We’ve been supporting patients since 1973
A lot has changed over the years, but we’ve always been there
With John, fighting AIDS in 1985
With Daniel, going through chemotherapy in 2010
With Vanessa, managing Crohn’s disease today
And we’ll continue to be there
For patients we haven’t yet met
For challenges they may face*
We are nutritional strength behind the scenes

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Malnutrition

Malnutrition

Malnutrition – Key Statistics

  • Malnutrition affects > 3 million people in the UK1,2
  • It is often under recognised and under treated1,2
  • Malnutrition is estimated to account for more than 15% of the total public expenditure on health and social care, that’s an annual cost in England of £19.6 billion3
  • The annual cost of treating a malnourished patient is 3-4 times more than treating a non-malnourished patient3
  • It is estimated that £5,000 per patient could be saved though better nutrition management3
  • Malnourished adults make up:3
    • 30% of adults on admission to hospital
    • 35% of adults admitted to care homes
    • 18% of adults on admission to mental health units
    • 15% of adults attending hospital outpatients
    • 10% of adults visiting their GP – that’s on average 4 patients per day4

Malnutrition – Causes5

Impaired intake 

  • Reduced appetite
    • Illness, pain/nausea when eating, depression/anxiety, food aversion, medication, drug addiction
  • Inability to eat
    • Diminished consciousness, confusion, weakness or arthritis in the arms or hands, dysphagia, vomiting, painful mouth conditions, poor oral hygiene or dentition, restrictions imposed by surgery or investigations
  • Lack of food
    • Poverty, poor quality diet at home, in hospital or in care homes, problems with shopping and cooking

Impaired digestion and/or absorption

  • Medical and surgical problems affecting stomach, intestine, pancreas and liver

Altered requirements

  • Increased or changed metabolic demands related to illness, surgery, organ dysfunction, or treatment

Excess nutrient loss

  • Gastrointestinal losses, vomiting, diarrhoea, fistulae, stomas, losses from nasogastric tube and other drains. Other losses e.g. skin exudates from burns

Malnutrition – Who is at risk6,7

People with long term conditions

For example:

  • Diabetes
  • Kidney disease
  • Chronic lung disease
  • Crohn’s disease

People with chronic progressive conditions

For example:

  • Cancer – patients with cancer are at significantly higher risk of malnutrition than those without (34% vs. 23%).8
  • Dementia
  • Cystic fibrosis

The Elderly and People with swallowing difficulties

  • Older people >65 – Older people may risk deficiencies as their appetites decrease, absorption of nutrients decreases, polypharmacy (multiple drugs) may interfere with absorption or metabolism of essential vitamins and minerals and the variety of food that they eat may become narrow for various reasons such as low income, ill-fitting dentures, poor appetite etc.

Pregnant women and women planning to become pregnant

  • These women should take 400 micrograms of folic acid every day until the 12th week of pregnancy to reduce risks of neural tube defects in the developing foetus.9
  • Pregnant women should always consult their doctor before taking any supplement.

Others at risk

  • Those convalescing from illness, chemo or radio-therapy or surgery often have poor appetites but require adequate intakes of vitamins and minerals to aid recovery and optimise tolerance to treatment.
  • Those following a restricted diet for medical reasons may lack essential vitamins and minerals, as may those with diseases of the digestive system which prevent normal absorption of nutrients.
  • Alcoholics tend to have a poor diet and alcohol abuse tends to damage the digestive system reducing absorption of nutrients and also altering metabolism.
  • People with food allergies and intolerances may have gaps in their nutritional intake.
  • Teenagers may be at risk of marginal vitamin and mineral deficiencies as adolescence is a period of growth and development, also teenagers do not always make the best possible food choices or may be “faddy eaters”.
  • Those living in poverty
  • People who are socially isolated

Malnutrition – Consequences2,3

  • Increased number of GP visits
  • Increased referrals to hospital and length of hospital stay
  • Increased vulnerability to illness and increased clinical complications
  • Increased prescription costs
  • Increased dependency on others
  • Increased number of deaths

Mechanisms by which malnutrition predisposes to certain clinical problems and delays their resolution

Adverse effect Consequence
Impaired immune responsesPredisposes to infection and impairs recovery when infected.
Impaired wound healingSurgical wound dehiscence, anastomotic breakdowns, development of post-surgical fistulae, failure of fistulae to close, increased risk of wound infection and un-united fractures. All can then lead to prolonged recovery from illness, increased length of hospital stay and delayed return to work.
Reduced muscle strength and fatigueInactivity, inability to work efficiently, and poor self-care. Abnormal muscle (or neuromuscular) function may also predispose to falls or other accidents.
Reduced respiratory muscle strengthPoor cough pressure, predisposing to and delaying from chest infection. Difficulty weaning malnourished patients from ventilators.
Inactivity, especially in bed bound patientPredisposes to pressure sores and thromboembolism, and muscle wasting.
Water and electrolyte disturbancesMalnourished individuals are usually depleted in whole body potassium, magnesium and phosphate, while simultaneously overloaded in whole body sodium and water. They also have reduced renal capacity to excrete a sodium and water load. This leads to vulnerability to re-feeding syndrome and iatrogenic sodium and water overload.
Vitamin and other deficienciesSpecific vitamin deficiency states e.g. scurvy and vitamin related re-feeding risks. Mineral deficiencies include iron deficiency anaemia, magnesium deficiency (see also above for electrolyte disturbances) and calcium deficiency, which can cause osteoporosis. A lack of trace elements can also be a cause of range of problems.
Impaired psycho-social functionDeficiency in nicotinamide (Vitamin B3) is known to cause pellagra and neurological changes10.

Malnutrition – Screening11

  • All hospital inpatients on admission and all outpatients at their first clinic appointment should be screened. Screening should be repeated weekly for inpatients and when there is clinical concern for outpatients. Hospital departments who identify groups of patients with low risk of malnutrition may opt out of screening these groups. Opt-out decisions should follow an explicit process via the local clinical governance structure involving experts in nutrition support. 
  • People in care homes should be screened on admission and when there is clinical concern. 
  • Screening should take place on initial registration at general practice surgeries and when there is clinical concern. Screening should also be considered at other opportunities (for example, health checks, flu injections).
  • Screening should assess body mass index (BMI) and percentage unintentional weight loss and should also consider the time over which nutrient intake has been unintentionally reduced and/or the likelihood of future impaired nutrient intake. 
  • The Malnutrition Universal Screening Tool (MUST) may be used to do this. MUST is a tool that has been developed by the British Association of Parenteral and Enteral Nutrition (BAPEN), and is recognised by NICE as a validated malnutrition screening tool.
    • Click here to view the MUST calculator
    • Click here to download the MUST guide