Disease-related malnutrition occurs when nutritional intake is insufficient during disease or ageing resulting in body weight and muscle mass loss, which lead to reduced physical and mental functionality and detrimental impact on disease.

Malnutrition is caused by a disease per se or by its associated symptoms, like dysphagia or digestive disorders or loss of appetite. It can also occur due to the ageing process and its frequently accompanying problems like loss of teeth, or cognitive decline, or just pure loneliness.
Malnutrition is further exacerbated due to lack of awareness resulting in under recognition and absence of treatment.

Despite developed healthcare systems and advanced social structures, there is a significant proportion of people and patients who are malnourished in various settings. On average the prevalence of malnutrition or malnutrition risk across Europe is:

25% of patients in hospitals

37% of hospital patients over 70yrs old

35% of cancer patients

30% of elderly people in care home facilities

30% of elderly people living independently at home

In the hospital setting, malnourished patients present multiple issues and risks. They have an increased risk for infections and complications, delayed wound healing, impaired recovery, poorer response to medical treatment (eg radiotherapy, chemotherapy), they stay longer in hospital and have increased mortality. In the home context, elderly people who are malnourished have a higher risk for frailty, reduced mobility and independence, and consequently a lower quality of life.

Malnutrition is also associated with high costs. It is estimated that there are totally 33 million people in Europe affected by malnutrition, and this is costing 170 bio€ each year. Studies have shown that the cost of malnutrition accounts for a significant part of healthcare spend, like in the UK where it amounts to 19.6 bio£ representing 15% of health and social care expenditure. In principle, a malnourished patient costs 2-3 times more than a well-nourished patient.

Treating malnutrition can improve disease outcomes which can then contribute to optimized public health and to cost savings for the healthcare system. However, we are far from reaping these benefits. As the prevalence numbers reveal, malnutrition goes unnoticed to a great extent, as there is insufficient awareness amongst healthcare professionals and carers. Also, healthcare systems are lacking processes and resources for identifying and managing malnutrition.

Malnutrition is a public health issue which is preventable and can be managed through a strategic, multistakeholder approach.

A well-structured strategic plan can help manage malnutrition, setting a clear vision, concrete objectives, detailed actions and timelines. Setting up an alliance of key stakeholders, comprising of medical and nutrition societies, patient associations, industry and policymakers, is crucial in order to trigger policy action and strategy implementation.

In summary, the strategic pillars for disease-related malnutrition management would need to encompass the following:

• Awareness building of malnutrition as a public health issue highlighting prevalence, clinical implications and associated costs towards all key stakeholders like government and policy makers.
• Advocacy for the solution being screening in all hospital and primary healthcare settings, resourcing with sufficient dieticians for nutritional protocol implementation and counselling, ensuring nutritional interventions are an integral part of healthcare.
• Access expansion via evidence base substantiation of nutritional interventions’ cost effectiveness in disease management, (eg cancer) towards payers and therefore extension of medical nutrition reimbursement schemes ensuring equality in access.

References

• ESPEN Fact Sheet: Disease-Related Malnutrition
• Medical Nutrition Industry. Better care through better nutrition: Value and effects of Medical Nutrition. A summary of the evidence base. 2021

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