Malnutrition is a common problem in the UK. Seriously! It is estimated that more than 3 million people in the UK do not get enough calories, protein, vitamins and minerals for optimal health. In 2007 it was estimated that malnutrition cost the NHS £13 billion, more than the cost of treating obesity.
Malnutrition means ‘poor nutrition’. Although few people in the UK are starving, malnutrition is a major health concern because it may make us more likely to develop illness and affect our ability to recover from an illness or operation. When we are ill our bodies need to use more energy (calories), vitamins and minerals to recover. Preventing malnutrition may reduce the likelihood of people developing illnesses or suffering infections and complications from operations if they are admitted to hospital.
Elderly people are at risk of malnutrition, especially if they live alone and don’t cook much, with meals consisting of little more than tea and toast. The elderly may not get enough calories or micronutrients if they eat smaller meals or eat less often than they did in the past. In addition, their bodies don’t absorb nutrients very efficiently. Elderly patients should be screened for malnutrition risk by their GPs.
Younger people may also be at risk of malnutrition…perhaps if they have lost weight quickly on a calorie restricted diet, or even if they were advised to lose weight to have an operation. People with digestive problems may eat less than usual, going off their food if they feel full quickly or if eating makes them feel bloated or is painful. People with poor mobility, poor physical health or mental health issues might also be at risk.
Research shows that many people are already malnourished when they are admitted to hospital or a care home and that malnutrition may be made worse while a patient is in hospital. People who are ill may lose their appetite; although hospitals have tried to improve the quality of their food service in recent years, hospital food may not provide enough calories, vitamins and minerals for someone who is already malnourished and who doesn’t feel like eating. Also, some elderly people may need practical help with eating (for example, if they can’t hold cutlery) or they may be too tired to eat their meals. In hospitals the nurses are busy and there may not be enough dietitians to make sure that all patients get the help they need with their food.
What should I look out for (in myself or others)?
- If there has been obvious weight loss, consider (or try to find out) if it was deliberate or ‘just happened’ – how long has it been going on? – losing more than half a stone in the first month and more than a pound a week after that is probably too much weight loss
- Look for other signs of weight loss, like loose clothes or wedding rings or a belt which is using new notches
- Look for changes in the healthy appearance of skin and nails – a lack of nutrients may cause skin to look pale and nails to look whitish rather than pink.
- In conversation, notice phrases like ‘Cooking is such a chore these days, I usually have toast’ or ‘Food seems to taste funny these days’
What should I do?
If you have lost weight quickly but are still within a healthy weight range, return to eating a healthy balanced diet, including protein, dairy, starchy foods and fruits and vegetables, to get a full range of nutrients. Always check with your doctor before making significant changes to your diet.
If your weight is lower than a healthy weight you can probably ignore normal ‘healthy eating’ advice. Advise your doctor that you want to return to a healthy weight and will be changing to whole milk and butter, adding cheese to everything, splurging on carbohydrates, enjoying proper puddings, adding ice-cream and full-fat cream to your fruit, eating sweets, sausage rolls, egg sandwiches, biscuits, cakes, extra toast and jam as a snack…or anything else that you might fancy. Be aware that this might not be advisable if you have other health issues, like diabetes or heart disease.
Generally women should aim to eat about 2,000 calories a day and men should aim for 2,500 calories a day, but your doctor or dietitian may recommend extra calories each day if you are trying to gain weight.
How can I protect someone else from malnutrition?
- Discuss any loss of appetite or rapid weight loss with your loved one (and a GP, if required)
- Ask the GP about the MUST test (a malnutrition screening tool) or ask if an omega-3 fish oil tablet or a multivitamin would be beneficial
- If your loved one is in hospital or a care home and you are concerned about malnutrition, ask the nurse or doctor about the MUST test or ask to be referred to a dietitian
So look for the signs of malnutrition among your friends and family and take steps to help them eat well.
More information
BAPEN http://www.bapen.org.uk/about-malnutrition
British Dietetic Association http://www.bda.uk.com/foodfacts/MalnutritionFactSheet.pdf
Malnutrition Task Force http://www.malnutritiontaskforce.org.uk/
MUST (Malnutrition screening tool) http://www.bapen.org.uk/screening-for-malnutrition/must/must-toolkit/themustitself
NHS Choices http://www.nhs.uk/conditions/malnutrition/pages/introduction.aspx
NICE http://www.nice.org.uk/guidance/cg32/informationforpublic
MINIMAL-ISH 