People are living longer, many with chronic disease. As more care is shifted away from hospitals and care homes into the community, people at risk of malnutrition in their own homes are largely being forgotten. Having enough to eat and drink is one of the most basic human needs. Yet we know that many vulnerable people are not having this fundamental need met. 

Reliable data does not exist – an unrecognised problem per se cannot be measured - and is based on estimates from the numbers of people screened for malnutrition when admitted to hospital.  In 2007 the British Association for Parental and Enteral Nutrition (BAPEN), which includes dietitians in its membership, established an annual survey to measure malnutrition in the UK. The results of this study have now been published for two consecutive years. 28% of people surveyed on admission to hospital were classified as malnourished with the majority classified as at high risk. 93% of all these individuals at risk of malnutrition are estimated to live in the community.

Whilst malnutrition is more common in older people, it is present in all age groups. Malnourished older people (over 65yrs) have twice as many hospital admissions compared with non malnourished older people.  They are more likely to visit their GP and to have more prescriptions than their well nourished peers.

Malnutrition is a serious problem - the consequences include vulnerability to infection, delayed wound healing, impaired function of heart and lungs, decreased muscle strength, depression and ultimately premature death. 

The invisible problem

Unlike obesity, an obvious public health problem, malnutrition is less visible.  People often do not seek advice about their health until malnutrition is severe; they are widely dispersed in the community often living in small family groups or alone.  Care is often provided by informal carers (family/friends) who report that they receive inadequate support. Treating malnutrition is cost effective

Malnutrition is treatable and could result in significant cost savings as well as improved quality of care.  But current knowledge of how to prevent malnutrition and provide adequate nutritional support amongst carers and many health and social care professionals is poor.  Some of this treatment is relatively simple – providing access to nutritious meals for those vulnerable people for whom even one meal a day is proving difficult.

The NICE guidance (CG 32) has established standardised patterns of care for treatment of malnutrition. The problem remains that it often goes undetected. British Dietetic Association Campaign

The BDA has launched the Mind the Hunger Gap: stamp out missing meals in the UK campaign to highlight this insidious killer. Malnutrition and mortality are usually closely linked. It leads to death by increasing the susceptibility of malnourished individuals to infectious diseases and, once infected, increasing the severity and duration of these diseases.

For more than 10 years we have known about the public health scandal that is malnutrition in the UK - yet still, thousands of older, vulnerable people go hungry in their own homes.  Both inside and outside the health and social care system, thousands of older people are surviving on less than one meal a day.

Progressive undernutrition leads to poor health, rising hospital admissions and a massive financial burden to the NHS.

Our aim is to put the spotlight on malnutrition in the community.  Dietitians’ expertise, partnership working and leadership skills are essential in protecting current services, to ensure that food is at the heart of community care. 

The campaign’s messages are: