Malnutrition a £7 billion plus Health Problem 

New research reveals huge variations in awareness and treatment by GPs and low use of diagnostic tools
Although approximately 2 million people in the UK, and up to 40% of adults admitted to hospital, are underweight, new research published today by Nutricia Clinical Care, a leading provider of prescription nutritional supplements and feeding support systems, reveals that the problem is under recognised and is not being addressed systematically within the primary care system.  Historically, experts have put the cost of under-nutrition to the NHS at between £2 and £4 billion per year; however, a study to be published later this year by the British Association for Parenteral and Enteral Nutrition, indicates that the costs are closer to £7 billion.

The growing problem of malnutrition in an ageing population in Europe is the subject of a major conference, hosted by The European Nutrition for Health Alliance, being held in central London today (14th September).  The GP research, covering a representative sample of UK GPs, will be the subject of one of a number of presentations to assembled experts from across the medical, nutrition, policymaking, insurance and carer communities.  Conference recommendations on a European action plan will be the subject of a report to policymakers at national and EU levels.

Nutricia's research shows that just over a third of GPs do not see malnutrition as a significant problem.  Very few GPs are aware of the availability of malnutrition screening tools and fewer than 4% make use of them.  It also reveals that 40% of GPs never provide dietary advice to patients at risk of malnutrition prior to an elective admission to hospital.  This is despite the fact that studies have shown up to 60% of in-patients in hospitals to be at medium or high risk of malnutrition, with between 10% and 40% shown in studies to be suffering from malnutrition when they enter hospital.

"The real cost is human," says Nutricia Clinical Care's Jude Livingston, "people who are malnourished are less likely to respond well to treatment, take much longer to recover from illness or surgery and, to be blunt, may not recover at all."  Livingston commissioned the research for Nutricia to inform a report, due out at the end of 2005, on current best practice in the identification, prevention and treatment of malnutrition in the UK .

 "One of the key priorities has to be improving awareness of and access to the important work that the British Association for Parenteral and Enteral Nutrition (BAPEN) did in developing the 'Malnutrition Universal Screening Tool' ('MUST')" says Livingston .

Nutricia was not involved in the development of the 'MUST' tool but Livingston believes that its systematic use within primary care settings could have a significant impact in reducing the incidence of malnutrition through early treatment of those at risk.  Looking long term this could reduce NHS costs by bringing down the number of people admitted to hospital and the average length of stay.  'MUST', which is easy to use and comes with a care plan for management, was designed by a multidisciplinary team comprising clinicians, academics, nurses and dietitians to help health care workers in care homes, hospitals and community health care facilities identify people who are at risk of malnutrition or obesity (www.bapen.org.uk).

The new research on the costs of malnutrition to the NHS was undertaken by Professor Marinos Elia, Professor of Clinical Nutrition and Metabolism at the University of Southampton , and former chairman of the Malnutrition Advisory Group.

He comments: "The cost of disease-related malnutrition, which is the cost of treating malnutrition and its associated disease, is more than £7 billion per year in the UK . If through intervention we can save even 1% of this, it still represents a saving of £7 million per year. There is still some concern that malnutrition continues to be unrecognised and untreated in the community. Use of simple tools should be able to overcome this problem."

The full findings from Professor Elia's study will be published in a report from BAPEN later in the year.

The problem of malnutrition is particularly acute in hospitals, where many patients are undernourished upon admission, and are at high risk of further malnutrition due to the effects of surgery and illness on appetite and the ability to eat.  "If we can ensure that people are not malnourished when they go into hospital we can potentially help to improve outcomes'," says Livingston .

Nutricia is currently researching the views of clinicians and dietitians on effective action plans to address the problem of malnutrition. This will be published at the end of 2005 in a report containing examples of best practice within primary care and acute trusts.  For a copy of this report, or the ENHA conference recommendations, contact Farrah Meherali on 020 7592 3100 or e-mail info@nutriciareport.org.



Notes

Key Facts
* 2 million malnourished (Source: Elia M. (2003) The 'MUST' report:  Nutritional Screening of adults: a multidisciplinary responsibility.  ISBN 1 899467 70 X)

* Malnutrition in up to 40% hospital admissions (Source: Stratton R, Elia M. How much undernutrition is there in British Hospitals?  British Journal Nutrition 2000;84:257-259)

* £2-£4 billion cost (Source: Calculations based on a secondary analysis of data in Finch S, Doyle W, Lowe C, Bates CJ, Prentice A, Smithers G, et al. National Diet and Nutrition Survey: people aged 65 years and over. The Stationery Office, London 1998.)

* 60% of inpatients malnourished (Source: Elia M. (2003) The 'MUST' report:  Nutritional Screening of adults: a multidisciplinary responsibility.  ISBN 1 899467 70 X)

* 10-40% malnourished (Source: Stratton R, Elia M. How much undernutrition is there in British Hospitals?  British Journal Nutrition 2000;84:257-259)

* Human cost of malnutrition (Source: Elia M. Detection and management of undernutrition in the community. A report by the Malnutrition Advisory Group. 2000)

The research was carried out by Doctors.net on behalf of Nutricia Clinical Care in August 2005.  The respondents comprised 205 doctors who are currently working General Practitioners in the UK .  Key research findings mentioned in the release above and detailed below are copyright, and may not be reproduced without referencing Nutricia Clinical Care.
Of patients admitted to hospital, up to 40 per cent are undernourished and they will often have experienced further weight loss by the time they leave. In addition, up to 29 per cent of residents in care homes and 12 per cent of patients with chronic disease have a body mass index of less than 20.

Research has shown that under nutrition increases the likelihood of hospital admissions, delays recovery and lengthens hospital stays.

Estimates suggest that under nutrition costs the UK more than the £2 billion a year attributed to obesity.  Costs have been estimated at up to £4 billion by calculations based on a secondary analysis of data in Finch S, Doyle W, Lowe C, Bates CJ, Prentice A, Smithers G, et al. National Diet and Nutrition Survey: people aged 65 years and over. The Stationery Office, London 1998.

Minimising the risk of under diagnosis can be done by measurement of the patient's weight and monitoring 
Key research findings are as follows:

* Whilst most UK GPs (57%) recognise malnutrition as a significant health problem, the remainder either disagreed that it was a significant problem or did not know. 

* Recognition of the problem was greater in doctors who had qualified in the 90's or later.  30% of doctors who qualified in the 70s, 50% in the 80s and 68% of those who qualified in the 80's believe malnutrition is a significant health problem.

* Only 10% of the doctors questioned were aware of the existence of malnutrition screening tools, and fewer than 4% had made use of any of them.

* An average of 10.43% of patients that were referred to acute facilities were believed by respondents to be malnourished to the point it might have a negative impact on outcomes.  The majority of respondents, 49%, placed the percentage of their patients affected in this way in the 1-5% band - which is significantly below the figures revealed in Stratton R, Elia M. How much undernutrition is there in British Hospitals?  British Journal Nutrition 2000;84:257-259.  Some respondents placed the numbers much higher, with three doctors estimating over half of their patients fell into this category.   

* There was a high level of consensus amongst respondents regarding which patients are at risk.  98% correctly identified elderly patients and 90% correctly identified cancer patients as at risk.

* Only 9% of doctors always, either directly or though another healthcare professional in their practice, issue written advice on diet to patients who they have found to be at risk of malnutrition prior to an elective admission to hospital.  GPs who qualified post 1990 and female GPs were the most likely to give written advice.

* 40% of GPs said that they never provide dietary advice to patients at risk of malnutrition prior to an elective admission to hospital.

* Only 13% of doctors who find a patient at risk of, or suffering from, malnutrition always refer the patient to an NHS dietitian.  37% referred frequently and 43% occasionally.

* Half of doctors always or frequently prescribed oral nutritional supplements to patients at risk of malnutrition, and a further 47% prescribed occasionally.

* 84% of respondents said that information on nutrition would be useful.

Please note: Key research findings detailed above are copyright, and may not be reproduced without referencing Nutricia Clinical Care as the research owners.

(15/9/05)