Fasting orders and malnutrition risk in hospitals: The impact of mandatory fasting on hunger perception in nutritionally at-risk patients

Abstract

<div><h3>Background & aims</h3><div>Hospitalized patients frequently undergo fasting for diagnostic procedures. This study investigated craving and hunger perceptions during fasting and assessed whether oral nutritional supplements (ONS) could alleviate these effects.</div></div><div><h3>Methods</h3><div>This post-hoc analysis of a randomized prospective study (July 2021–May 2023) included 210 of 215 evaluated patients (of 250 enrolled patients), of whom 30 % (64) were screened as at risk of malnutrition (ARM) according to the Nutritional Risk Score 2002 (NRS). The original study compared three preparation protocols (breakfast, fasting, and ONS) before abdominal ultrasound. The 15-item Food Craving Questionnaire-State (FCQ-S) assessed cravings (items 1–12) and hunger (items 13–15) on a 5-point Likert scale. Secondary outcomes included the effects of the preparation protocols on these scores.</div><div>Statistical analysis included Welch's t-test, ANOVA with Tukey's post-hoc correction, and two-way ANCOVA (adjusted for age and sex), with Bonferroni correction for multiple comparisons.</div></div><div><h3>Results</h3><div>ARM patients reported significantly higher FCQ-S Hunger scores than patients screened as not at risk of malnutrition (NARM) (M_diff = -1.24, 95 % CI [-2.24, -0.24], <em>p</em> = 0.016). This difference was driven by the fasting group, where ARM patients had significantly higher Hunger scores than NARM patients (M_diff = -2.88, 95 % CI [-4.51, -1.25], <em>p</em> < 0.001). In ARM patients, ONS significantly reduced Craving and Hunger scores, with an effect comparable to breakfast, particularly in hunger perception (ONS vs. Fasting: M_diff = -3.83, 95 % CI [-6.13, -1.53], <em>p</em> < 0.001; Breakfast vs. Fasting: M_diff = -3.78, 95 % CI [-6.07, -1.49], <em>p</em> < 0.001). In contrast, NARM patients receiving ONS had similar Hunger scores to those who fasted. ARM status did not adversely affect abdominal ultrasound assessment.</div></div><div><h3>Conclusion</h3><div>ARM patients experienced greater fasting-related hunger, indicating a disproportionate impact of fasting and suggesting a different adaptation to fasting. ONS could alleviate cravings and hunger, similar to the effects of a breakfast in ARM patients. Reevaluating fasting orders could help mitigate hospital malnutrition effects.<br></div></div>