Malnutrition and undernourishment: the state of inadequate or unbalanced nutrition, is a well-known issue in developing countries, but it also occurs in developed countries. In fact, malnutrition can often go unrecognised in clinical settings, such as hospitals or care homes, a phenomenon that, in my opinion, should not be overlooked. At the 2007 European Society for Clinical Nutrition and Metabolism Symposium, it was reported that the average prevalence of malnutrition in those hospitals and care homes was 35%, with a range from 10-85%.¹

The presence of malnutrition has been associated with gender, presence of malignant disease (e.g. cancer), dysphagia, poly-medication, and age.^{2 3} A 2010 survey conducted in the UK and Republic of Ireland showed that the risk of malnutrition was 28% in patients under 60 years old, 32% in those aged 60-79 years, and 44% in those 80 years and over.⁴ 

Video: Alliance of Aging Research

 Malnourished patients have higher rates of morbidity, mortality, hospital infections, and hospital re-admissions which means longer hospital stays and major medical emergencies. As a further consequence, there are increased costs which could have been avoided.^{2 5} To identify contributing factor of malnutrition, we should be aware of:

• Food intended for patients being inappropriately consumed by others
• Food not being consumed at all, (also causing food waste)

Monitoring food waste in these institutions is therefore vital because of the nutritional, health, and cost implications. As well as monitoring food waste, there are other recommendations from the Alliance for Aging Research:

• Involving all staff in malnourished patients’ treatment
• Change a patient’s diet in order to provide more nutrient and protein content meals to cover requirements
• Support community-based programmes that allow more access to food.

Further recommendations include:

• Patients should be  given a menu option asking for assistance in eating or help with packaging.
• Healthcare professionals should receive appropriate training on the importance of systematic screening, monitoring, and intervening in cases of malnutrition.
• Communication and coordination amongst these professionals eg physicians, nurses, pharmacist, dieticians etc. is a key element to execute a high-quality nutrition care plan.

Two examples of this latter point can be found in UK, where the "Listen to Patients, Speak Up for Change" and "Nutrition Now" campaigns have demonstrated success in recognising malnutrition in hospitals, and raising nutritional and hydration standards.⁶

As I’ve mentioned in several of my previous food blogs - food, and subsequently nutrition, is an important area in hospitals that is often overlooked. This is chaning, however, some countries have developed national,or even local strategies and tools to identify adults at risk of malnutrition.^{7 8 9 10}  

An example of this is the  five-step Malnutrition Universal Screening Tool (MUST), based fundamentally on measuring height and weight to get a BMI score and developing a care plan.¹¹ Screening when a patient is admitted or hospitalised is just the first step, a tailored nutritional assessment should follow, even after the patient has been discharged, particularly for those over 65 years, because of difficulties shopping or cooking their own food. It is because of this, community-based programmes are so important, as they can provide this support, improve the health of the general population, and reduce health expenditures.

With tools such as this already existing, we don’t necessarily need more resources, but as the Alliance for Aging Research suggests, we should start recognising this problem and solve it by encouraging people to talk about the issue. All the while, nutritious and healthy food should continue to be provided, and practices to tackle it being shared among professionals and healthcare facilities.

- Paola Hernández, Sustainable and Healthy Food Programme Assistant

_{Preview image: Siobhan via Flickr cc}

References:

1. Abby Sauer. Hospital Malnutrition: Assessment and Intervention Methods.
2. Álvarez-Hernández J, Planas Vila J, León-Sanz M, et al. Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES® Study. Nutr Hosp. 2012;27(4):1049-1059.
3. Pirlich M, Schütz T, Norman K, et al. The German hospital malnutrition study. Clin Nutr. 2006;25(4):563-572. doi:10.1016/j.clnu.2006.03.005.
4. Russell CA, Elia M. Nutrition Screening Survey in the UK and Republic of Ireland in 2010: 2011.
5. Guenter P, Jensen G, Patel V, et al. Addressing Disease-Related Malnutrition in Hospitalized Patients: A Call for a National Goal. Jt Comm J Qual Patient Saf. 2015;41(10):469-473.
6. The Patients Association (2011). Malnutrition in the community and hospital setting
7. European Food Information (2011). Time to recognise malnutrition in Europe
8. The Association of UK Dieticians (2012). The Nutrition and Hydration Digest: Improving Outcomes through Food and Beverage Services
9. Recommendations of the Scientific Group of Malnutrition experts advising on Belgium's National Food and Health Plan
10. The Newcastle upon Tyne Hospitals NHS Foundation Trust, Nutrition Policy (2014)
11. BAPEN. Malnutrition Universal Screening Tool