Malnutrition in hospital: Avoidable ... but not a priority?

Malnutrition is often thought of in the context of people who do not, or simply cannot, consume enough food or the right nutrients.

But another, sometimes forgotten reason for malnutrition can be when adequate nutrients are taken in but are not digested or absorbed properly by the body. Indeed, when it comes to developed countries at least, disease is one of the most common causes of malnutrition.

In this NutraIngredients special edition we ask why this avoidable, global issue is not a priority for more governments, healthcare providers, and food manufacturers who can make a difference

Widespread, yet overlooked​

Whether implicated in chronic disease or short-term illness, hospital related (or disease-related) malnutrition can result in compromised immune responses that lead to increased risk of infection, increased recovery times, and worse wound healing, and longer times spent in hospital.

Speaking at the recent ESPEN conference​ Professor Alessandro Laviano commented that malnutrition “is not seen as a priority in patients; their underlying pathologies take priority.”​

Health risks​

Writing in Clinical Nutrition​​, a team of Dutch researchers led by Karen Freijer of Maastricht University warn that DRM (disease-related malnutrition) “adversely impacts every organ system in the body with potentially serious consequences on a physical and psycho-social level that in turn contribute to increased morbidity and mortality.”​

The relationship between malnutrition and surgical morbidity and mortality has been well established, with various studies revealing increased risks for malnourished patients who have cancer surgery, heart disease and transplants, kidney transplants, chest and lung operations, brain surgery, and liver transplantation.

“We need to realise that without proper nutrition, malnutrition will lead to increased complications and longer recovery times amongst patients,”​ argued Laviano.

“Closer attention should be paid to basic serum and blood markers of malnutrition that correlate with increased mortality and important infections,”​ add researchers writing inThe Journal of Heart and Lung Transplantation​​.

The cost of medical malnutrition​

While the problem of malnutrition in hospitals has been acknowledged in some quarters for many years, wider public and political awareness of the problem is still fairly low, while the costs associated with the problem are high.

In the EU alone around 20 million patients are affected by disease related malnutrition– costing EU governments an estimated €120bn annually.

A recently published dossier from the Medical Nutrition International Industry (MNI - found in full here​ and in summary form here​) suggests the malnutrition bill for the whole of Europe is closer to €170bn every year – a figure the report said is more than double the amount spent on obesity.

Further research from Australia, published in the e-SPEN Journal​​, reveals that malnutrition is a commonly reported problem amongst hospitalised elderly patients – with estimates of between 30 and 43% in acute Australian hospitals.

“Our study provides convincing evidence that, within an acute hospital setting, the majority of older patients admitted are either malnourished or at risk of malnutrition,”​ conclude the researchers.

“It is obvious that the consequences of DRM result in increased treatment costs or healthcare utilization and associated costs to the society,”​ said Freijer and her colleagues – revealing in their study​ that hospital related malnutrition costs Germany, the UK and Ireland an estimated €9bn, €15bn and €1.5bn respectively.

Yet, by simply supplying better nutrition to hospital patients, by targeting the delivery of the right nutrients to those at risk, many of these issues can be avoided.