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Last Updated: Wednesday, 22 February 2006, 09:49 GMT
Malnutrition test 'must be norm'
Elderly people are most at risk
All hospital patients should be routinely screened for malnutrition and offered specialist nutritional support if required, new guidelines say.

The National Institute for Health and Clinical Excellence (Nice) issued the guidance designed to improve the way the NHS deals with the problem.

It is thought as many as 40% of hospital patients are at risk.

A report published in December estimated that malnutrition costs the NHS 7.3bn a year.

Impaired immune responses
Reduced muscle strength and fatigue
Increased difficulties in breathing
Impaired thermoregulation
Impaired wound healing
Apathy, depression and self-neglect
Poor libido

The report, by the British Association for Parenteral and Enteral Nutrition, said this was more than double the annual bill for obesity-related problems.

Testing for malnutrition is already mandatory in Scotland and Nice is calling for the guidelines to be extended to England and Wales.

The problem is particularly serious among the elderly. It is thought more than 10% of people aged over 65 are malnourished, and as many at 60% of pensioners who are admitted to hospital.

Need for support

The Nice guidelines were developed in collaboration with the National Collaborating Centre for Acute Care.

Julian O'Connor
Julian O'Connor, 42, has an auto-immune disease which led to muscle wastage
He was at risk of malnutrition after not being able to eat proper food for five weeks, instead relying on a drip
Fortunately he has now been able to start eating again

They recommend all hospital and care home patients should be weighed and measured on admission, and all outpatients should be similarly checked at their first clinic appointment.

Checks should be repeated weekly for inpatients, and where there is clinical concern for outpatients, say the guidelines.

Nice says specialised nutritional support should be considered for people who are malnourished. This is defined as:

  • Having a body mass index (BMI) of less than 18.5. BMI is calculated by dividing your weight in kilograms by your height in metres squared.

  • Unintentional weight loss greater than 10% in the last three to six months.

  • a BMI of less than 20 coupled with unintentional weight loss greater than 5% within the last three to six months.

It also recommends that nutrition support be considered for people at risk of malnutrition - such as those who have eaten little or nothing for more than five days, or who are unable to take in nutrients properly.

All acute hospitals are advised to employ at least one specialist nutrition support nurse.

Most people including kitchen staff have little idea about a healthy meal
Roger W, London

Andrea Sutcliffe, who took the lead role in drawing up the guidelines, said they could save the NHS at least 45m a year.

Malnourished patients stay in hospital for longer, have a higher mortality rate and are three times as likely to develop complications during surgery.

She said: "This guideline should help reassure patients and give confidence to their relatives and carers, that all at-risk patients, no matter where they live or what their underlying condition, will now be screened and if necessary offered appropriate nutritional support."

'Incredibly welcome'

Dr Mike Stroud, of the Institute of Human Nutrition at the University of Southampton, also worked on the guidance.

Malnutrition of our most vulnerable members of society has been swept under the carpet
Dr Lorna Layward, Help the Aged

He said: "Ensuring patients receive adequate nutrition is an essential part of basic patient care, yet we know malnutrition is still a big problem for the NHS.

"The guideline contains one obvious and simple message - do not let your patients starve and when you offer them nutrition support, do so by the safest, simplest, most effective route."

Shadow Health Secretary Andrew Lansley welcomed the guidance.

He said: "Far too many patients leave hospital less nourished than when they were admitted.

"Patients are often unable to feed themselves effectively because of lack of continuity of care and observation failures."

Dr Lorna Layward, of the charity Help the Aged, said the guidelines were "incredibly welcome".

"Our preoccupation with obesity means that malnutrition of our most vulnerable members of society has been swept under the carpet."

Your comments

My father-in-law has recently been in hospital in Sheffield where he was off food for a little over a week; subsequently the nurses ensured that he received full nutritional support which extended to his return home, so clearly some hospitals have got the message already. Of course now he has some good Yorkshire home cooking to build him up!
Giles, London

My mother's aunt was over 90 when admitted to hospital - despite being over 90, frail and with very poor sight she was left in a ward with 3 other similarly frail ladies. Food was brought to them and about 30 minutes later the plates were collected - in the most part untouched. Whether the food was of a good nutritional value and appetising is neither here nor there as their conditions meant that they could not or would not feed themselves. In their case, time needed to be spent feeding them - not just leaving it on the tray. Hospitals can penny pinch on the food - which is bad enough but nowhere did I see a nurse or auxiliary try and help the old folk- that would have made the cost of feeding them even greater.
W. Stevens, Scotland

If it is recommended that hospitals should test patients for malnutrition, then they should also look at the food that they are serving their patients. My father is in hospital at the moment, trying to recover from an infection after having a triple bypass operation. During his stay in 2 hospitals since Christmas, he has had to put up with the hospitals not supplying enough food to go round all the patients on the ward he was on repeatedly, and at a second hospital, being served food that had not been cooked properly and still being cold in the middle. These situations are the last thing he needs after the problems he has had, and as a result of these and other incidents, he has lost weight during his stay in hospital. This is also hampering his recovery, as his body is not receiving the nutrients it needs to fight infections and give him enough energy to get up and about again.
Mark Gleadell, Rainham, Kent

Why some patients are at risk of malnutrition


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