Association Between Nutritional Risk and Anticholinergic Burden Among Internal Medicine Inpatients: A Retrospective Cross-Sectional Study
Serap Balaban Barta1, Rıdvan Erdin2, Hilal Şimşek3, Rıfat Bozkuş2, Emin Gemcioğlu21Department of Nutrition and Dietetics, Faculty of Health Sciences, Gaziantep University, Gaziantep, Türkiye2Department of Internal Medicine, Ankara Etlik City Hospital, Ankara, Türkiye
3Department of Nutrition and Dietetics, Bor Faculty of Health Sciences, Niğde Ömer Halisdemir University, Niğde, Türkiye
INTRODUCTION: Nutritional risk is common among hospitalized patients, and anticholinergic burden may impair nutritional status. This study aimed to evaluate the association between anticholinergic burden and nutritional risk among adult patients hospitalized in an internal medicine ward.
METHODS: This retrospective cross-sectional study included 1570 internal medicine inpatients. Nutritional risk was assessed using the Nutritional Risk Screening 2002 (NRS-2002), with scores ≥3 indicating high nutritional risk. Anticholinergic burden was calculated using the Anticholinergic Cognitive Burden (ACB) Scale and categorized as no burden, low–moderate burden, and high burden. Binary logistic regression identified factors associated with high nutritional risk.
RESULTS: Among the participants, 51.2% had no anticholinergic burden, 32.3% had low–moderate burden, and 16.5% had high burden. High nutritional risk increased progressively across anticholinergic burden groups, from 47.3% in the no-burden group to 69.2% in the low–moderate burden group and 88.8% in the high-burden group (p<0.001). NRS-2002 scores also increased significantly with increasing anticholinergic burden (2.64±1.81, 3.55±1.82, and 4.25±1.48, respectively; p<0.001). In the adjusted logistic regression model, each one-point increase in ACB score was independently associated with higher odds of high nutritional risk (OR=1.96, 95% CI: 1.71–2.34, p<0.001), after controlling for potential confounders. Lower albumin level was also independently associated with high nutritional risk (OR=0.92; 95% CI: 0.89–0.95; p<0.001).
DISCUSSION AND CONCLUSION: A higher anticholinergic burden was independently associated with higher odds of nutritional risk among internal medicine inpatients. These findings suggest that anticholinergic exposure may be a clinically relevant and modifiable factor in nutritional risk assessment.
Keywords: Anticholinergic burden, nutritional risk, internal medicine, polypharmacy, hospitalized patients.
Manuscript Language: English
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