtained through the NutritionDay and to compare these data between years and with the results of other institutions in order to identify areas for nutritional care improvement.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA one-day cross-sectional retrospective study was conducted at the NutritionDay global data collection date. The data were analyzed by comparing the nutritional care provided at the hospital in 2019 with national and global scenarios. Additionally, data on nutritional care in our hospital from 2017 to 2020 was compared. Quantitative variable groups were compared by the Student\u0026rsquo;s t-test. Relationships were analyzed using the Pearson\u0026rsquo;s chi-square test or the Fisher\u0026rsquo;s exact test for categorical data. The significance level was set at 10.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWeighing on admission is a point of improvement for all groups. In our hospital it led to the creation of an institutional indicator for its monitoring. From 2017 to 2020, nutritional screening and assessment used the body mass index (BMI) and a non-validated tool until 2018. After 2019, we adopted nutritional risk screening (NRS2002) and a tool based on the Global Leadership Initiative on Malnutrition (GLIM) to improve nutritional care. We found a trend towards improvement in satisfaction with the diet provided, which was associated with a significant increase in meal consumption and which is due to the monthly monitoring of meal satisfaction that generate action plans. We notice an increase in dietary restrictions reported by patients associated with adhering to a healthier diet. Thus, the composition of the meals changed over the years, with a decreased use of processed products.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe analysis of NutritionDay data is an effective strategy for better understanding nutritional risk factors, enabling comparisons with other services and facilitating the implementation of enhanced nutritional care protocols.\u003c/p\u003e","manuscriptTitle":"NutritionDay: effective strategy for understanding nutritional risk factors and facilitating the implementation of nutritional care protocols - an analysis over the years","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-16 00:46:40","doi":"10.21203/rs.3.rs-4823607/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd044ba5-0482-4501-b4d7-3422bccb0ec3","owner":[],"postedDate":"September 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":36916819,"name":"Health sciences/Health care"},{"id":36916820,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2024-09-30T04:38:51+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-16 00:46:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4823607","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4823607","identity":"rs-4823607","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}