Malnutrition and opportunities for the food industry

Dr Mabel Blades explains what food industry can do to tackle malnutrition. 

Introduction 

With an aging population as well as people requiring additional nutritional support for various health reasons, there are numerous opportunities for the food industry to develop both ingredients and products to meet these challenges.

Malnutrition

Malnutrition is defined as “A state of nutrition in which a deficiency, excess or imbalance of energy, protein, and other nutrients causes measurable adverse effects on body function and clinical outcome” by the British Association for Parenteral and Enteral Nutrition (BAPEN) ⁽¹⁾.  

In the UK, obesity associated with the over consumption of calories for individual requirements has led to a prevalence of 58% of women and 68% of men in the UK in 2015 being assessed as overweight or obese ⁽²⁾. Thus this is a major form of malnutrition and already there is considerable attention paid to this area by the food industry with variety of items such as reduced energy alternatives to foods and beverages being produced as well as ingredients to support them.

This article is going to focus on undernutrition, which is often referred to as malnutrition.  

Undernutrition

Under nutrition was defined by the Malnutrition Advisory Group as a Body Mass Index (BMI) <18.5kg/m²  and unintentional weight loss greater than 10% within the last 3-6 months or BMI <20kg/m² and unintentional weight loss greater than 5% within the last 3-6 months ⁽³⁾.  

It is associated with numerous consequences which have a major impact on health and well-being. These include:

• weight loss plus the associated impaired temperature control with the loss of insulating body fat
• increased muscle loss (sarcopenia) and resultant associated muscle weakness and fatigue meaning people are too weak, to in some cases, lift  a glass to drink from
• apathy and depression, which often leads to self neglect
• impaired immune response which causes an increase in susceptibility to infections
• increased tissue breakdown such as pressure ulcers plus an impaired wound healing meaning that wounds remain inflamed and painful
• osteoporosis and increased risk of fracture after often a very small incident such as a sneeze
• constipation, which is often treated by laxatives; this can in turn result in incontinence and a loss of dignity
• anaemia, which itself results in a feeling of tiredness and depression

Not surprisingly these issues related to malnutrition result in an increased number of visits to GPs and increased risk of hospital admission and length of stay. However, if the malnutrition is treated, then the effects can be reversed.

Costs of malnutrition

It is estimated that malnutrition costs the UK almost 20 billion pounds per year due to the increased costs of healthcare, hospital admissions plus support ⁽⁴⁾. This figure is similar to the £27 billion pounds per year that obesity costs the economy ⁽⁵⁾.  At any time it is considered that 3 million people in the UK are malnourished or at risk of malnutrition ⁽⁶⁾.

Yet despite the vast costs of malnutrition plus enormous numbers, it seems very much a neglected area and one which is often unrecognised both by sufferers, their families and even health professionals.

Screening for malnutrition

The National Institute for Health and Care Excellence (NICE) recommends that people in hospital or care are screened for malnutrition. One of the recommended tools to use is the MUST - Malnutrition Universal Screening Tool ⁽⁷⁾.

This is very simple and quick to use and is based on 5 simple steps using a chart to evaluate the scores.

1. Calculate or estimate the BMI score
2. Note percentage of unplanned weight loss and assign score
3. Establish acute disease effect and score
4. Add scores together to obtain overall malnutrition risk
5. Develop care plan using management guidelines or local policy

A score of 0 indicates a low clinical risk and repeat screening is recommended. A score of 1 indicates a medium risk and observations are recommended which include observing and documenting food intake for 3 days. A score of 2 or more indicates a high risk and treatment is recommended. Such treatment can include referral to a Registered Dietitian or Nutritional Support team, increasing and improving nutritional intake.

The MUST is effective and easy to use in numerous situations from care settings to developing countries. Additionally people are able to easily access the tool at the BAPEN website and use it for themselves or friends and relatives.

Improving intake

However it is not just about assessing who is at risk of malnutrition but it is imperative to do something about it.  This means boosting intakes with enjoyable and acceptable foods pertinent to the individuals likes and dislikes. While ordinary foods can be used to increase intakes, this requires some degree of knowledge and culinary ability. There are various prescribable products but in a financially stretched NHS obtaining these may be difficult.

Yet despite the large numbers of people suffering from or at risk of undernutrition there are relatively few fortified foods available. Foods such as yoghurts or soft cheeses produced with additional calcium and vitamin D are usually aimed at the children’s market or for catering use in care settings. Items rich in protein are usually promoted for those involved in sport as are energy drinks.

Summary

Malnutrition is a very real and difficult, not to mention costly, problem in the UK. With an aging population (and often a group who are financially stable), the provision of fortified products of all types could prove beneficial in maintaining health of people.

It is certainly an area where both the development and appropriate marketing of fortified foods could be extremely useful for the food industry to examine.

Dr Mabel Blades

Freelance Registered Dietitian and Nutritionist and Member of IFST

Nutrition and Dietetic Services

202 Newton Rd

Rushden

Northants

NN10 0SY

E-mail: mabelblades202@gmail.com

References

1. BAPEN (2000) Guidelines on the Detection and Management of Malnutrition.
2. NHS Digital England (2017) Statistics on obesity, physical activity and diet. 30^th March 2017
3. Malnutrition Advisory Group Malnutrition Advisory Group (2003) The “MUST” explanatory booklet. BAPEN
4. M. Ella on behalf of Southampton University Biomedical Research Centre  and BAPEN (2015) The cost of malnutrition in England an potential cost savings from nutritional interventions (full report) BAPEN
5. The UKs fact checking charity (2016) What does obesity cost the economy?13th Dec 2016
6. The Patients Association (2011) Malnutrition in the community and hospital setting. 29^th August 2011.
7. NICE (2012) Nutrition support in adults. November 2012