Multidimensional Assessment of Nutritional Status Among Hospitalized Older Adults With Pneumonia at a Tertiary...

Malnutrition is a common but often overlooked problem among hospitalised older adults, particularly those admitted with acute infections such as pneumonia. Pneumonia can worsen nutritional status through inflammation, fever, poor appetite, breathlessness, fatigue, and reduced food intake, while malnutrition can, in turn, weaken immunity, reduce respiratory muscle strength, and delay recovery. This study assessed the spectrum of nutritional status among hospitalised older adults with pneumonia at the 37 Military Hospital in Accra, Ghana.

A descriptive cross-sectional study was conducted among 74 hospitalised adults aged 60 years and above with a confirmed diagnosis of pneumonia. Data were collected on socio-demographic and health-related characteristics, dietary intake, anthropometry, and haemoglobin status. Nutritional status was assessed using Body Mass Index (BMI), the Mini Nutritional Assessment (MNA), mid-upper arm circumference (MUAC), calf circumference, dietary diversity score, and haemoglobin concentration. Associations between nutritional indicators were examined using chi-square and Monte Carlo exact tests, and multivariable prevalence-ratio regression was used to identify factors independently associated with MNA-defined malnutrition and BMI-defined underweight.

Participants had a mean age of 72.3 ± 8.6 years, with 38 males and 36 females. Based on BMI, 66.2% were underweight, 31.1% had a healthy weight, and 2.7% were overweight. The MNA classified 39.2% of participants as malnourished, 50.0% were at risk of malnutrition, and only 10.8% as well nourished. Among participants with haemoglobin data, 77.5% were anaemic. MUAC classified 9.5% as underweight and 32.4% as at risk, while 31.1% had a low calf circumference; 56.8% had inadequate dietary diversity. MUAC and calf circumference were significantly associated with both MNA classification (p = 0.0047 and p = 0.0309) and BMI category (p = 0.010 and p = 0.035), whereas MNA classification was not significantly associated with BMI category (p = 0.142). In multivariable analysis, each 5-year increase in age was associated with a 21% higher prevalence of MNA-defined malnutrition (aPR = 1.21, 95% CI: 1.01-1.46, p = 0.040); no factor was independently associated with BMI-defined underweight.

Malnutrition was highly prevalent and manifested in multiple, only partly overlapping forms among hospitalised older adults with pneumonia. Because BMI, MNA, MUAC, calf circumference, and dietary diversity captured related but distinct dimensions of nutritional risk, reliance on a single indicator particularly BMI alone may underestimate the true burden of malnutrition. Routine screening with multiple, low-cost indicators should be integrated into pneumonia care for older adults to support early detection, targeted intervention, and improved recovery.