Missed opportunities in nutritional care: prevalence, mortality, and resource utilization in internal medicine wards.

Background: Malnutrition is a highly prevalent and underdiagnosed condition among hospitalized patients, especially in internal medicine wards. Hospital malnutrition is associated with increased morbidity, mortality, prolonged admissions, and a substantial economic burden. Objectives: This study aimed to assess the clinical and economic impact of nutritional risk in patients admitted to internal medicine wards, focusing on mortality, hospital resource utilization, and the effectiveness of nutritional interventions. Methods: A retrospective cohort study was conducted at ULS Santo António, Porto, including 1,150 hospital admissions from January to December 2022. All adult patients with nutritional risk screening (NRS-2002) in the first 48 h of admission were included. Data were collected from hospital information systems on demographic, clinical, and economic variables, with outcomes including in-hospital mortality, readmissions at 30, 90, and 180 days, and one-year post-discharge mortality. Results: Nutritional risk (NRS-2002 ≥ 3) was identified in 42.4% of patients ( Conclusion: Nutritional risk affected 42.4% of internal medicine inpatients and was associated with higher mortality and resource use. The finding that 74.4% of at-risk patients received no nutritional intervention represents a substantial missed opportunity. Patients who received nutritional supplementation showed a pattern of lower mortality risk than unsupplemented at-risk patients, consistent with but not proving a beneficial association. These findings support systematic nutritional screening and timely intervention in hospital care.