Managing malnutrition in the community: we will all gain from finding and feeding the frail

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Malnutrition matters. Too little, too much or an incorrect energy, protein, and micronutrient balance not only affects anthropometry, but impacts on function, disease risk, and clinical outcomes.1 ‘Malnourishment’ may apply to normal or overweight individuals but usually refers to those who are underweight and affects an estimated 3 million people in the UK, with older people being at higher risk.2 Surveys suggest the majority at risk or affected by malnutrition live in the community (93%), largely in their own homes, 2–3% in sheltered housing, plus around 5% in care homes. Only 2% are in hospitals.3 Thus malnutrition is not a ‘third world’ or even secondary care phenomenon: the growth of our older population suggests that the burden of community malnutrition will increase. Disease-related malnutrition has detrimental physiological, psychosocial, and clinical effects impairing quality of life, delaying recovery from illness and surgery, plus increasing morbidity and mortality.4 One only needs to recall the misery of temporary, appetite-suppressing illness to imagine enduring chronic malnutrition. Malnutrition is costly, triggering more GP contacts than well-nourished individuals, and correlating directly with increased length of hospital stay, treatment costs, time to return to usual life, and rates of hospital readmission. Overall, malnutrition leads to an estimated £13 billion annual cost to the public sector (2007 prices).3 Unravelling the costs of malnutrition from the inevitable costs of the coexisting chronic diseases, that it is strongly associated with, is not easy,5 but the high ranking of NICE Clinical Guideline 32 …