COVID-19 MQii RESOURCES

We have compiled resources and events to support you and your colleagues in caring for patients experiencing or at risk for malnutrition throughout the COVID-19 pandemic.
The MQii is designed to help your organization improve
malnutrition care and subsequently achieve better outcomes.

Malnutrition Matters

Malnutrition Matters
Last Updated on April 6, 2021

The Case for MQii

Malnutrition, sometimes referred to as “poor nutrition,” is the inadequate intake of nutrients, particularly protein, over time and can occur in people who are both underweight or overweight (including obese). It is a highly burdensome condition that places a great burden on patients, providers, and the broader healthcare system. The MQii seeks to address this problem through identification and appropriate treatment malnourished individuals. More details on the prevalence and burden of malnutrition are outlined below.

Malnutrition Is A Highly Preventable Condition

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Malnutrition affects 20–50% of patients who are at risk of becoming or are malnourished.1

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Malnutrition is typically only diagnosed in 8% of hospitalized patients, leaving many potentially undiagnosed and untreated.2

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Up to 31% of malnourished patients and 38% of well-nourished patients experience nutritional decline during their hospitals stays.3

Malnutrition Poses a Significant Burden to Patients and Hospitals

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higher likelihood of in-hospital death compared to non-malnourished patients.4

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higher likelihood of 30-day readmissions, with septicemia as the leading diagnosis upon readmission.5

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higher costs for a malnourished patient hospital stay compared to non-malnourished patients.6

Addressing Malnutrition Can Improve Patient Outcomes and Lower Costs

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reduction in 30-day readmission rates for a multi-hospital ACO that optimized its malnutrition care.7

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in cost savings generated by a 4-hospital system that implemented a nutrition-focused quality improvement program.8

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relative reduction in readmission risk for malnourished patients with a nutrition care plan vs those patients without a care plan.9

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Malnutrition Evidence Library

The evidence library contains references and links to the most recent and relevant scientific articles reflecting the evidence that supports the malnutrition care workflow, malnutrition quality measures and the need for malnutrition quality improvement more broadly. The articles span a myriad of topics, and are ordered by most recently updated. 5 articles are displayed here; please  click ‘See All’ below to navigate to the entire evidence library.

Deutz, Nicolaas E., Eric M. Matheson, Laura E. Matarese, Menghua Luo, Geraldine E. Baggs, Jeffrey L. Nelson, Refaat A. Hegazi, Kelly A. Tappenden, and Thomas R. Ziegler. 2016. “Readmission and Mortality in Malnourished, Older, Hospitalized Adults Treated with a Specialized Oral Nutritional Supplement: A Randomized Clinical Trial.” Clinical Nutrition 35 (1): 18–26. https://doi.org/10.1016/j.clnu.2015.12.010.
“36th International Symposium on Intensive Care and Emergency Medicine : Brussels, Belgium. 15-18 March 2016.” 2016. Critical Care (London, England) 20 (Suppl 2): 94. https://doi.org/10.1186/s13054-016-1208-6.
“A.S.P.E.N. Clinical Guidelines - Mueller - 2011 - Journal of Parenteral and Enteral Nutrition - Wiley Online Library.” n.d. Accessed March 15, 2021. https://aspenjournals.onlinelibrary.wiley.com/doi/full/10.1177/0148607110389335.
Amaral, T. F., A. Antunes, S. Cabral, P. Alves, and L. Kent-Smith. 2008. “An Evaluation of Three Nutritional Screening Tools in a Portuguese Oncology Centre.” Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association 21 (6): 575–83. https://doi.org/10.1111/j.1365-277X.2008.00917.x.
Schiesser, Marc, Sven Müller, Philipp Kirchhoff, Stefan Breitenstein, Markus Schäfer, and Pierre-Alain Clavien. 2008. “Assessment of a Novel Screening Score for Nutritional Risk in Predicting Complications in Gastro-Intestinal Surgery.” Clinical Nutrition (Edinburgh, Scotland) 27 (4): 565–70. https://doi.org/10.1016/j.clnu.2008.01.010.
Raslan, Mariana, Maria Cristina Gonzalez, Maria Carolina Gonçalves Dias, Mariana Nascimento, Melina Castro, Patrícia Marques, Sabrina Segatto, Raquel Susana Torrinhas, Ivan Cecconello, and Dan Linetzky Waitzberg. 2010. “Comparison of Nutritional Risk Screening Tools for Predicting Clinical Outcomes in Hospitalized Patients.” Nutrition (Burbank, Los Angeles County, Calif.) 26 (7–8): 721–26. https://doi.org/10.1016/j.nut.2009.07.010.
Ozkalkanli, Murat Y., Dila Tuna Ozkalkanli, Kaan Katircioglu, and Serdar Savaci. 2009. “Comparison of Tools for Nutrition Assessment and Screening for Predicting the Development of Complications in Orthopedic Surgery.” Nutrition in Clinical Practice: Official Publication of the American Society for Parenteral and Enteral Nutrition 24 (2): 274–80. https://doi.org/10.1177/0884533609332087.
Kyle, Ursula G., Michel P. Kossovsky, Veronique L. Karsegard, and Claude Pichard. 2006. “Comparison of Tools for Nutritional Assessment and Screening at Hospital Admission: A Population Study.” Clinical Nutrition (Edinburgh, Scotland) 25 (3): 409–17. https://doi.org/10.1016/j.clnu.2005.11.001.
Raslan, Mariana, Maria Cristina Gonzalez, Raquel Suzana M. M. Torrinhas, Graziela Rosa Ravacci, Julio C. R. Pereira, and Dan L. Waitzberg. 2011. “Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for Predicting Poor Clinical Outcomes in Hospitalized Patients.” Clinical Nutrition (Edinburgh, Scotland) 30 (1): 49–53. https://doi.org/10.1016/j.clnu.2010.07.002.
Rypkema, G., E. Adang, H. Dicke, T. Naber, B. de Swart, L. Disselhorst, G. Golüke-Willemse, and M. Olde Rikkert. 2004. “Cost-Effectiveness of an Interdisciplinary Intervention in Geriatric Inpatients to Prevent Malnutrition.” The Journal of Nutrition, Health & Aging 8 (2): 122–27.
Vivanti, A., E. Isenring, S. Baumann, D. Powrie, M. O’Neill, D. Clark, S. Courtice, K. Campbell, and M. Ferguson. 2015. “Emergency Department Malnutrition Screening and Support Model Improves Outcomes in a Pilot Randomised Controlled Trial.” Emergency Medicine Journal: EMJ 32 (3): 180–83. https://doi.org/10.1136/emermed-2013-202965.
Guerra, Rita S., Isabel Fonseca, Ana S. Sousa, Alison Jesus, Fernando Pichel, and Teresa F. Amaral. 2017. “ESPEN Diagnostic Criteria for Malnutrition – A Validation Study in Hospitalized Patients.” Clinical Nutrition 36 (5): 1326–32. https://doi.org/10.1016/j.clnu.2016.08.022.
Sorensen, Janice, Jens Kondrup, Jacek Prokopowicz, Marc Schiesser, Lukas Krähenbühl, Rémy Meier, Martin Liberda, and EuroOOPS study group. 2008. “EuroOOPS: An International, Multicentre Study to Implement Nutritional Risk Screening and Evaluate Clinical Outcome.” Clinical Nutrition (Edinburgh, Scotland) 27 (3): 340–49. https://doi.org/10.1016/j.clnu.2008.03.012.
Burden, S. T., and E. R. Brierley. 2014. “Evaluation of Adherence to a Nutrition-Screening Programme over a 5-Year Period.” European Journal of Clinical Nutrition 68 (7): 847–52. https://doi.org/10.1038/ejcn.2014.95.
Valentini, Alessia, Massimo Federici, Maria Assunta Cianfarani, Umberto Tarantino, and Aldo Bertoli. 2018. “Frailty and Nutritional Status in Older People: The Mini Nutritional Assessment as a Screening Tool for the Identification of Frail Subjects.” Clinical Interventions in Aging 13: 1237–44. https://doi.org/10.2147/CIA.S164174.
Henderson, Sarah, Nicola Moore, Emma Lee, and Miles D. Witham. 2008. “Do the Malnutrition Universal Screening Tool (MUST) and Birmingham Nutrition Risk (BNR) Score Predict Mortality in Older Hospitalised Patients?” BMC Geriatrics 8 (October): 26. https://doi.org/10.1186/1471-2318-8-26.
Kruizenga, Hinke M., Maurits W. Van Tulder, Jaap C. Seidell, Abel Thijs, Herman J. Ader, and Marian A. E. Van Bokhorst-de van der Schueren. 2005. “Effectiveness and Cost-Effectiveness of Early Screening and Treatment of Malnourished Patients.” The American Journal of Clinical Nutrition 82 (5): 1082–89. https://doi.org/10.1093/ajcn/82.5.1082.
Silver, Heidi J., Kelsey Jones Pratt, Michelle Bruno, Joe Lynch, Kristi Mitchell, and Sharon M. McCauley. 2018. “Effectiveness of the Malnutrition Quality Improvement Initiative on Practitioner Malnutrition Knowledge and Screening, Diagnosis, and Timeliness of Malnutrition-Related Care Provided to Older Adults Admitted to a Tertiary Care Facility: A Pilot Study.” Journal of the Academy of Nutrition and Dietetics 118 (1): 101–9. https://doi.org/10.1016/j.jand.2017.08.111.
Khalatbari-Soltani, Saman, and Pedro Marques-Vidal. 2016. “Impact of Nutritional Risk Screening in Hospitalized Patients on Management, Outcome and Costs: A Retrospective Study.” Clinical Nutrition (Edinburgh, Scotland) 35 (6): 1340–46. https://doi.org/10.1016/j.clnu.2016.02.012.
Jie, Bin, Zhu-Ming Jiang, Marie T. Nolan, Shai-Nan Zhu, Kang Yu, and Jens Kondrup. 2012. “Impact of Preoperative Nutritional Support on Clinical Outcome in Abdominal Surgical Patients at Nutritional Risk.” Nutrition (Burbank, Los Angeles County, Calif.) 28 (10): 1022–27. https://doi.org/10.1016/j.nut.2012.01.017.
Lim, Su Lin, Kian Chung Benjamin Ong, Yiong Huak Chan, Wai Chiong Loke, Maree Ferguson, and Lynne Daniels. 2012. “Malnutrition and Its Impact on Cost of Hospitalization, Length of Stay, Readmission and 3-Year Mortality.” Clinical Nutrition (Edinburgh, Scotland) 31 (3): 345–50. https://doi.org/10.1016/j.clnu.2011.11.001.
Agarwal, Ekta, Maree Ferguson, Merrilyn Banks, Marijka Batterham, Judith Bauer, Sandra Capra, and Elisabeth Isenring. 2013. “Malnutrition and Poor Food Intake Are Associated with Prolonged Hospital Stay, Frequent Readmissions, and Greater in-Hospital Mortality: Results from the Nutrition Care Day Survey 2010.” Clinical Nutrition (Edinburgh, Scotland) 32 (5): 737–45. https://doi.org/10.1016/j.clnu.2012.11.021.
Allard, Johane P., Heather Keller, Khursheed N. Jeejeebhoy, Manon Laporte, Don R. Duerksen, Leah Gramlich, Helene Payette, et al. 2016. “Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force.” JPEN. Journal of Parenteral and Enteral Nutrition 40 (4): 487–97. https://doi.org/10.1177/0148607114567902.
Stratton, Rebecca J., Claire L. King, Mike A. Stroud, Alan A. Jackson, and Marinos Elia. 2006. “‘Malnutrition Universal Screening Tool’ Predicts Mortality and Length of Hospital Stay in Acutely Ill Elderly.” The British Journal of Nutrition 95 (2): 325–30. https://doi.org/10.1079/bjn20051622.
Kaiser, Matthias J., Jürgen M. Bauer, Christiane Rämsch, Wolfgang Uter, Yves Guigoz, Tommy Cederholm, David R. Thomas, et al. 2010. “Frequency of Malnutrition in Older Adults: A Multinational Perspective Using the Mini Nutritional Assessment.” Journal of the American Geriatrics Society 58 (9): 1734–38. https://doi.org/10.1111/j.1532-5415.2010.03016.x.
Goldfarb, Michael, Sandra Lauck, John G. Webb, Anita W. Asgar, Louis P. Perrault, Nicolo Piazza, Giuseppe Martucci, et al. 2018. “Malnutrition and Mortality in Frail and Non-Frail Older Adults Undergoing Aortic Valve Replacement.” Circulation 138 (20): 2202–11. https://doi.org/10.1161/CIRCULATIONAHA.118.033887.
Holyday, M., S. Daniells, M. Bare, G. A. Caplan, P. Petocz, and T. Bolin. 2012. “Malnutrition Screening and Early Nutrition Intervention in Hospitalised Patients in Acute Aged Care: A Randomised Controlled Trial.” The Journal of Nutrition, Health & Aging 16 (6): 562–68. https://doi.org/10.1007/s12603-012-0022-3.
Keller, Heather H., Renata Valaitis, Celia V. Laur, Tara McNicholl, Yingying Xu, Joel A. Dubin, Lori Curtis, et al. 2019. “Multi-Site Implementation of Nutrition Screening and Diagnosis in Medical Care Units: Success of the More-2-Eat Project.” Clinical Nutrition (Edinburgh, Scotland) 38 (2): 897–905. https://doi.org/10.1016/j.clnu.2018.02.009.
Roberts, S., W. Chaboyer, and B. Desbrow. 2015. “Nutrition Care-Related Practices and Factors Affecting Nutritional Intakes in Hospital Patients at Risk of Pressure Ulcers.” Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association 28 (4): 357–65. https://doi.org/10.1111/jhn.12258.
Skipper, Annalynn, Maree Ferguson, Kyle Thompson, Victoria H. Castellanos, and Judy Porcari. 2012. “Nutrition Screening Tools: An Analysis of the Evidence.” JPEN. Journal of Parenteral and Enteral Nutrition 36 (3): 292–98. https://doi.org/10.1177/0148607111414023.
Rabito, Estela Iraci, Aline Marcadenti, Jaqueline da Silva Fink, Luciane Figueira, and Flávia Moraes Silva. 2017. “Nutritional Risk Screening 2002, Short Nutritional Assessment Questionnaire, Malnutrition Screening Tool, and Malnutrition Universal Screening Tool Are Good Predictors of Nutrition Risk in an Emergency Service.” Nutrition in Clinical Practice: Official Publication of the American Society for Parenteral and Enteral Nutrition 32 (4): 526–32. https://doi.org/10.1177/0884533617692527.
Smith, Louise, Amanda Chapman, Kelli Flowers, Kylie Wright, Tanghua Chen, Charmaine O’Connor, Cecilia Astorga, Nevenka Francis, Gia Vigh, and Craig Wainwright. 2018. “Nutritional Screening, Assessment and Implementation Strategies for Adults in an Australian Acute Tertiary Hospital: A Best Practice Implementation Report.” JBI Database of Systematic Reviews and Implementation Reports 16 (1): 233–46. https://doi.org/10.11124/JBISRIR-2016-003071.
Gomes, Filomena, Peter W. Emery, and C. Elizabeth Weekes. 2016. “Risk of Malnutrition Is an Independent Predictor of Mortality, Length of Hospital Stay, and Hospitalization Costs in Stroke Patients.” Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association 25 (4): 799–806. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.017.
Doundoulakis, Ioannis, Kalliopi Anna Poulia, Christina Antza, Emmanouil Bouras, Eirini Kasapidou, Stanislaw Klek, and Michael Chourdakis. 2018. “Screening for Malnutrition Among People Accessing Health Services at Greek Public Hospitals: Results From an Observational Multicenter Study.” JPEN. Journal of Parenteral and Enteral Nutrition 42 (4): 709–18. https://doi.org/10.1177/0148607117722748.
Putwatana, Panwadee, Pinmanee Reodecha, Yupapin Sirapo-ngam, Panuwat Lertsithichai, and Kanit Sumboonnanonda. 2005. “Nutrition Screening Tools and the Prediction of Postoperative Infectious and Wound Complications: Comparison of Methods in Presence of Risk Adjustment.” Nutrition (Burbank, Los Angeles County, Calif.) 21 (6): 691–97. https://doi.org/10.1016/j.nut.2004.10.015.
Jeejeebhoy, Khursheed N., Heather Keller, Leah Gramlich, Johane P. Allard, Manon Laporte, Donald R. Duerksen, Helene Payette, et al. 2015. “Nutritional Assessment: Comparison of Clinical Assessment and Objective Variables for the Prediction of Length of Hospital Stay and Readmission.” The American Journal of Clinical Nutrition 101 (5): 956–65. https://doi.org/10.3945/ajcn.114.098665.
Dent, Elsa, Olivia Wright, Emiel O. Hoogendijk, and Ruth E. Hubbard. 2018. “Nutritional Screening and Dietitian Consultation Rates in a Geriatric Evaluation and Management Unit.” Nutrition & Dietetics: The Journal of the Dietitians Association of Australia 75 (1): 11–16. https://doi.org/10.1111/1747-0080.12391.
Starke, Juliane, Heinz Schneider, Birgit Alteheld, Peter Stehle, and Rémy Meier. 2011. “Short-Term Individual Nutritional Care as Part of Routine Clinical Setting Improves Outcome and Quality of Life in Malnourished Medical Patients.” Clinical Nutrition (Edinburgh, Scotland) 30 (2): 194–201. https://doi.org/10.1016/j.clnu.2010.07.021.
Leistra, Eva, Marian A. E. van Bokhorst-de van der Schueren, Marjolein Visser, Anja van der Hout, Jacqueline A. E. Langius, and Hinke M. Kruizenga. 2014. “Systematic Screening for Undernutrition in Hospitals: Predictive Factors for Success.” Clinical Nutrition (Edinburgh, Scotland) 33 (3): 495–501. https://doi.org/10.1016/j.clnu.2013.07.005.
Kissova, Viera, Jaroslav Rosenberger, Maria Goboova, and Adrian Kiss. 2015. “Ten-Year All-Cause Mortality in Hospitalized Non-Surgical Patients Based on Nutritional Status Screening.” Public Health Nutrition 18 (14): 2609–14. https://doi.org/10.1017/S1368980015000063.
Cereda, Emanuele, Catherine Klersy, Carlo Pedrolli, Barbara Cameletti, Chiara Bonardi, Lara Quarleri, Silvia Cappello, Alberto Bonoldi, Elisa Bonadeo, and Riccardo Caccialanza. 2015. “The Geriatric Nutritional Risk Index Predicts Hospital Length of Stay and In-Hospital Weight Loss in Elderly Patients.” Clinical Nutrition (Edinburgh, Scotland) 34 (1): 74–78. https://doi.org/10.1016/j.clnu.2014.01.017.
“Tobert and Malnutrition and 2018 - Search Results - PubMed.” n.d. Accessed March 15, 2021. https://pubmed.ncbi.nlm.nih.gov/?term=Tobert+and+malnutrition+and+2018.
Kruizenga, Hinke, Suzanne van Keeken, Peter Weijs, Luc Bastiaanse, Sandra Beijer, Getty Huisman-de Waal, Harriët Jager-Wittenaar, et al. 2016. “Undernutrition Screening Survey in 564,063 Patients: Patients with a Positive Undernutrition Screening Score Stay in Hospital 1.4 d Longer.” The American Journal of Clinical Nutrition 103 (4): 1026–32. https://doi.org/10.3945/ajcn.115.126615.
Guerra, Rita S., Isabel Fonseca, Fernando Pichel, Maria T. Restivo, and Teresa F. Amaral. 2015. “Usefulness of Six Diagnostic and Screening Measures for Undernutrition in Predicting Length of Hospital Stay: A Comparative Analysis.” Journal of the Academy of Nutrition and Dietetics 115 (6): 927–38. https://doi.org/10.1016/j.jand.2014.11.015.
Lew, Charles Chin Han, Rosalie Yandell, Robert J. L. Fraser, Ai Ping Chua, Mary Foong Fong Chong, and Michelle Miller. 2017. “Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review [Formula: See Text].” JPEN. Journal of Parenteral and Enteral Nutrition 41 (5): 744–58. https://doi.org/10.1177/0148607115625638.
Wakahara, Toshitatsu, Makoto Shiraki, Kayoko Murase, Hideki Fukushima, Katsuhiko Matsuura, Ayumi Fukao, Sachiko Kinoshita, et al. 2007. “Nutritional Screening with Subjective Global Assessment Predicts Hospital Stay in Patients with Digestive Diseases.” Nutrition (Burbank, Los Angeles County, Calif.) 23 (9): 634–39. https://doi.org/10.1016/j.nut.2007.06.005.
Zhong, Yue, Joshua T. Cohen, Scott Goates, Menghua Luo, Jeffrey Nelson, and Peter J. Neumann. 2017. “The Cost-Effectiveness of Oral Nutrition Supplementation for Malnourished Older Hospital Patients.” Applied Health Economics and Health Policy 15 (1): 75–83. https://doi.org/10.1007/s40258-016-0269-7.
Sungurtekin, Hülya, Uğur Sungurtekin, Canan Balci, Mehmet Zencir, and Ergün Erdem. 2004. “The Influence of Nutritional Status on Complications after Major Intraabdominal Surgery.” Journal of the American College of Nutrition 23 (3): 227–32. https://doi.org/10.1080/07315724.2004.10719365.
Gariballa, S. E., S. G. Parker, N. Taub, and C. M. Castleden. 1998. “A Randomized, Controlled, a Single-Blind Trial of Nutritional Supplementation after Acute Stroke.” JPEN. Journal of Parenteral and Enteral Nutrition 22 (5): 315–19. https://doi.org/10.1177/0148607198022005315.
Gariballa, Salah, Sarah Forster, Stephen Walters, and Hilary Powers. 2006. “A Randomized, Double-Blind, Placebo-Controlled Trial of Nutritional Supplementation during Acute Illness.” The American Journal of Medicine 119 (8): 693–99. https://doi.org/10.1016/j.amjmed.2005.12.006.

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