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What Does The New BAPEN Report Tell Us About The Nutritional Management Of Malnutrition?

  By The Malnutrition Action Group of BAPEN

We have known for many years that disease-related malnutrition is a common and often unrecognised and undertreated problem in our society. BAPEN, in partnership with the Malnutrition Taskforce, is committed to raising awareness of malnutrition and how to prevent and manage it during its annual awareness weeks.  

This new report from the Malnutrition Action Group of BAPEN highlights results from the first online national survey of malnutrition and nutritional care using the newly developed portal undertaken during the last UK Malnutrition Awareness Week in 2019.

Over 1000 patients were included in the survey from different care settings across England.  Around 40% were at risk of malnutrition, although the prevalence varied according to the setting and diagnosis of patients. For those patients at risk of malnutrition, around two thirds received at least one food-based intervention, half received oral nutritional supplements and about 10% received enteral tube feeding. We hope that a larger survey this year as part of #UKMAW2020, with broader participation across different settings, from dietitians and other care professionals throughout the UK, will give further clarity on how common this costly condition is and how it is being managed.

How common is malnutrition?

In the survey, 42% were at risk of malnutrition (13% were medium and 29% were high risk, using the ‘Malnutrition Universal Screening Tool’ (‘MUST’)).  Most patients in the survey were in care homes (n 359), hospitals (n 751) or their own home (n 149).

Of the most common primary diagnoses for the patients recorded in the survey, malnutrition risk was documented in around 40% (e.g. cancer 39%, neurological conditions 44%, gastrointestinal conditions 42%, cardiovascular conditions 36%, frailty 44%).

How is malnutrition being managed?

It was encouraging to see that just over half (64%) of all patients in the survey had a nutritional care plan in place, and that 86% of medium and 92% of high risk patients had nutritional care plans. It will be interesting to see if this is broadly representative of levels of nutritional management of malnourished patients in all settings in future surveys, or if this a higher proportion, perhaps due to these patients being under the care of a dietitian (the profession who entered most of the survey data).  In the survey, patients could have be recorded has having more than one type of treatment across all the options, from food based to medical nutrition interventions (oral nutritional supplements, tube feeding, parenteral nutrition).

Food based intervention

Of those that had a care plan in place, and were at risk of malnutrition, around two thirds received at least one food-based intervention, with the most common ones being food snacks (54%), dietetic counselling (45%) and use of a fortified diet (42%). Other options included fortifying the diet with modular feeds, a texture modified diet, fluids only and input by a non-Dietitian.

Use of medical nutrition

Around half of the patients at risk of malnutrition received oral nutritional supplements (ONS) (39% of those at medium risk and 55% of those at high risk).

The most commonly used ONS were ready to drink liquids, either energy dense, compact-style (>2kcal/ml) or standard energy density (1.0-1.5kcal/ml).

A tenth of medium risk and 13% of high risk patients were receiving tube feeding, mostly via a continuous feeding regimen. Around 10% were recorded as being bolus fed. The tube feeds recorded were most commonly ‘standard’ feeds that varied in energy density (1 to >2kcal/ml). Low energy density feeds (<1kcal/ml), fibre containing feeds and peptide or amino acid based feeds were less frequently reported in the survey (< 10% of patients at risk of malnutrition).

Only about 1% of care plans (11 patients) recorded parenteral nutrition, most (82%) were centrally fed and only 45% were managed by a nutrition support team.

We recognise that this survey is just a small snapshot into how common malnutrition is and how it is managed. Larger surveys, across more settings, patient groups and countries will help us to understand better the extent of this condition and how we can improve its management.

We are so grateful to everyone who participated in BAPEN’s first online survey of malnutrition and nutritional care (see the full report on BAPEN’s website: www.bapen.org.uk). We would encourage as many people as possible to take part in our next survey during #UKMAW2020 to help us gain even more insights to help us raise the profile of malnutrition and the importance of identifying and treating it.