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Emerald Group Publishing Limited
Copyright © 2001, MCB UP Limited
Although we hear a lot about overweight and obesity in the modern world, malnutrition is often overlooked and considered to be a minor problem in comparison with overnutrition. Unfortunately malnutrition is a UK health problem and not, as many perceive, a problem restricted to the developing world. In England 6.9 per cent of women and 4.2 per cent of men are underweight. In Scotland 8.7 per cent of women and 5.1 per cent of men are underweight. In total 3.2 million people in England, Wales and Scotland are underweight with a body mass index of less than 20.
The prevalence of malnutrition is 11 per cent in patients who have had major surgery, 10 per cent in cancer patients and 10 per cent in patients who have chronic disease of the lung, gastrointestinal tract or nervous system with the prevalence increasing as the disease progresses. Studies have shown that 40 per cent of adults and 60 per cent of the elderly who are admitted to hospital are malnourished. The incidence of malnutrition appears greater in the lower social classes. Babies born to mothers of a lower social class have lower birth weight and a greater likelihood of nutrient deficiencies. Poor housing, high rates of unemployment and social exclusion are also contributory factors.
Malnutrition is caused by a wide variety of factors, disease being the primary cause. A MORI survey commissioned by the Malnutrition Advisory Group found that 60per cent of GPs felt they needed more training in malnutrition and 74 per cent of GPs had received no undergraduate training in nutrition. Malnutrition causes deterioration in physical function, such as weakness and fatigue; psychological function such as apathy, depression and anxiety; and general wellbeing. Malnutrition predisposes individuals to infections, delays recovery from illness and increases the likelihood of complications which often increase the length of time spent in hospital.
The King's Fund has estimated that up to £266 million (1992 figures) could be saved each year if malnourished patients were given appropriate nutritional intervention. One study demonstrated that, if patients undergoing surgery were given adequate nutritional intervention, the length of stay in hospital would be reduced by half and £233 would be saved for each in-patient day. Despite the high cost of malnutrition in hospital, food intake of hospital patients is often inadequate and wastage rates are high.
Concern among academics and health professionals over the lack of awareness of the problems of malnutrition and inappropriate management has led to the establishment of the Malnutrition Advisory Group (MAG). Its objectives include raising the profile of malnutrition among health professionals, to communicate the benefits of timely and appropriate use of nutritional supplements and to produce definitive guidelines for the management of malnutrition in the community.
To help health professionals tackle the problem of malnutrition MAG has produced guidelines for its detection. The guidelines have two main elements. One of these detects malnutrition by measuring a person's body mass index and assessing whether the individual has unintentionally lost weight over the last three to six months. The second provides health professionals with guidance on how to treat and manage malnutrition. Combating malnutrition early on has been shown to be cost-effective and can greatly improve quality of life. Contrary to popular belief, malnutrition is not restricted to the developing world and is a serious UK public health problem.