Re: Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning: a prospective cohort study.

In a study published in this journal Wakabayashi & Sashika (1) report that a poor rehabilitation outcome for hospital-associated deconditioning in elderly patients is associated with nutritional state, chronic disease-related malnutrition and albumin levels. Hospital-associated deconditioning, described as functional decline related to acute hospitalization, is of particular relevance, as it has a high prevalence in elderly patients (approximately 30%). In addition, hospital-associated deconditioning increases the risk of institutionalization and death (2). In this context, we regard the current results as of particular importance in generating preventive strategies for hospital-associated deconditioning. We would like to comment on this study. In recent years, we have learnt that patient tolerance to physical or occupational therapy, cognition/ability to learn, motivation and mood are potential confounders in the outcome of rehabilitation programmes for hospital-associated deconditioning (2). Low mood, which commonly presents as depression in elderly patients, and impaired cognition may also adversely affect the dietary intake and nutritional state of this group of patients (3). However, Wakabayashi & Sashika’s study excluded subjects with deconditioning secondary to specific neurological insult, and did not report any screening or clinical evaluation results for the cognitive ability and mood of participants. We suggest that inclusion of these parameters would affect the multivariate analyses. Secondly, this study should focus on the daily calorie and protein intake of participants during the inpatient rehabilitation programme. Previous studies have shown that the protein and caloric intake of elderly and critically ill patients are frequently suboptimal during a period of hospitalization (4, 5). It has been reported in a meta-analysis that, in elderly subjects, adequate protein supplementation increases muscle mass and strength gains during prolonged resistance-type exercise training (6). The present study did not report adequate data on daily protein and calorie requirements and their management. Wakabayashi & Sashika’s study identifies relevant issues in the management of elderly inpatients; however, we suggest that future studies with a similar design should are required to address the above-mentioned methodological drawbacks.