Annchen Weidemann | Dietician Western Cape

Hospital Malnutrition

Annchen Weidemann, Dietician, Western Cape

December 07 2017

Yes, hospital malnutrition is still real and happening, and probably hampering the success of your treatment more than you appreciate. You all know the high statistics of hospital-induced malnutrition, or pre-admission malnutrition, which is worsened by hospitalisation if not addressed properly by involving the Dietician early.

May I just emphasise that hospital malnutrition has clearly been shown to increase recovery time, length of stay, and patient morbidity and mortality. In 2005, Koch and Heller did a study in patients following major gastrointestinal surgery and identified the two stongest predictors of length of hospital stay:

1. the amount of n-6 fat infused daily; and

2. the delay in onset of initiating nutritional support.

On the 5th December 2001, the BBC issued front-page news: Hospital Patients – ‘Malnourished on Arrival’. “An incidence of one patient in every five admitted to hospital in the UK was found to be malnourished, and this [they say] may be an underestimate of the true scale of the problem” (BBC, 2001). While healthcare staff regularly monitor patients for adverse changes in respiratory function, fluid and electrolyte balance, the effects of starvation or semi-starvation often go unrecognised. Clinical nutrition is not taught to the present generation of doctors, and it is a cinderella subject in undergraduate medical and nursing schools (N.M.E., 1983, cited in Lennard-Jones, 1992; Judd, 1988, cited in Lennard-Jones, 1992; Plester, 1996).

Rightly so. Nutrition is extensively taught to qualified Dieticians, and referring your malnourished patient to the Dietician is crucial in both your successful treatment and the patient’s speedy recovery. Only 2-3% of ward patients are referred to the Clinical Nutrition Services (St. Luke’s Hospital) for treatment of malnutrition (Clinical Nutrition Services Statistics, Malta, 2003).

A major symposium at the ESPEN 2007 congress, heard leaders voice a call for action to address hospital malnutrition in Europe:

• acknowledge the consequences of poor nutrition

• involve active nutritional support as an integral part of treatment

• affirm access to specialized nutritional care as a fundamental human right; and

• support nutritional reimbursement policies.

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