Backgrounder 2
MEDIA INFORMATION from
BAPEN the British Association for Parenteral and Enteral Nutrition
Registered Charity No.1023927
Issued Tuesday, 11 November 2003
BACKGROUNDER 2: MALNUTRITION AND THE WIDER CONTEXT
DEFINITION OF MALNUTRITION
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. Malnutrition predisposes people to disease and delays recovery, but still it frequently goes undetected and untreated.
A suggested definition of malnutrition is as follows: a state of nutrition in which a deficiency, excess or imbalance of energy, protein, and other nutrients causes measurable adverse effects on tissue (shape, size, composition), function and clinical outcome.
CONSEQUENCES OF MALNUTRITION
Malnutrition is frequently undetected and untreated causing a wide range of adverse consequences.
Some adverse effects of malnutrition include:
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Impaired immune responses - increasing risk of infection
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Reduced muscle strength and fatigue
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Reduced respiratory muscle function - resulting in increased difficulties in breathing and expectoration (in turn increasing the risk of chest infection and respiratory failure)
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Impaired thermoregulation (predisposed to hypothermia)
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Impaired wound healing and delayed recovery from illness
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Apathy, depression and self-neglect
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Increased risk of admission to hospital and length of stay
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Poor libido, fertility, pregnancy outcome and mother child interactions
MALNUTRITION AND PUBLIC HEALTH
Throughout the UK, the problem of malnutrition is frequently under-recognised. It is still perceived as a concern restricted to the developing world and not as a developed world health problem. Despite this, approximately 5%1 of people in this country are underweight, and it is estimated that around 2 million people in the UK are malnourished at any one time.
Malnutrition affects all kinds of social groups in all sorts of settings, the most vulnerable being patients with chronic disease, the elderly, those recently discharged from hospital and those who are poor or socially isolated.
Risk of malnutrition is affected by a number of factors, including existing medical conditions, age, food availability and diversity, income, class, psychological problems and unusual dietary habits. In addition, lack of awareness, education, training and use of a validated screening tool result in malnutrition often going unrecognised and therefore untreated.
WIDER CONTEXT
A wide range of policy makers, specialists, healthcare professionals and organisations - including the Department of Health - recommend nutritional screening as the preferred way of improving nutritional care in the UK.
There are nutritional screening tools in existence that are unsuitable for widespread application. Now, however, 'MUST' is available and suitable for use across all healthcare settings and across all patient groups.
Scotland has just introduced new NHS Quality Improvement Scotland (QIS) Standards in Food, Fluid and Nutritional Care for hospitals. These measures make nutritional screening mandatory and will therefore ensure that each and every person is screened and assessed on admission to hospital. NHS Scotland has recognised that 'MUST' is appropriate for this purpose. Wales also made nutritional screening for hospital patients mandatory from December 2002 and is currently working on implementation.
Following this trend, England is also looking at its nutritional care provision and standards. Initiatives such as the National Service Framework for Older People (designed to set new national standards of care across health and social services for all older people) and 'the Essence of Care' (aiming to improve quality in the fundamental aspects of care in hospital) are helping to bring previously neglected health issues such as nutritional care to the fore.
Reference
1. 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
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.