About 20% of patients in general hospitals are malnourished, or thin and losing weight, or both, warn experts in this week's BMJ. And up to 80% of these patients enter and leave hospital without any action being taken to treat their malnutrition because screening tools are underused and poorly enforced, they add.
Malnutrition is a common cause and consequence of illness particularly in older people, write Professors Mike Lean and Martin Wiseman. The number of malnourished people leaving NHS hospitals in England has risen by 85% over the past 10 years and is still rising.
Malnutrition affects the function and recovery of every organ system, increases the risk of infection, extends hospital stay, and makes readmission more likely. So clinicians need to be able to identify patients who have malnutrition or are at risk of malnutrition.
So how can this be achieved, they ask?
Several scoring systems that allow health professionals to identify and refer adults at risk of malnutrition exist, but they need to be validated before use in the community and hospital settings.
In 2006, the National Institute for Health and Clinical Excellence (NICE) recommended that all patients in hospital should be screened and monitored regularly for malnutrition, but these standards are weakly policed and are probably insufficient to stop many elderly people becoming malnourished if the quality of food is poor and there is a lack of staff to feed people.
Nutritional support is an important part of medical treatment, say the authors, yet hospital food is still provided by caterers who lack validated training in nutrition. Malnutrition is also often overlooked in residential care homes. They believe the final solution to malnutrition in hospitals probably lies in recognizing human nutrition as a discrete discipline, in which all medical graduates should reach a minimum level of competence, and some will specialize.
As such, they call for a basic understanding of human nutrition to be part of medical training and formal course in nutrition to be a requirement for higher training in medical specialties such as cardiology, diabetes, and public health.