Disease related malnutrition

Disease related malnutrition

 

Disease is a major cause of malnutrition.1 Disease related malnutrition (DRM) (under-nutrition) can be defined as a deficiency of energy, protein and other nutrients that causes adverse effects on the body, its functions and clinical outcomes.2

 

Disease related malnutrition is common, affecting around 143,000 adults3 in the Republic of Ireland, with most of these individuals (93%) residing in the community.4 Population sub-groups with the highest prevalence of malnutrition include those aged > 65years, hospital patients, care home residents, those with chronic disease4.

 

Disease related malnutrition is costly.  The annual cost of managing the consequences of malnutrition in the Republic of Ireland is estimated as €1.43 billion5 or 10% of the healthcare budget - this is higher than the cost of obesity (€1.13 billion)6 throughout the island of Ireland.  The annual cost of healthcare per person with malnutrition is triple that of a non-malnourished person,4 because:

  • malnourished patients have twice as many GP visits7
  • malnourished patients are admitted to hospital three times as often as their non-malnourished counterparts7
  • once in hospital, their hospital stays tend to be three to four days longer than average8

Malnutrition has adverse consequences for both the patient and the wider healthcare economy. It delays recovery, increases complications (infections, pressure sores and falls), and is associated with a twelvefold increased risk of death.8

 

 

Malnutrition Screening And Management

 

Screening for malnutrition is vital to identify individuals who are at risk so appropriate management can be implemented. 'MUST' (Malnutrition Universal Screening Tool) (www.bapen.org.uk) is one tool used in Ireland and is validated for use in all health care settings. Nutritional screening is recommended by national bodies including the Department of Health (2009) and HIQA Standard 2.2 (2016). However, results from BAPEN malnutrition screening week (2011) and HIQA Hospital Nutrition & Hydration Report (2016) tell us that screening is not being implemented fully.9,10

Earlier identification means earlier intervention. A recently published study by Rice et al. in the Irish Medical Journal demonstrated that earlier detection and treatment of malnutrition with ONS in the community setting could save ~460 hospital beds per day,11 which would reduce pressure on the acute healthcare system and also help to improve patient outcomes.

 

Oral nutritional supplements (ONS) are an evidence based strategy for the management of disease related malnutrition (DRM).1,12 Appropriate use of ONS is clinically and cost effective, as demonstrated by:

 

  • Significant reduction in admissions/readmissions to hospital (30%)13
  • Significant reduction in length of hospital stay (~3 days)14
  • Significant reduction in complications e.g. infections, pressure ulcers, wounds (34% in community, 31% in hospital)15,16
  • Significant increase in weight, handgrip strength and total nutrient intake, without suppressing normal food intake17,18
  • Functional benefits such as increased muscle strength, activity, health perception/wellbeing, independence, quality of life, and reduced falls, depression and fatigue1,4,13,15,19
  • Good compliance - 78% compliance for 1.5kcal/ml ONS and 91% compliance for ≥2kcal/ml ONS20

 

A wide variety of ONS providing a full range of nutrients are available, including different styles (milk, juice, yoghurt), types (high protein, low volume), and formats  (liquid, powder, pudding) with a range of energy densities (1-4.5kcal/ml) and flavours available to suit a wide range of patient needs.