UK Malnutrition Awareness
This coming week (11th – 17th October) I want to highlight and celebrate the 3rd anniversary of UK Malnutrition Awareness Week #UKMAW. This was established by BAPEN and the Malnutrition Task Force with the overall aim to highlight the risks of malnutrition and help people across social care, government and ALL healthcare professionals and indeed the public to better understand malnutrition and what can be done to identify and tackle this problem.
So what is malnutrition?
This is normally something we often associate with poverty and an extreme health condition of undernutrition associated with weight loss from a lack of calories, protein and reduced intake of vitamins and minerals our body needs to optimally function. This has wide ranging implications for normal growth, ageing and detrimental impacts on our immune system. This is something we hope would not be commonly associated with the UK however, there are many high-risk groups that get overlooked and is therefore still prevalent in this country.
How big is the problem?
It is estimated that there is approximately 3 million people in the UK who are malnourished or at high risk of malnutrition (1). This remains a HUGE public health issue costing the NHS and social care an estimated £19 billion per year and to give this context; that is the approximate cost equal to building 200 new hospitals (2).
One of the higher risk groups is the elderly population whereby up to 1 in 10 people over the age of 65 years are malnourished (3). This has a significant impacts on the social and care system and hospitals as we know malnutrition associates with worse clinical outcomes, increased length of stay in hospital, increased risk of infection and subsequently increasing readmission rates (4).
It is a big myth that by default we lose weight as we age. In reality unintentional weight loss is a cause for concern and can be a sign of worsening health, indicate an underlying disease or flag a change in social, financial circumstances where access to food is impacted. It is therefore not only the elderly at risk but individuals with conditions that severely impact food and dietary intake (1). This could be someone with a cancer, digestive disease or someone undergoing surgery (and many more) where their diet or appetite is severely affected.
Another more recent impact has been the COVID-19 pandemic. Not only the direct impact of having the illness but also the issue of ‘food poverty’ - essentially when an individual or family cannot access food deemed appropriate quality or quantity. The Food Foundation found that 4.7 million adults and 2.3 million children lived in households which experienced this in the first 6 months of the pandemic, including 12% of all households with children (5). This continues to cause concern with food prices forever increasing and families finding their finances stretched further making access to food harder.
With these facts in mind it is ESSENTIAL to identify and recognise people or groups at risk of malnutrition early. This aims to reduce the health burden and applying the old philosophy that “prevention is better than cure” and that is why this year’s awareness campaign focuses on ASK, LOOK, LISTEN.
So how do we identify malnutrition?
There are various tools which can be applied and used in health and social care settings chiefly the use of nutritional screening tools which involve basic measures of weights and tracking weight changes. The Malnutrition Universal Screening Tool (MUST) being one of the most well known in the UK and continues to be promoted by BAPEN and can be easily accessed here online.This helps to rapidly and simplistically identify individual’s risk i.e. people at a low weight or that have lost a significant amount of weight in a short period of time.
Who can identify malnutrition?
The simple answer is ANYONE, but individuals should use validated tools and objective measures (with appropriate training) to help assess this and should contact a qualified health professional if you have concerns so this can be carried out correctly. More importantly this is to also ensure that subsequent actions are taken to address malnutrition and the correct nutritional management can be applied. Therefore if you are worried about yourself or someone else experiencing unplanned weight loss you should seek medical advice from your GP or practice nurse.
This also brings me on to the involvement of DIETITIANS and NUTRITIONISTS. Whether this is educating and training others to assess for malnutrition, helping to guide hospital, community and government policy or providing bespoke nutritional advice to tackle this – the scope of practice is vast! Navigating dietary and nutritional changes can be challenging and will vary individually. Often the primary goal will be to optimise the amount of calories and protein to safely prevent further weight loss and as needed induce weight gain. This can include various methods and techniques e.g. ‘fortifying’ foods i.e. making every mouthful pack a nutritious punch, providing support to access food and where needed prescribing oral nutrition support (many people recognise the use of fruit or milkshake based drinks to help achieve this). Nutritional quality is also key and importantly factored in that an individual is receiving the right vitamins and minerals.
However, we need to IDENTIFY MALNUTRITION first to help get to this stage.
As a medical doctor and dietitian this is an area I continue to be passionate about and would strongly encourage your involvement. UK Malnutrition Awareness Week (UKMAW) is a great way to learn more and help get involved and see how you can contribute to this area of nutrition. Social media has become a great forum to help exchange knowledge and share stories so look out for #UKMAW2021 and if you want further information on this awareness week or topic in general please see the below websites.
This blog is written by dietitian and medical doctor Timothy who currently sits on the BAPEN medical trainee committee and contributes to nutritional education resources and has clinical interests in weight management, cardiovascular disease and diabetes care. If you would like to book a consultation with Timothy, please contact us for more information.
Websites
References
1. Russell CA, Elia M. Malnutrition in the UK: where does it begin? Proc Nutr Soc [Internet]. 2010 Nov [cited 2021 Oct 10];69(4):465–9. Available from: https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/malnutrition-in-the-uk-where-does-it-begin/4AC860F0ED0D113EFF2483ADD5A3C0AE
2. Elia M. The cost of malnutrition in England and potential cost savings from nutritional interventions (full report) A report on the cost of disease-related malnutrition in England and a budget impact analysis of implementing the NICE clinical guidelines/quality standard on nutritional support in adults. 2015 - Available from: www.bapen.org.uk
3. Malnutrition Task Force. Older people and malnutrition in the UK today; State of the Nation. 2017
4. Saunders J, Smith T, Stroud M. Malnutrition and undernutrition. Medicine (Baltimore). 2011 Jan 1;39(1):45–50.
5. Francis-Devine B, Tyler G, Danechi S. Food poverty: Households, food banks and free school meals. Available from: https://commonslibrary.parliament.uk/research-briefings/cbp-9209/
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