Results show evidence of improvements in Wales in awareness of malnutrition, screening practices and organisation of nutrition support services.
Today BAPEN publishes five Nutrition Screening Week (NSW) Reports which cover the UK as a whole and its four nations; England, Northern Ireland, Scotland and Wales. The Reports contain the amalgamated data of its four Nutrition Screening Weeks which took place over a five year period between 2007 and 2011, each in a different season of the year. The four NSW surveys involved a total of 661 hospital centres (130-185 per survey) and 34,699 patients (6068-9567 per survey). 83 hospital centres in Wales provided data on 2,939 patients but the majority of the data were provided from England (406 hospital centres and 26,065 patients) and to a progressively smaller extent from Scotland (133 hospital centres and 3,934 patients), and Northern Ireland (39 hospital centres and 1,650 patients).
The results for Wales suggest that over the five year period in which the NSW surveys were carried out there were some improvements in awareness about ‘malnutrition’*, nutritional screening and in the operational infrastructure of nutrition support services although responses to some questions were variable. In the last three surveys more than 90% of hospitals had a screening policy and in all surveys more than 90% of hospitals recorded weight and more than 60% recorded height (except in 2010) on most wards. The majority of hospitals reported screening 76-100% patients on admission although the responses during the four surveys were variable (47-64% of centres) and a substantial proportion did not know what proportion of patients were screened. However, there was a significant improvement in the proportion of hospitals undertaking annual audit of nutritional screening with almost 90% hospitals auditing screening practice by 2011.
The ‘Malnutrition Universal Screening Tool’ (‘MUST’) was the most commonly used screening tool being used by 64% of centres by 2011. This is lower than in other nations and in the UK as a whole, where ‘MUST’ was the main tool used in over 80% of centres, The lower value in Wales is mainly due to greater use of local tools.
“Whilst there was evidence of improvement in nutritional care over the five years in Wales, There was variable access to Nutrition Support Teams, which are recommended to manage the more complex nutritional cases, with most hospitals in the surveys reporting no access. As such there is therefore room for improvement in this respect.” Marinos Elia, BAPEN Lead, Nutrition Screening Week.
The overall mean prevalence of ‘malnutrition’ in patients admitted to hospitals in Wales was 28% comparable to that in England, Northern Ireland and the UK as a whole (29-30%) but higher than that in Scotland (25%). ‘Malnutrition’ was lowest in those age 40-50 years and higher in those who were either older or younger.
Explanations for the national differences are complex and need to take into account the different healthcare systems that operate in the devolved nations such as; the distribution of care between hospitals and the community; the number of beds per capita of population,; the differences in screening policies, screening practice, audits, standards and inspections. In addition, national differences in age, gender, BMI distribution and types of diseases also affect the individual populations.
The prevalence of ‘malnutrition’ on admission to hospitals in Wales was found to vary significantly between seasons being 26% in autumn, 40% in summer, 33% in winter, and 22% in spring. The variation was greater in older (>65 years) than younger adults (<65 years). The reason for this variation is unclear. It may be related to non-random selection of hospital centres.
Age related Data
The mean age of those admitted to hospital was 64.2 ± 19.0 years, some 15 years higher than that of the general adult population of Wales. The mean BMI of those admitted to hospital was 26.9 kg/m2, which was found to be the same as that of the general population. The BMI distribution was wider than that of the general population, and was associated with a greater proportion of both underweight people (<20 kg/m2 and <18.5 kg/m2) and severe obesity (>40 kg/m2). Patients at both ends of the BMI distribution need to be identified and directed towards appropriate management pathways.
In Wales as with the UK as a whole there was a consistently higher prevalence of malnutrition in women than men by 3-8% (mean 6%) especially in those aged 65 years or older
Source of Admission
In all the surveys, during all seasons, the majority of patients were admitted from their own homes and at least 1 in 4 were at risk of ‘malnutrition’ on admission, Overall, half of the patients admitted from care homes were also at risk but these accounted for the smallest proportion of admissions.
“Since the NSW surveys involved nutritional screening on admission to hospital, mainly of patients from their own homes, the data reflect problems that arose in the community which could be identified prior to admission. Policies aiming to prevent the problems from developing or to initiate treatment at an early stage need to focus on the community and to integrate services between care settings. Hospitals have a role to play in identifying ‘malnutrition’ and communicating the results to the community so that treatment initiated for inpatients or outpatients can be continued in the community.” Christine Russell, BAPEN Lead, Nutrition Screening Week.
The NSW surveys in all the nations have re-emphasised the widespread nature of ‘malnutrition’. They have also confirmed that the prevalence of ‘malnutrition’ varies according to many factors including: the source of admission; the type of ward (being higher in care for the elderly and oncology wards than orthopaedic wards); disease category (being higher in gastrointestinal and respiratory diseases than musculoskeletal and cardiovascular diseases), and presence of cancer (being higher in those with cancer than those without).
*. ‘Malnutrition’ – refers to those at medium + high risk according to ‘MUST’ (http://www.bapen.org.uk/screening-for-malnutrition/must/introducing-must)
For more information, interviews and comment:
Notes for Editors
The Nutrition Screening Week surveys involved a total of 661 hospital centres and 34,699 patients across the UK. The majority of data were provided from England (406 hospital centres and 26,065 patients) and to a progressively smaller extent from Scotland (133 hospital centres and 3,934 patients), Wales (83 hospital centres and 2,939 patients) and Northern Ireland (39 hospital centres and 1,650 patients). It is the biggest survey into the prevalence of malnutrition ever conducted. Whilst the individual results have been announced annually, these new Reports highlight seasonal and country specific trends and chart the changes made to organisational infrastructure for providing nutritional care and malnutrition screening in various care settings.
The current 5 reports are based on the amalgamated data from the four surveys. A copy of these Reports can be downloaded at:
Malnutrition, in terms of undernourishment, is both a cause and consequence of disease in adults and children. It is common and affects over 3 million people in the UK with associated health costs exceeding £13 billion annually.1 It is often unrecognised and untreated, yet it has a substantial impact on health and disease in all community care settings and hospitals.1,2
The benefits of improving nutritional care and providing adequate and appropriate hydration are immense, especially for those with long term conditions and problems such as stroke, pressure ulcers or falls. The evidence shows clearly that if nutritional needs are ignored health outcomes are worse and meta-analyses of trials suggest that provision of nutritional supplements to malnourished patients reduces complications such as infections and wound breakdown by 70% and mortality by 40%.2
- Elia M, Russell CA (eds). Combating malnutrition; Recommendations for Action. A report from the Advisory Group on Malnutrition, led by BAPEN. Redditch: BAPEN, 2009.
- Stratton RJ, Green C and Elia M. Disease related malnutrition; an evidence-based approach to treatment. Oxford:CABI, 2003.