Malnutrition Risk among Adult Inpatients in Sulaimani: A Cross-sectional Study with Implications for Early Acute-Care Screening

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Background: Nutritional risk is relevant to early inpatient and acute-care pathways because early recognition of malnutrition may support timely referral. This study estimated the prevalence of malnutrition risk among adult inpatients in Sulaimani using the Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA), and examined its association with age, sex, length of hospital stay, and primary cause of admission. Methods: This observational cross-sectional study was conducted in four public hospitals in Sulaimani from March 1 to March 31, 2024. Individual-level data from 169 adult inpatients aged 18 years or older who had remained hospitalized for more than three days were analyzed. Nutritional status was assessed between days 3 and 7 of hospitalization using MUST and SGA. Therefore, the findings reflect patients who remained hospitalized beyond three days rather than nutritional status at the exact time of emergency department arrival or hospital admission. Results: The mean age was 53.6 ± 18.08 years, and 87 participants (51.5%) were female. MUST identified 131 patients (77.5%; 95% CI: 70.6-83.2) as being at medium or high risk of malnutrition, while SGA classified 140 patients (82.8%; 95% CI: 76.4-87.8) as moderately or severely malnourished. Hospital stay of 8 days or longer was associated with SGA-defined moderate/severe malnutrition after adjustment for available covariates (adjusted OR: 12.30; 95% CI: 1.60-94.78; P = 0.016), although the temporal direction of this association cannot be determined. Severe malnutrition was present in 69 patients (40.8%; 95% CI: 33.7-48.4) and was associated with age >65 years, hospital stay ≥8 days, and oncological admission after adjustment for available covariates. MUST and SGA showed high observed agreement after dichotomization (92.3%), with Cohen's kappa = 0.759. Conclusion: Malnutrition risk was very common among adult inpatients who remained hospitalized for more than three days in Sulaimani. The findings may be relevant to early acute-care screening, particularly for patients who remain hospitalized after urgent admission pathways. However, this study was not designed to estimate malnutrition at emergency department triage, and causal conclusions about malnutrition and length of stay should be avoided.