Raising Awareness of Malnutrition  

The British Association of Parental and Enteral Nutrition (BAPEN) and Malnutrition Task Force (MTF) have joined together once again for Malnutrition Awareness Week (6^th – 12^th November), an annual, international campaign aiming to inform and increase awareness of malnutrition across the globe.^1-2 

What is malnutrition?  

The definition of malnutrition can often be misunderstood, and, at present, there is no universally agreed definition.³ Malnutrition means undernutrition or an imbalance of energy and nutrients. This can refer to people that are either underweight, including wasting and stunting, or overweight. Nutrient deficiency can occur when your body is not provided with essential nutrients through food and drink, however, it can also be a result of illness, disease, or hospitalisation, most commonly referred to as disease-related malnutrition.⁴ 

Malnutrition Awareness Week has a particular focus on malnutrition within older people and disease-related malnutrition (DRM) and how this can be detected and treated early.  

The latest stats 

There is no gold-standard method used to diagnose malnutrition as definitions and criteria vary depending on geographical location. There are many different screening tools available to diagnose malnutrition worldwide. In the U.K., the Malnutrition Universal Screening Tool (MUST) is used. This 4-step scoring system was designed for health care professionals (HCPs) to screen patients and easily diagnose malnutrition.  

BAPEN reports that “malnutrition affects over 3 million people in the United Kingdom (U.K.)”. Of these, about 1 million are over the age of 65. Unfortunately, disease-related malnutrition is prevalent within the U.K; BAPEN reports that “25-34% of patients admitted to hospital are at risk of malnutrition”.⁵ This can be for a number of reasons, for example loss of appetite, inability to eat, and lack of appropriate food options. The World Health Organization (WHO) reports that, globally, 462 million adults are underweight.⁶ 

Symptoms of malnutrition can vary, and in some cases, it can be challenging to recognise as changes can occur over a long period of time. Symptoms may include weight loss, reduced muscle strength, fatigue, and increased risk of infection due to a compromised immune system. The focus of the 2023 Malnutrition Awareness Week is to ‘Ask, Look, Listen’ to encourage HCPs to be vigilant in recognising signs of malnutrition.  

What are the available treatments and how can dietitians help? 

There are different treatment options available for malnutrition, and dietitians are there to provide support and advice depending on preference and circumstance. It is important to note that a food first approach is often preferred, however in some instances it may be necessary to obtain nutrition through other ways, such as: 

• Oral Nutrition Supplements (ONS): may be recommended to supplement meals to achieve energy requirements.  
• Feeding tubes: may be required for those unable to obtain sufficient nutrients from an oral diet alone. Types of feeding tubes include nasogastric tubes (goes through the nose and directly into the stomach) and percutaneous endoscopic gastrostomy (PEG) tubes (inserted directly into the stomach or gut to provide nutrition).  
• Parenteral nutrition is sometimes used to provide nutrient-containing solutions directly into the blood stream when enteral nutrition is insufficient/not possible.⁴ 

Untreated malnutrition can lead to serious health consequences and can negatively impact every organ system in the body. Long-term consequences of malnutrition include gastrointestinal complications, compromised immunity, and psychological effects such as depression and anxiety.⁷ 

Spreading awareness of malnutrition is essential to finding treatments and working to reduce prevalence across the globe, and campaigns such as Malnutrition Awareness Week are fundamental in achieving this. You can download BAPEN and MTF’s 2023 joint mission statement here. In addition to this, initiatives such as The United Nations (UN) Decade of Action on Nutrition are critical in working towards a world in which food systems lower the risk of malnutrition, helping to achieve the UN’s Sustainable Development Goals and decrease the prevalence of malnutrition worldwide.^8–9 

This article has been written in collaboration with one of the HRS Communications Interns, Bells Hann.  

References  

1. BAPEN (2023) UK Malnutrition Awareness Week 2023 [online] Available at: https://www.bapen.org.uk/malnutrition-undernutrition/combating-malnutrition/uk-malnutrition-awareness-week#:~:text=BAPEN%20is%20delighted%20to%20be,place%20between%206th%20%E2%80%93%2012th%20November.  [Accessed: 20 October 2023]  

2. Malnutrition Task Force (2023) UK Malnutrition Awareness Week 2023 [online] Available at: https://www.malnutritiontaskforce.org.uk/uk-malnutrition-awareness-week-2023#:~:text=%23UKMAW2023%20is%20confirmed%20for%206,focus%20on%20disease%20related%20malnutrition. [Accessed: 20 October 2023] 

3. Elia, M. (2017) Defining, Recognizing, and Reporting Malnutrition, The International Journal of Lower Extremity Wounds, 16(4). Doi: https://doi.org/10.1177/1534734617733902  

4. NHS Inform (2023) Malnutrition [online] Available at: https://www.nhsinform.scot/illnesses-and-conditions/nutritional/malnutrition/#:~:text=Malnutrition%20means%20poor%20nutrition.,vitamins%2C%20to%20keep%20you%20healthy. [Accessed: 20 October 2023] 

5. BAPEN (2018) Introduction to Malnutrition [online] Available at: https://www.bapen.org.uk/malnutrition-undernutrition/introduction-to-malnutrition?start=4 [Accessed 20 October 2023] 

6. WHO (2021) Malnutrition [online] Available at: https://www.who.int/news-room/fact-sheets/detail/malnutrition [Accessed 20 October 2023] 

7. Saunders, J. and Smith, T. (2010) Malnutrition: causes and consequences, Clinical Medicine, 10(6), pp. 624-637. Doi: 10.7861/clinmedicine.10-6-624  

8. United Nations (2023) Decade of Action on Nutrition [online] Available at: https://www.un.org/sustainabledevelopment/development-agenda/ [Accessed 2 November 2023]  

9. United Nations (2023) The Sustainable Development Agenda [online] Available at: https://www.un.org/sustainabledevelopment/development-agenda/ [Accessed 2 November 2023]