Malnutrition is a facet of poor nutrition and costs the UK alone up to £7.4 billion per year
"The message could not be clearer: malnutrition is highly prevalent and leads to poor clinical outcomes. Solutions are available and effective nutritional support improves clinical outcomes and is cost-effective. The time to act is now."
Professor Claude Pichard
In the current era of the obesity epidemic, most attention from policymakers and health promotion campaigns is aimed at reducing caloric intake and improving nutritional habits. Yet a forgotten facet of poor nutrition is malnutrition, defined as an imbalance of energy, protein, and other nutrients that causes measurable adverse effects on tissue and body form and function as well as clinical outcomes.
The prevalence of malnutrition is high
Estimates vary, as methods for detection are not standardised. But the prevalence of malnutrition is undeniably high: up to 40% of patients of all ages are malnourished upon admission to hospital. Certain groups are particularly at risk: older people, patients with cancer, renal disease, chronic heart failure and patients who have had surgery. In all clinical and community settings and across the population, malnutrition is severely unrecognised.
Malnutrition leads to poor clinical outcomes
Malnutrition is not only a problem on its own. For example, complication rates in malnourished surgical patients, for example, are 2-3 times higher than in patients who are well-nourished.
Malnutrition may also:
- delay speed of recovery
- predispose patients to infections, impair wound healing
- lead to pneumonia
- impair thermoregulation, leading to an increase in falls.
It also poses a huge cost to society
Individuals suffering from malnutrition are more likely to visit the GP. Their higher vulnerability to different conditions increases their need for health and social care, as well as hospital care. The burden on carers can be significant. This translates into huge costs for the health care system. A recent UK study estimated that disease-related malnutrition cost the UK up to £7.4 billion, 50% of which was spent in community settings (Jones et al, 2005; Elia et al, 2005).
Effective prevention and nutritional support exist:
Nutritional support may include: nutritional advice and counselling, oral dietary supplementation, enteral tube feeding and parenteral nutrition. Early detection and prompt treatment are essential as much of malnutrition is reversible. Treatment can also be extremely effective in reducing mortality and complication rates.
Barriers to access to prevention and care are significant
Barriers occur at a number of levels:
- General awareness of the issue malnutrition is poor
- The issue has not yet risen to the political agenda.
- Professional training is poor ? a recent UK survey found that 40% of GPs did not think malnutrition was a problem.
- Malnutrition is under-recognised and under-treated.
- Treatment guidelines exist, but they are rarely applied in practice.
- Nutrition therapy has no place within health and social care budgets.
"How will history judge the early 21st century? If things go on as they are, the verdict will be dismay and condemnation, that wealthy societies and established social protection systems could allow the tragedy of malnutrition to occur in such a large segment of the population. This is just not tolerable, and the European Nutrition for Health Alliance, with growing support, is determined to tackle this issue."
Mel Read, former Member of the European Parliament.