"Malnutrition test 'must be norm'", BBC News, February 22, 2006,
Link: http://news.bbc.co.uk/1/hi/health/4733278.stm
All hospital patients should be routinely screened for malnutrition and
offered specialist nutritional support if required, new guidelines say.
The National Institute for Health and Clinical Excellence (Nice) issued
the guidance designed to improve the way the NHS deals with the
problem.
It is thought as many as 40% of hospital patients are at risk.
A report published in December estimated that malnutrition costs the
NHS £7.3bn a year.
The report, by the British Association for Parenteral and Enteral
Nutrition, said this was more than double the annual bill for
obesity-related problems.
Testing for malnutrition is already mandatory in Scotland and Nice is
calling for the guidelines to be extended to England and Wales.
The problem is particularly serious among the elderly. It is thought
more than 10% of people aged over 65 are malnourished, and as many at
60% of pensioners who are admitted to hospital.
Need for support
The Nice guidelines were developed in collaboration with the National
Collaborating Centre for Acute Care.
They recommend all hospital and care home patients should be weighed
and measured on admission, and all outpatients should be similarly
checked at their first clinic appointment.
Checks should be repeated weekly for inpatients, and where there is
clinical concern for outpatients, say the guidelines.
Nice says specialised nutritional support should be considered for
people who are malnourished. This is defined as:
* Having a body mass index (BMI) of less than 18.5. BMI is calculated
by dividing your weight in kilograms by your height in metres squared.
* Unintentional weight loss greater than 10% in the last three to six
months.
* a BMI of less than 20 coupled with unintentional weight loss greater
than 5% within the last three to six months.
It also recommends that nutrition support be considered for people at
risk of malnutrition - such as those who have eaten little or nothing
for more than five days, or who are unable to take in nutrients
properly.
All acute hospitals are advised to employ at least one specialist
nutrition support nurse.
Andrea Sutcliffe, who took the lead role in drawing up the guidelines,
said they could save the NHS at least £45m a year.
Malnourished patients stay in hospital for longer, have a higher
mortality rate and are three times as likely to develop complications
during surgery.
She said: "This guideline should help reassure patients and give
confidence to their relatives and carers, that all at-risk patients, no
matter where they live or what their underlying condition, will now be
screened and if necessary offered appropriate nutritional support."
'Incredibly welcome'
Dr Mike Stroud, of the Institute of Human Nutrition at the University
of Southampton, also worked on the guidance.
He said: "Ensuring patients receive adequate nutrition is an essential
part of basic patient care, yet we know malnutrition is still a big
problem for the NHS.
"The guideline contains one obvious and simple message - do not let
your patients starve and when you offer them nutrition support, do so
by the safest, simplest, most effective route."
Shadow Health Secretary Andrew Lansley welcomed the guidance.
He said: "Far too many patients leave hospital less nourished than when
they were admitted.
"Patients are often unable to feed themselves effectively because of
lack of continuity of care and observation failures."
Dr Lorna Layward, of the charity Help the Aged, said the guidelines
were "incredibly welcome".
"Our preoccupation with obesity means that malnutrition of our most
vulnerable members of society has been swept under the carpet."