Malnutrition in hospitals

The problem of malnutrition in our hospitals will be discussed at the New Zealand Dietetic Association National Conference in Hamilton next week.

Global trends show between 10 and 60 percent (with an average 40 percent) of all people admitted to hospital are either malnourished or at significant risk of malnutrition.  This is predominant amongst older people, but not limited to this group, as even some obese patients arrive in hospital malnourished.

A recent UK report has highlighted that malnutrition is widespread in their hospitals, and New Zealand is expected to be on a similar footing. Helen Davidson, a leading dietitian in Scotland, will be visiting New Zealand next week to speak about a report recently published in the UK. She comments, “Malnourished patients tend to stay in hospital longer as their recovery time is longer; they are 3 times more likely to develop complications during surgery, and have a higher mortality rate”

In New Zealand hospitals, a Nil-by-mouth (NBM) policy can lead to malnutrition.

Helen Wallwork, Manager of Clinical Dietetics at Health Waikato, comments:

“It is never a medical professional’s intention to have patients NBM waiting for surgery longer than absolutely necessary, but it can happen at busy acute public hospitals that patients are ‘bumped’ from theatre lists for consecutive days. Often patients are put NBM from midnight the night before the anticipated surgery.  If surgery is postponed for any reason (sometimes for several days in a row), patients may only be allowed to eat 1 meal after they are officially stood down from that day’s theatre list.  This may effectively mean that their nutritional and calorie intake is more than halved for several days consecutively. Some hospitals are providing patients with oral carbohydrate and electrolyte drinks to ensure the maintenance of fluid hydration, but this cannot effectively address the reduction in macro and micro nutrient intake for that patient. Part of the malnutrition problem resides with older people who may require assistance with feeding. Nursing staff are generally very good at assisting patients, but they have enormous demands on their time, so problems can always occur.”

Malnutrition is frequently under-recognised amongst hospital patients, as treatment concentrates on their admission problems. There are internationally validated nutrition screening tools, however, which can be used to detect malnutrition or risk of malnutrition, but they require significant resources to implement.  The ensuing referrals generated would also require significant dietetic resources to follow this up.

“Individual dietitians in New Zealand recognise their value and are working towards the implementation of these tools in hospitals, “says Helen Wallwork.

To talk to these or any other scientists about the Dietetic Association Conference (which takes place from 1-3 September in Hamilton) or any nutrition issues, please contact the Science Media Centre on tel: 04 499 5476 or email:

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