Page last updated at 17:47 GMT, Monday, 9 February 2009

Viewpoint: Why malnutrition matters

Dr Mike Stroud
Chairman of the British Association for Parenteral and Enteral Nutrition

Patient
Elderly people are most at risk

Malnutrition is both a cause and consequence of disease.

Anyone undernourished is vulnerable - reduced muscle strength, impaired resistance to infection and wound healing.

The consequence can be a vicious cycle and all healthcare professionals should take the threat of malnutrition seriously.

But do they? The answer is a resounding "no" and British Association for Parenteral and Enteral Nutrition (BAPEN) aims to change that.

But where to start? For me, the answer is simple.

Whereas most nurses, physiotherapists, pharmacists, health-care assistants and, of course, dietitians have spotted the obvious, most doctors have not.

There is overwhelming scientific evidence that ensuring adequate nutritional intake makes a real difference to clinical outcome and reduces health care costs.

Research has shown that complications related to malnutrition could be reduced by more than 50% and mortality by about 40% simply by giving malnourished patients oral nutritional supplements - little cartons of liquid feeds.

'Faulty thinking'

Yet, the majority of the medical profession seem to believe that their patients' nutritional care is someone else's job.

What lies behind this faulty thinking?

Firstly, there is a widespread perception that there is little or no malnutrition in the UK and most doctors share it - but it is a myth.

Secondly, doctors don't notice malnutrition, because they haven't been trained to recognise it.

Extraordinary as it may seem, nutritional teaching did not feature in medical courses until recently and even now teaching on malnutrition has been swamped by that on obesity. This is not balanced.

Furthermore, because of their ignorance, doctors persistently fail to spot those at nutritional risk.

The clinical risks from malnutrition are surprisingly little influenced by patients' starting weights and you cannot tell just by looking
Dr Mike Stroud

Sure, they notice the patients who are wasting away, perhaps from advanced cancer, and know that such patients do badly.

But they do not realise that the clearly poorer outcomes linked to malnutrition are not confined to patients who are thin, but relate more to recent weight loss and how much food someone has eaten in the last few days.

Doctors are therefore likely to ignore the possibility of beneficial nutritional interventions in a lot of their patients since so many of them are now overweight when they become ill.

It may therefore take weeks of illness and weight loss for them to look overtly malnourished, but the dangers inherent in eating little or nothing appear very much sooner.

The clinical risks from malnutrition are surprisingly little influenced by patients' starting weights and you cannot tell just by looking.

Weight change

Instead, you must ask about food intake and determine if there has been significant weight change. Beware of the fat malnourished.

Of course, it is not all the doctors' fault. Care managers need to be convinced of the real economic benefits of treating malnutrition and the Department of Health needs to take it more seriously.

To be fair, the latter has acknowledged the efforts of BAPEN and others and published a Nutrition Action Plan last year.

The media occasionally produce a flurry of "my mum was starved" articles.

But these are quickly forgotten, rapidly replaced by the endless articles on ward superbugs - despite the fact that there are many more deaths from unnecessary nutritionally related complications than from MRSA.

So, a lot of people need a wake up call and I am going to start with doctors. If more doctors understand the issue, they will take the lead.

Then the provision of safe, effective nutrition support will move from being a Cinderella subject to a position of prominence in medical care.



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