MEDIA INFORMATION from
BAPEN the British Association for Parenteral and Enteral Nutrition
Registered Charity No.1023927
Issued Tuesday, 11 November 2003
MALNUTRITION IN THE UK: UNDER-RECOGNISED AND COSTLY REVEALS NEW REPORT TODAY
Malnutrition1 , usually thought of as a health issue prevalent only in the developing world, goes under-recognised and under-treated in the UK, detrimentally affecting the health of the nation, reveals a new Report launched today ('MUST' Launch, London, 11 November 2003).
The 'MUST' Report, written by the Malnutrition Advisory Group, a Standing Committee of national charity BAPEN (the British Association for Parenteral and Enteral Nutrition), provides comprehensive evidence regarding the extent and effects of this clinical and public health problem. Alongside the Report is launched the 'MUST' ('Malnutrition Universal Screening Tool'), the first universal nutritional screening tool for adults, a landmark development in addressing the damaging effects of malnutrition.
About 5%2 of the population are thought to be underweight, and it is estimated that approximately 2 million people in the UK are malnourished at any one time. Malnutrition can - and does - affect anyone in society. However, the most vulnerable groups include those with chronic diseases, the elderly, those recently discharged from hospital, and poor or socially isolated individuals. Malnutrition is both a cause and consequence of disease; it predisposes to and delays recovery from illness.
Up to 40% of those admitted to hospital are underweight3 - evidence shows that many will lose further weight whilst in hospital - and up to 60% of hospital patients are clinically malnourished4. Furthermore, up to 50% of patients in care or residential homes, up to 30% of patients attending outpatient clinics and GP surgeries, and up to 14% of elderly people not in hospital or care5 are either malnourished or at risk of malnourishment.
These surprising statistics have an enormous economic impact. The Report illustrates the widespread effects on the NHS. Malnourished patients when discharged from hospital are two and a half times more likely to require healthcare at home6, underweight patients visit their GP more frequently and require more prescriptions7, and malnourished individuals are more likely to need a longer stay in hospital8. Although there is no formal economic evaluation of disease-related malnutrition, it is estimated to carry a heavier price tag than the £2bn linked to obesity.
Despite the management and treatment of malnutrition being associated with improved outcomes for patients and decreased costs of care, the problem often goes unrecognised and untreated. Experts have predicted that £226million could be saved each year in UK hospitals if malnourished patients were identified and treated appropriately9. Yet, there is no consistent or coherent framework in place to deal with this problem.
A wide range of policy makers, healthcare professionals and organisations are in favour of nutritional screening for patients in hospital, at risk individuals in the community, and residents in care homes. Scotland is leading the way in the UK and has just made nutritional screening mandatory for all of those admitted to hospital - illustrating NHS Scotland's commitment to improving the quality of nutritional care.
In response to these demands, BAPEN's Malnutrition Advisory Group, led by Professor Marinos Elia, designed 'MUST' (the 'Malnutrition Universal Screening Tool') to detect whether adults have a low, medium, or high risk of malnutrition, or are obese. It is the first nutritional screening tool that has been specifically designed for use in all healthcare settings on the entire range of adult patients.
'MUST' is therefore the first tool to allow and actively encourage continuity of nutritional care on all types of patients across all settings, from the GP surgery to hospital, to home or residential accommodation. If it were to be used in public health surveys, it would facilitate the development of health promotion programmes and reduce the burden on health care resources.
The 'MUST' takes the form of a 5 Step flow-chart, collating information on a person's current BMI (body mass index), weight loss over the last 3-6 months, and the presence of acute disease (which could prevent eating for more than 5 days). A score is then calculated, the final total indicating the individual's risk of malnutrition, which can be used as a guide for care - anything from simple dietary advice or referral for expert nutritional treatment (specialised supplements, prescription of tube or vein feeding).
Professor Elia, Chairman of MAG, says "Research shows that malnutrition is a serious public health issue in the UK and that good nutritional care can have a positive impact on health. It is therefore absolutely essential for us to radically improve nutritional care provision. In order for this to happen, all healthcare professionals - GPs, nurses, residential care staff, dietitians - need to be given the means to accurately screen, monitor, and nutritionally treat those under their care, with continuity from hospital to home and vice versa".
The 'MUST' has been field-tested by a wide spectrum of over 200 healthcare professionals, and has been found to be an easy, quick, and consistent first step for dealing with malnutrition. The tool is being supported by the British Dietetic Association and also by organisations such as the Royal College of Nursing and the Registered Nursing Homes Association. It is also deemed an appropriate tool by NHS Scotland as part of their new standards for screening hospital patients.
Elia concludes, "Used in tandem with the Report's recommendations, we are optimistic that 'MUST' will become a nationally recognised and universally used tool, implemented in all care settings by a wide range of health professionals. Adoption of 'MUST' will result in the improved detection and management of malnutrition, making healthcare provision for all.
Reference
1. The literal meaning of malnutrition is 'bad' nutrition and therefore the term can encompass wasting (undernutrition) and/or obesity (overnutrition). Despite this, the term malnutrition is more commonly used to refer to undernutrition rather than overnutrition. It is in this sense that the term is used in the 'MUST' report.
2. Gregory, J., Foster, K., Tyler, H. and Wiseman, M. (1990) The Dietary and Nutritional Survey of British Adults. Office of Population Censuses and Surveys, Her Majesty's Stationary Office, London
3. Stratton, R., Elia, M., How much undernutrition is there in British Hospitals? British Journal of Nutrition, 2000; 84:257-279
4. The 'MUST' Report: Nutritional Screening for Adults - a multidisciplinary responsibility, MAG (2003) - see Section B for results using 'MUST'
5. Stratton, RJ., Thompson, R.L., Margetts, B.M., Stroud, M., Jackson, A.A., Elia, M., Healthcare utilisation according to malnutrition risk in the elderly; an analysis of data from the National Diet and Nutrition Survey, Proceedings of the Nutrition Society 2002; 61:20A
6. Chima CS, Barco K, Dewitt MLA, Maeda M, Teran JC, Mullen KD. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalised in the medicine service. Journal of the American Dietetic Association 1997;97:975-978.
7. Martyn CN, Winter PD, Coles SJ, Edington J. The effect of nutritional status on the use of health care resources by patients with chronic disease living in the community. Clinical Nutrition 1998;17:119-123.
8. Green C. Existence, causes and consequences of disease-related malnutrition in the hospital and the community, and clinical and financial benefits of nutritional intervention. Clinical Nutrition 1999;18 (Supplement 2):3-28.
9. Lennard-Jones JE, editor. A positive approach to nutrition as treatment. London: King's Fund Centre (Available from the King's Fund Centre, 126 Albert Street, London NW1 7NF), 1992.
Notes to Editors
For further information, please contact Claire Davies on 020 7072 4269 or at cldavies@gciuk.com or Rhonda Smith at rsmith@gciuk.com, Siobhan Thwaites or Rachel Burgess via 020 7072 4100.
BAPEN - The British Association for Parenteral and Enteral Nutrition is a multi-professional association and charity established in 1992. Its membership is drawn from doctors, dietitians, nurses, patients, pharmacists and representatives from the health policy, industry, public health and research sectors. BAPEN is Registered Charity Number 1023927
BAPEN's principal functions are to:
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Enhance understanding and management of malnutrition
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Establish a clinical governance framework to underpin the nutritional management of all patients
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Enhance knowledge and skills in clinical nutrition through education and training
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Communicate the benefits of clinical and cost-effective optimal nutritional care to all healthcare professionals, policy-makers and the public
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Fund a multi-professional research programme
Log on to www.bapen.org.uk
MAG - the Malnutrition Advisory Group, led by Professor Marinos Elia, is a Standing Committee of BAPEN, which is committed to raising the profile of malnutrition among healthcare professionals and the media.
MAG looks to ensure that appropriate priority is given to the malnutrition issue by the wide spectrum of healthcare professionals.
MAG aims to produce definitive guidelines for the management of malnutrition and to work nationwide with key influential groups to promote standards of excellence in the management and treatment of malnutrition.