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Nutrition in acute and chronic diseases

Exploration of an objective and simple index as the outcome of nutrition support for elderly patients and identification of risk factors



The study aimed to explore the risk factors for the outcome of nutrition support teams (NSTs) for elderly patients. Previously identified risk factors lack general versatility owing to slightly subjective judgment standards; this study aimed to explore an objective and simple index of NST outcome and identify the risk factors for NST outcome.


This retrospective observational study analyzed, 372 elderly patients enrolled in the NST between January 2014 and July 2018. We identified that the energy fill rate to total energy expenditure (%TEE) at the time of NST termination (post-%TEE) < 75.0% was the most valid index for the outcome in our previous study. The cutoff values of continuous variables at the time of NST enrollment (pre-) were set for post-%TEE < 75.0% using receiver operating characteristic curve analysis, and hazard ratios (HRs) were calculated.


From the multivariable Cox proportional hazard analysis, pre-%TEE < 62.6% (HR: 1.96; 95% confidence interval [95% CI]: 1.29–2.99; p = 0.002), presence of pressure ulcers (HR: 1.74; 95% CI: 1.02–2.98; p = 0.042), pre-prognostic nutritional index (PNI) < 32.7 (HR: 1.78; 95% CI: 1.13–2.82; p = 0.014), and presence of pre-peripheral parenteral nutrition (PPN) (HR: 1.74; 95% CI: 1.19–2.56; p = 0.005) were identified as independent risk factors for post-%TEE < 75.0%.


Post-%TEE < 75.0% was the objective and simple index for NST outcomes. Patients with low pre-%TEE, pressure ulcers, low pre-PNI, or pre-PPN require early nutritional intervention.

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Fig. 1: Flow chart of patient selection in this study.

Data availability

Additional data are available from the corresponding author on reasonable request.


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The authors are grateful to the participants and hospital members.

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Authors and Affiliations



MH, YY, and DH contributed to study conception and design; MH, YO, and TF contributed to data acquisition; MH and DH contributed to data analysis and interpretation; MH, YY, and DH contributed to the drafting of manuscript and making critical revisions related to important intellectual content of manuscript; All authors have approved the final version of the manuscript.

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Correspondence to Masakazu Hiramatsu.

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Hiramatsu, M., Oide, Y., Yasui, Y. et al. Exploration of an objective and simple index as the outcome of nutrition support for elderly patients and identification of risk factors. Eur J Clin Nutr (2022).

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