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David Gray, Senior Specialist Dietitian at Guy’s and St Thomas’…
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Malnutrition may result from poor nutritional intake, defective utilisation of nutrients as a result of organ failure or endocrine disorders, increased requirements due to infection or surgery or increased nutrient loss through wound exudates or diarrhoea.
1 in 3 adults admitted to hospitals and care homes are at risk of malnutrition. It is significantly more common in certain diagnostic categories than others e.g. gastrointestinal disease (43%) and neurological disease (33%) versus cardiovascular (21%) and musculoskeletal conditions (18%). It is common in patients with cancer, COPD, dementia and in patients with chronic wounds and pressure ulcers.
Malnutrition is common in infants and children with cancer, gastrointestinal disorders, neurodevelopmental disabilities, cardiac and respiratory disease, and cystic fibrosis.
It has clinical consequences such as muscle wasting, increased risk of infection, predisposition to falls and pressure ulcers, delayed recovery and reduced quality of life. It doubles the risk of mortality in hospital patients and triples mortality in elderly patients in hospital and after discharge and costs the UK more than £7.3 billion annually.
Routine screening is recommended and should be undertaken by appropriately trained health professionals using a validated screening tool (e.g. ‘MUST’). The result of screening should be linked to a care plan so patients receive the nutritional care they need.
Nutritional intervention can be effectively used in the management of disease-related malnutrition; analysis of trials using oral nutritional supplements and enteral tube feeding demonstrate significant and clinically relevant beneficial effects compared to routine care on mortality, complications and length of stay.
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