Malnutrition – frequently asked questions

In hospital, the term ‘malnutrition’ usually refers to undernutrition, typically due to

• loss of appetite
• poor dietary intake (not eating well)
• and/or increased energy needs in someone who has an underlying illness or inflammatory condition

• Weight loss – unintentionally losing 5-10% or more of your weight over three to six months
• Muscle wastage – you may have noticed a reduction in your strength
• Low body mass index – having a low body weight increases your risk of malnutrition
• If you don’t weigh yourself regularly, signs of weight loss include: Loose belts, rings, watch or clothing
• Reduced intake – a lack of interest in eating and drinking
• Becoming unwell and taking longer to recover
• Or getting recurrent infections

You can check your risk of malnutrition by completing this screening tool

Anyone could be at risk of malnutrition but it is more common in:

• Elderly people,
• People with diseases like cancer, COPD and progressive conditions like dementia or neurological diseases (e.g. multiple sclerosis, motor neuron disease)
• People with conditions like cystic fibrosis, Crohn’s disease and any other diseases that affect digestion/absorption.
• People who need extra energy, such as those recovering from a serious injury or surgery.
• People with chewing or swallowing difficulties (e.g. as a result of a stroke).

Malnutrition can be difficult to recognise in people who are overweight or obese. However, loss of appetite and unintentional weight loss are signs that an individual has an inadequate intake of energy, protein and other nutrients and this should not be ignored, regardless of the person’s weight or body mass index.

Treatments depend on the person’s general health and how severely malnourished they are.

The first line advice is usually a ‘food first’ approach whereby we use common foods to increase the energy and protein in your diet.

Your dietitian may suggest that you:

• ‘Fortify your diet’ with high calorie foods like butter, cheese, oils and cream e.g. add cream and honey to porridge.

• Eat ‘little and often’, aiming for 3 small meals and 3 snacks per day.
• Choose snacks foods that are high in energy and protein, such as:

• Full fat/high protein milk,
• Peanut butter on toast,
• Cheese and crackers,
• Nuts,
• Eggs – scrambled, poached or boiled,
• Milky puddings or custards,
• Cakes, biscuits, chocolate or ice-cream – if that is what you fancy.

Download ‘Making the most of every bite’ a handy guide to helping you get more calories and protein from your food. Or pick up some ideas for high protein, high calorie recipes from the ‘Making the most of every bite cookbook.’

If you cannot get all the energy that you need from food, your dietitian or healthcare team may recommend oral nutritional supplements. These are nourishing drinks, puddings or shots that are prescribed to boost your intake.

For some patients, your dietitian or healthcare team may recommend tube feeding or intravenous feeding if you are unable to eat or drink enough to meet your nutritional needs

Malnutrition is surprisingly common in the hospital setting, our research shows that 1 in 3 patients admitted to St. Vincent’s University Hospital are malnourished or at risk of malnutrition before they are admitted.

Malnutrition, in a hospital setting, can lead to slow healing and recovery and may extend hospital stays.

Research shows that once admitted to hospital, patients identified as ‘at risk’ of malnutrition were found to have:

• 3 x greater risk of surgical site infection
• 5 x risk of catheter associated urinary tract infection
• 2 – 3.8 times risk of developing pressure ulcers
• Higher risk of readmission to hospital within 45 days
• 2 – 3 x greater risk of dying (according to age)

Good nutrition is vital for recovery.

In hospital, nursing staff will complete MUST (Malnutrition Universal Screening Tool) to check if you’re at risk of malnutrition. This involves measuring your weight and height, asking about any medical problems you have, and asking about recent changes in your weight or appetite. Once admitted to hospital, you should expect to be weighed weekly to assess your nutritional status