Malnutrition

Recently had this published by the Royal Society of Public Health --this is a shortened version


Malnutrition in the UK
Malnutrition is estimated to cost the UK twice that of obesity every year, but it is still an often overlooked problem. Dr Mabel Blades, a freelance Registered Dietician and Nutritionist, looks at the problems that malnutrition presents and the solutions that we can use to combat it.

Malnutrition is defined  as ‘a state of nutrition in which a deficiency, excess or imbalance of energy, protein, and other nutrients causes measurable adverse effects on body function and clinical
outcome.’

In the UK most of the focus on malnutrition is in the form of obesity, with over-consumption of calories being the key problem. Under-nutrition is also a very real, but often neglected, problem and this article focuses on under-nutrition as a form of malnutrition.Under-nutrition is defined as a body mass index (BMI) < 18.5kg/m2 and unintentional weight loss greater than 10% within the last three to six months, or BMI < 20kg/m2 and unintentional weight loss greater than 5% within the last three to six months.

Malnutrition is associated with numerous consequences that have an impact on health and wellbeing, including weight loss plus impaired temperature control with the loss of insulating body fat; increased muscle loss (sarcopenia) and resultant weakness and fatigue; apathy; depression and self-neglect; impaired
immune response; increased tissue breakdown and impaired wound healing; osteoporosis and increased risk of fracture; constipation; and anaemia.

These issues related to malnutrition result in increased numbers of visits to general  practitioners (GPs) and an increased risk of hospital admission with a lengthy stay, but if the malnutrition is treated, the effects could be reversed.

Malnutrition costs the UK more than £13 billion per year due to the increased costs of healthcare,
hospital admissions and support.This figure is more than twice the cost of obesity, which the Department of Health quotes as £5.1 billion per year. Yet despite the vast costs ofmalnutrition, it seems very much a
neglected area. Indeed, in a survey of GPs in 2010,4 a large proportion were unaware of malnutrition – as indeed are many managers of services.

Malnutrition at present occurs in:
• 10–14% of those in sheltered housing
• 16–20% of outpatients
• 24–34% of those admitted to hospital
• 30–42% of those in residential care

The National Institute for Health and Clinical Excellence  recommends that people in hospital or in care are
screened for malnutrition. One of the recommended tools to use is the MUST – the Malnutrition Universal Screening Tool. This is very simple and quick to use and is based on five simple steps, using a chart to evaluate the scores:

However, it is not just important to assess who is at risk of malnutrition; it is imperative to do something about it. This means boosting energy intake with enjoyable and acceptable foods pertinent to the individual’s likes and dislikes. This is particularly important in hospital or care settings where there have been cases of neglect.

While one wishes to encourage a healthy balanced diet as portrayed by the Eatwell Plate, to encourage a reversal of the malnutrition more fatty and sugary foods and drinks can be useful to increase calories. It may
be a time to recommend numerous