Associations between transition of malnutrition diagnosis defined by the Global Leadership Initiative on Malnutrition criteria and functionality, mortality, and weaning of enteral nutrition in an inpatient rehabilitation setting: findings from a national surveillance.

BACKGROUND AND AIMS: Malnutrition is a prevalent condition in rehabilitation settings that can negatively impact functional recovery and prognosis. To date, the clinical importance of changes in nutritional status during hospitalization remains unclear. Therefore, this study aimed to determine whether the trajectories of Global Leadership Initiative on Malnutrition (GLIM) -defined malnutrition in inpatient rehabilitation are associated with Functional Independence Measure (FIM) gain, in-hospital mortality, and tube feeding (TF) removal. METHODS: The 2024 nationwide survey conducted by the Kaifukuki (convalescent) Rehabilitation Ward Association, which included adults aged ≥18 years with a hospital stay of ≥30 days, was retrospectively analyzed. GLIM-defined malnutrition at admission and discharge was employed to classify patients into four trajectory groups: preserved (remained well-nourished during hospitalization), sustained (remained malnourished during hospitalization), improved, and declined. The primary and secondary outcomes included FIM gain, in-hospital mortality, and weaning from TF. Multivariate analysis was conducted to elucidate the association between change in nutritional status and outcome measures. RESULTS: A total of 13,386 patients were analyzed (women, 57.7%; median age, 81 years). FIM gain significantly differed across the groups: (preserved, 29; sustained, 21; improved, 29; declined, 20; p < 0.001). The declined group exhibited the highest in-hospital mortality (2.5%; p < 0.001). Among patients who received TF, the improved group had the highest incidence of TF weaning (48.5%). After adjustment for confounders, both sustained and declined nutritional statuses were significantly associated with FIM gain (β = -5.947 and -8.121, respectively) and in-hospital mortality (odds ratios (OR) = 3.145 and 9.514, respectively). TF weaning was more likely in the improved group than in patients without nutritional improvement (OR = 1.997). Among patients with cerebrovascular disease, the declined group had the lowest FIM gain (β = -10.011) and the highest in-hospital mortality risk (OR = 11.873). CONCLUSIONS: Persistent and new-onset malnutrition during hospitalization was associated with poorer functional recovery and higher in-hospital mortality in a convalescent rehabilitation ward. Conversely, nutritional improvement was associated with a higher likelihood of successful TF weaning.