Malnutrition and sarcopenia in inpatient rehabilitation: prevalence and associations with changes in body weight, muscle strength and functional independence

To investigate the prevalence of malnutrition and sarcopenia in different disciplines of inpatient rehabilitation and the course of nutritional status parameters. Design: Multi-centre cross-sectional prevalence study and longitudinal observational study. Subjects/Patients: Inpatients (> 18 years) in geriatric, pulmonary, cardiovascular, internal medicine/ oncological, musculoskeletal, or neurological rehabilitation in 5 rehabilitation centres were included. Methods: Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition criteria. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People criteria. Bodyweight, hand grip strength (HGS), and functional independence measure (FIM) were assessed within 3 days of admission and after 21 days of rehabilitation and analysed using linear mixed models with time*diagnosis interaction. Results: The study included 558 patients (51.8% male, median age 73.0 years). The overall prevalence of malnutrition and sarcopenia was 35.5% (95% CI 31.5, 39.6%) and 32.7% (95% CI 28.8, 36.8%), respectively. Patients with risk of malnutrition lost on average 1.14 kg (95% CI-1.64,-0.63) during rehabilitation. Patients slightly increased their HGS and FIM, irrespective of risk or diagnosis of malnutrition or sarcopenia. However, at the end of the rehabilitation, malnourished or sarcopenic patients had still a significantly lower bodyweight, HGS, and FIM than patients without (p < 0.01). Some 37.3% of patients at risk of and 35.4% with diagnosed malnutrition did not receive group or individual nutritional counselling. Conclusion: Malnutrition and sarcopenia are highly prevalent during inpatient rehabilitation. Nevertheless, dietitians are often not involved in the therapy. While nutritional parameters and functional independence improve, patients with malnutrition and sarcopenia remain on a lower level after 3 weeks of rehabilitation. Long-term follow-up after rehabilitation is recommended to prevent nutritional and muscular decline and related negative health outcomes.