Q J Med 2000; 93: 640-641
© 2000 Association of Physicians
Correspondence |
Malnutrition in hospital
University Department of Medicine City Hospital Birmingham
Sir,
We read with interest the article by Kelly et al.1 suggesting that malnutrition in acute hospital admissions is common, and apparently is unrecognized and unmanaged in 70% of cases. We suggest that malnutrition in acute hospital admissions may actually be further exacerbated by the diet provided to in-hospital patients.
In a pilot project to study patient nutrition in our city centre teaching hospital, we evaluated the dietary intake of 35 patients (18 males, 17 females; mean age 64.9 and 64.4 years) in our cardiac rehabilitation ward. All patients were mobile and clinically stable, after having been admitted as emergency admissions with acute coronary syndromes (myocardial infarct or unstable angina). Patients were studied 72 h prior to planned discharge and the self-reported food intake assessed using a standard detailed dietary questionnaire over a two-day period, which consisted of two 24-h recording periods, starting arbitrarily at midnight, with the two recording days running consecutively. Patients were instructed to record all nutrient intake, whether from meals provided by the hospital, or any additional food intake from self-purchased food or any food brought in by relatives.
Detailed calculations of nutrient intake was based on portion weights from the hospital's catering services and nationally accepted guidelines.2 They were then compared to the recommended dietary allowances (RDA), as defined by the Committee of Medical Aspects of Food Policy,3 and the mean intakes for the UK population. Our results are summarized in Table 1
.
|
All patients received a mean total energy intake which was far less than the RDA or the mean UK intake, even though it could be argued that these patients would require more nutrition and protein for the metabolic processes of body repair following an acute illness.4 The main reduction in nutrient intake was related to a reduction in carbohydrates and total fat intake. Within the latter, polyunsaturated fat consumption was far lower than the RDA in both sexes whilst cholesterol intake was much higher in men. Total protein and sodium intakes were higher than the RDA, but were well below the mean UK nutrient intake (Table 1
). Thus one factor that may exacerbate malnutrition amongst acute hospital admissions may be the poor diet provided by the hospital, with total energy intake below the RDA. We have previously reported that hospital food served in cardiology units in the UK was generally ‘unhealthy’, with many units reporting a general disregard for healthy eating options and the lack of provision of good dietary advice.5 One confounder for the reduction in nutrient intake is loss of appetite after an acute physical illness. Perhaps patient education on healthy eating coupled with limited menu options may also be a factor for patients refusing much of the food on their plate following an acute admission. Finally, hospital servings are also usually less compared with home servings, and much of the energy requirement is provided as fat, with a high cholesterol component amongst men, which is unacceptable on a cardiac ward.
Following this pilot study, a list of recommendations were handed to the hospital catering services which included a menu option for ‘healthy eating’ that was low in saturated fat and cholesterol, and an overall better balance of nutrient content.
References
1.
Kelly IE, Tessier S, Cahill A, Morris SE, Crumley A, McLaughlin D, McKee RF, Lean MEJ. Still hungry in hospital: identifying malnutrition in acute hospital admissions. Q J Med2000; 93:93–8.
2. Ministry of Agriculture, Fisheries and Food. Food Portion Sizes, 2nd edn. HMSO, London, 1993.
3. Department of Health. Dietary reference values for food, energy and nutrients for the United Kingdom. Report of the panel on dietary reference values of Committee on Medical Aspects of Food Policy, 1991.
4. Department of Health. Nutritional aspects of cardiovascular disease: report on health and social subjects, report 46. 1994.
5. Lip GYH, Lip PL, Murray S, Beevers DG. A survey of diet in British Coronary Care Units. Br J Cardiol1997; 4:17–19.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||