Malnutrition is a condition seen all over the world, not just in developing nations.
In the United States, food deserts (areas without access to high-quality food) exist in rural and urban areas alike, affecting our society’s nutritional health community by community, state by state, throughout the country.
Even in areas where healthy foods are available, Americans have a propensity to ingest too much salt, saturated fat, and added sugars while not including adequate servings of fruits and vegetables. The result is a high percentage of our population being overweight or obese (67%),1 the latter of which is a form of malnutrition.
Despite its high prevalence, malnutrition is underrecognized by health care providers. Complicating this issue is that obesity commonly is associated with heart disease, diabetes, osteoarthritis, and cancer and that most symptoms of malnutrition mimic symptoms of these and other common diseases. Thus, it is difficult to recognize malnutrition itself as a problem that needs to be addressed in a patient’s plan of care. This is compounded by inconsistent education of health care providers about nutrition, which results in a poor recognition of malnutrition and how it influences disease outcomes.
Despite these challenges, this is an important health care issue that needs to be addressed. In hospitalized patients, the presence of malnutrition is associated with poor outcomes after surgery (urinary tract or wound infections), poor response to disease management, and increased ICU and hospital lengths of stay.2 In elderly patients, malnutrition is a common denominator to the development of “frailty,” a generalized decline in functional and cognitive ability that reduces an individual’s independence, leading to social isolation and depression.
This public policy issue recently was addressed by 2 states—Massachusetts and Ohio—which created malnutrition commissions charged with the responsibility to evaluate problems in these states related to nutrition, especially in the elderly, and recommend actions to improve nutrition care provided by health practitioners and health care systems.3,4 At the national level, education of professionals also is being considered, with proposed legislation (HR 1413: Expanding Nutrition’s Role in Curricula and Healthcare [ENRICH] Act).5
Because recognition of malnutrition often is missed during assessments within our health care system, it is important that all health care practitioners, in all sites of care, be aware of this “invisible” diagnosis that impedes our ability to successfully manage acute and chronic diseases with medications and medical care.
The American Society for Parenteral and Enteral Nutrition (ASPEN) offers a Malnutrition Resource Center to provide resources and support to help health professionals prevent and treat malnutrition (www.nutritioncare.org/?guidelines_and_clinical_resources/?Malnutrition_Solution_Center/?) as well as an annual Malnutrition Awareness Week, a multiorganizational, multipronged campaign that aims to 1) educate health care professionals to identify and treat malnutrition; 2) educate consumers/patients to discuss their nutritional status with health care professionals; and 3) increase awareness of nutrition’s role on patient recovery. These resources can help you stay abreast of the latest knowledge about malnutrition to facilitate improved nutritional care for your patients.