The Undernourished Epidemic

Malnutrition is a hidden health burden with costs that may be higher than the well publicised obesity problem. Identifying those who are malnourished, particularly the elderly, and appropriately treating them will improve the health of the nation.

Malnutrition, particularly in the elderly, is a relatively common problem.

It is not just confined to hospitals, but also occurs in the community.

It is a public health issue, but in general is not recognised as such. The health costs are at least equivalent to the so-called obesity epidemic.

Malnutrition that is related to disease delays patient recovery. Malnourished patients tend to spend much longer in hospital.

There is a devastating social impact on those people living at home that have inadequate nutritional status.

Much malnutrition remains under-diagnosed because there is no adequate screening process in place.

There are particular groups that are more at risk of being undernourished and they have a worse outcome in terms of disease:

  • The elderly.
  • Patients with particular cancers.
  • Those who suffer from chronic disease.

Malnutrition is a catchall that includes energy imbalance and starvation and also certain micronutrient deficiencies which are often associated with protein energy malnutrition. Protein energy malnutrition is often masked by obesity.

Sarcopenic obesity can be overlooked. This is where an obese person has reduced and weakened muscle mass. It increases disease related complications.

Statistics show that malnutrition is increasing and it is a common occurrence. Up to 5% of the entire population of the EU could be considered either malnourished or at increased risk of malnutrition.

It is more common in those over 65, and even more common in the older age group. It is a significant problem in patients who are admitted to hospital.

Patients stay longer in hospital if they are malnourished. They are more likely to be discharged to ongoing care in terms of nursing homes, sheltered housing other than their own house if they are malnourished.

There are also many people in the community who are not adequately nourished and there are several consequences:

  • They see their GP consultation more often.
  • They require more prescriptions.
  • They end up in hospital more often.
  • They tend to be more debilitated by their illnesses and are at increased risk of mortality.

The concept of a malnourished carousel has been promoted for malnutrition.

  • People who are admitted to hospital are malnourished or at risk of malnutrition.
  • When they are malnourished coming into hospital then they are at more of a risk of being even more malnourished when they leave the hospital.
  • People who have cancer and a terminal illness would be expected to lose weight in hospital, but they are not the only category of hospital patients that do so.
  • At discharge the malnourished patients need even more help and more care.
  • They get more infections. Thus they are often readmitted to hospital again more quickly.

Malnutrition has a considerable burden in terms of healthcare costs.

There should be mandatory nutrition risk screening.

In some people it is obvious.

But 30-40% of patients don’t look like they are malnourished and are at risk and need to be screened.

Nutrition screening can be performed by nursing and ancillary staff. All patients should be weighed and BMI can be calculated from a self-reported height.

It is not just BMI, but also the distribution of weight in the body in terms of abdominal obesity that is associated with greater health risk.

In terms of underweight the muscle mass is important and this needs to be assessed for sarcopenic obesity.

One treatment option is oral nutrition supplements, but this approach has been criticised by some experts. They may be overused or taken incorrectly.

If used properly they can reduce the risks of hospital admission in people who are malnourished in the community. If used correctly in hospital patients they can ensure that weight loss does not occur during hospital stay if it is avoidable weight loss.

This use would ease the health burden of malnutrition and associated cost, especially if there was a standardised protocol for their use.


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