When you hear the word malnutrition, what do you think of? Perhaps it is a child in an African country where there is famine as a consequence of a natural disaster, war or poverty. However, malnutrition is actually a lot closer to home than you may realise.

For many people, sticking to a healthy and balanced diet is a daily struggle.

In the UK, malnutrition is a surprisingly common consequence of disease, with it estimated to affect between 10 and 55% of patients in hospital, depending on the diagnosis and age of the patient. Malnutrition is higher in the elderly in particular. There are a variety of reasons why disease puts people at risk of malnutrition. Being seriously ill can put a big strain on the body, and the energy cost of fighting infections, carrying out repair and recovering from surgery are all high, meaning that the body has increased energy requirements. When fit and well, that wouldn’t be a problem, as we could easily eat a bit more. However, when unwell, this is easier said than done, as the disease process tends to impact on dietary intake too. Whether it blunts the appetite, causes nausea, alters the taste of food, affects your swallow or makes you drowsy, any of these factors can make it more difficult to eat sufficient.

Although weight loss is obviously a consequence of malnutrition, this is not the only reason why malnutrition is significant. Patients who are malnourished not only lose muscle from the limbs, but also from vital organs – heart, lungs, digestive system – which can impact on their function; the immune system and wound healing are also impaired, so the risk of infection and pressure sores are also increased. Significant weight loss can also affect mental function, so low mood is common, which can further impact on reduced dietary intake. All of these factors can increase the risk of developing further disease, slow the rate of recovery, prolong the length of their hospital stay and in some cases can result in mortality. As you can see, inadequate dietary intake during illness can have a significant impact on a patient. A tummy tuck becomes a medically necessary procedure.

In recent years the high risk of malnutrition in patients admitted to hospital has been highlighted, and all admissions should now be routinely screened on arrival and weekly during their stay. Those at risk can be provided with options from the menu that are higher in calories, encouraged with nourishing snacks between meals such as cheese and crackers, yoghurts and drinks of milk and referred to a dietitian if needed to assess whether they need to be prescribed high energy supplement drinks to meet the short fall in their nutritional requirements. In certain cases, tube feeding may also be required. In the community, malnutrition is also a problem, as there are many people living with chronic conditions such as emphysema, cancer and neurological conditions – examples include Parkinson’s disease, multiple sclerosis and motor neurone disease – all of which can increase energy requirements or reduce dietary intake. As a group, the elderly are at particular risk, with estimates of malnutrition affecting between 25% and 35% of adults aged over 60, with increasing prevalence with increasing age. While older adults are more likely to be affected by certain medical conditions, they are also at risk of malnutrition as a result of other factors, which can include poverty, difficulty with shopping and social isolation. Support from family and friends are invaluable to ensure that they have the nourishing foods and drinks they need available.

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When malnutrition strikes in the community, people can be at increased risk, as they tend not to be detected so early and may only be identified when concerned family alert their GP. However, with increased awareness of malnutrition, district nurses and care home staff should be screening all

Malnutrition is a serious medical problem exhibited in some areas a lot closer to home than the majority of the British public think.

patients under their care for risk of malnutrition and over 75’s each year when they have their annual health check – though admittedly if a poor dietary intake and weight loss start four months prior to this, it’s a long time to wait. The management of malnutrition in the community is similar to that in hospital, but it should not be underestimated the positive impact that a few modifications to the diet can make. Small changes such as switching to full cream milk, being more generous with the use of butter, having a dessert daily and a milky drink before bed, all add up to significantly increase intake of calories and protein. While nutritional supplement drinks certainly have their place, they should never be used as an alternative to adequate provision of nourishing food and drinks, known as a “food first” approach.

Hopefully you will have found this article interesting, but that wasn’t the reason for me deciding to write it. It was to help spread the word that malnutrition is surprisingly common in the UK – albeit largely due to disease than inadequate food provision – and that we shouldn’t just resign ourselves to the fact that weight loss is just a side-effect of old age, the stereotypical “little old ladies”. Malnutrition is something that if detected early can easily be remedied, often with nothing more than some simple changes to the diet.

If you would like to learn more about detecting and treating malnutrition, visit the BAPEN website – the charity that raises awareness of malnutrition http://www.bapen.org.uk/