Malnutrition: the hidden problem that costs €1.4 billion
Disease-related malnutrition costs the healthcare system more than obesity, yet it often goes undiagnosed and untreated
People can become malnourished when they are sick, due to the combined effect of reduced intake of food, the body’s attempt to deal with the illness, and prescribed medications. Photograph: Thinkstock
When we hear the word malnutrition, our thoughts turn to starving children in the developing world. But another form of malnutrition which, if left undiagnosed and untreated, has an impact on a large number of people in Ireland whose health is already compromised by illness or disease.
This form of disease-related malnutrition affects about 140,000 people living either at home, in hospital or in a nursing home.
It principally affects older people with chronic disease but it also affects some people with cancer, Crohn’s disease, cystic fibrosis, multiple sclerosis and conditions that affect a person’s appetite or their ability to chew, swallow and digest food.
Dietitians and medical doctors are calling for action on disease-related malnutrition, not least because the annual healthcare costs are estimated at more than €1.4 billion, which is more than the estimated costs of obesity.
Figures also show that there are more than 250,000 extra “inpatient” bed days in Irish hospitals every year due to a longer stay caused by malnutrition.
“The problem is that some people can look overweight and still be malnourished. They can be losing muscle mass and muscle strength, and they can have fluid retention that masks weight loss.
“They can be quite thin and frail underneath,” says Carmel O’Hanlon, a dietitian at Beaumont Hospital.
UnderstandingCora Byrne, who was recently a patient in Beaumont Hospital, has a clear understanding of how her health problems are exacerbated by malnourishment.
“I suffer from anaemia, arthritis and leg ulcers. Sometimes I can’t eat because of mouth ulcers.
“My mood drops. I lose strength in my body and I get depressed.
“Then, when I come into hospital I’m given protein drinks, and blood, and within a few days I’m back on my food again, eating all my meals and snacking in between.”
According to Dr Declan Byrne, a geriatrician at St James’s Hospital in Dublin, one in 10 older people is at risk of malnutrition, and one in four hospital patients has a similar risk.
Essentially, this means they can become malnourished when they are sick, due to the combined effect of reduced intake of food, the body’s attempt to deal with the illness, and prescribed medications.
“People with [disease-related] malnutrition are twice as likely to access GP care, three times more likely to require hospital admission and five times more likely to have complications or adverse events while in hospital,” says Byrne.
Illness itself puts more demands on the body, and low energy levels, lack of appetite or interest in eating compound the problem.
Not getting the appropriate combination of protein, fats and carbohydrates slows down wound healing and general recovery from surgery.
Another patient, who suffers from a rare bowel disease, says that she becomes malnourished because she loses interest in food after surgery.
“I’ve had 18 operations in 20 years and the pain is intolerable before I go in for surgery. In hospital, I feel weaker still until I start eating.