Background: Prevalence studies on hospital malnutrition are still scarce in the Middle East region despite recent global recognition of clinical malnutrition as a health care priority. Malnutrition has been associated with worsening health outcomes and it is associated with numerous factors beyond the clinical ones. The aims of this study is to measure the prevalence of malnutrition in adult hospitalized patients in Lebanon using the newly developed Global Leadership Initiative on Malnutrition tool (GLIM) and to explore the association between malnutrition and the length of hospital stay (LOS) as clinical outcome. We also aim to assess the association of different risk factors as part of the Social Determinants of Health in addition to the level of food security to malnutrition and study if any of these factors can be potential predictors. It will help in adding the perspective of Right to Health to the diagnosis and management of malnutrition in hospitalized patients.

Methods: A systematic review was firstly conducted to identify and summarize the available evidence regarding the prevalence and the nutrition assessment tools used in hospitalized patients in the region of the Middle East. Second, a nationally representative cross-sectional sample of hospitalized patients was selected from random sample of hospitals in the five districts in Lebanon. Malnutrition was screened and assessed using the Nutrition Risk Screening tool (NRS-2002) and GLIM criteria. Mid upper arm muscle circumference (MUAC) and handgrip strength were used to measure and assess muscle mass. Length of stay was recorded upon discharge. Patients were interviewed to collect social and economic characteristics. Social Determinants of Health were categorized into four criteria: (1) area of residence (urbanization level), (2) level of education, (3) employment status and (4) source of health coverage. Food security level was determined by validated tool targeting both quantity and quality. Level of knowledge of the Right to Health among hospitalized patients was also assessed by asking about awareness and definition as part of the survey conducted.

Results: The systematic review identified only ten studies that reported prevalence of malnutrition with small sample size and focused mainly on older adults or specific medical conditions. After the systematic review, a multicenter study was conducted enrolling 343 adult hospitalized patients. The prevalence of malnutrition according to NRS-2002 and GLIM criteria was 31.2% and 35.6%, respectively. The most frequent malnutrition associated criteria were weight loss and low food intake. Malnourished patients had significantly longer LOS as compared to patients with adequate nutritional status (11 days versus 4 days). Handgrip strength and MUAC measurements were negatively correlated with the length of hospital stay. Patients with low level of food security, mainly low quality of food, have higher odds of being malnourished (OR=2.93, 95% CI [1.09; 7.850]). Unemployed or retired patients and those who has only reached elementary school had higher odds of being malnourished as compared to those employed or had university degrees respectively (OR=4.11, 95% CI [2.43; 6.95] and OR=2