1.4 Consequences of malnutrition
Summary
Malnutrition leads to far-reaching physical and psycho-social consequences such as impaired immune response, impaired wound healing, reduced muscle strength and fatigue, inactivity, apathy, depression and self-neglect. Malnutrition is also associated with poorer quality of life. In children, growth and development is adversely impacted by malnutrition. Malnutrition has a particularly high adverse impact in the older person impairing function, mobility and independence.
These effects in turn contribute to increased morbidity and mortality. Malnourished hospital patients experience significantly higher complication rates than well-nourished patients (30.6% vs 11.3%) and the risk of infection is more than three times greater. Significantly higher mortality rates have been found in ‘at-risk’ hospital patients compared with ‘not-at- risk’ patients (12% vs 1%).
It is thus unsurprising that malnutrition is associated with increased healthcare resource use across all age groups such as increases in length of hospital stay, increased readmissions and more care needed after discharge. Average length of hospital stay may be increased by 30% in malnourished patients. In community patients malnourished patients visit family doctors more often and have more frequent hospital admissions than well-nourished patients.
As a result of increased morbidity and healthcare resource use malnutrition is costly to the individual, to society and to the economy. The estimated cost of managing patients at risk of malnutrition in the EU is €120 billion and €170 billion across Europe. This estimate is based on economic evidence from the UK undertaken in 2005 showing costs for managing patients at risk of malnutrition exceed €15 billion. An update conducted in 2015 puts the figure at £23.5 billion for England alone so it is highly likely that the figures above are now a very conservative estimate of the true cost of malnutrition in Europe.
The extra cost of treating a patient with malnutrition is 2-3 times greater than for a non-malnourished patient.
Conclusion
The adverse consequences of malnutrition arising as a result of disease and disability are far-reaching at both the individual and the societal level. Malnutrition leads to impaired immune response, increased morbidity and mortality, and reduced quality of life. Inadequate and untimely management of malnutrition exacerbates healthcare system constraints, leading to higher costs, prolonged hospital stays, and suboptimal care. Implementing evidence-based nutritional screening programs, nutritional care pathways, and nutritional guidelines is crucial for early identification and intervention, thereby improving patient outcomes and reducing the economic burden on healthcare systems. Immediate implementation of these programs is crucial to mitigate nutritional and comorbidity risks associated with malnutrition, ensuring overall quality of care.
Recommendations
On the issue of consequences of malnutrition, the MNI makes the following recommendation:
| Action | Issues to consider |
|---|---|
| Awareness should be raised about the wide-ranging negative consequences of malnutrition for patients, for healthcare providers and for society in general Evidence based screening programmes should be used to ensure that malnutrition and risk of malnutrition is identified early, and appropriate action is taken to minimise its consequences. Additionally, nutritional screening should be carried out within 24 hours of admission. |
|
Malnutrition adversely impacts on every organ system in the body, with potentially serious consequences (see Table 1.14)
Restricted recent dietary intake has been shown to affect metabolic, psychological, and physical function in the presence and absence of disease, and in surgical patients to reduce collagen deposition, with implications for effective wound healing.53 Recent research highlights the role of micronutrient deficiencies in exacerbating these effects, particularly in vulnerable populations such as the elderly and chronically ill. Moreover, malnutrition can negatively influence clinical outcomes and may affect physical function, which in turn impacts overall quality of life.98
Key physical and psychosocial effects of malnutrition (adapted from Elia and Russell 2009)122
| Effect | Consequences |
|---|---|
| Impaired immune response | Impaired ability to fight infection |
| Reduced muscle strength and fatigue | Inactivity, and reduced ability to work, shop, cook and self-care. Poor muscle function may result in falls, and poor respiratory muscle function may result in poor cough pressure – delaying expectoration and recovery from chest infection |
| Inactivity | In bed-bound patients, this may result in pressure ulcers and venous blood clots, which can break loose and embolise |
| Impaired temperature regulation | Hypothermia |
| Impaired wound healing | Increased wound-related complications, such as infections and un-united fractures |
| Impaired ability to regulate salt and fluid | Predisposes to over-hydration or dehydration |
| Impaired psycho-social function | Apathy, depression, introversion, self-neglect, hypochondriasis, loss of libido and deterioration in social interactions |