Malnutrition in Ireland

It is estimated that 145,000 people in Ireland are either malnourished or at risk of malnutrition at any given time. In most cases this is due to illness, but psychological factors such as substance abuse, or social factors such as isolation, can also play a role.

The majority of adults who are at risk of malnutrition reside in the community.

It is estimated that the prevalence of malnutrition in care settings in Ireland are as follows:

  • Approximately 1/3 of adult patients admitted to an acute hospital are at risk of malnutrition,
  • Approximately 1/3 patients in publicly funded long stay residential care beds, i.e. nursing homes are at risk of malnutrition,
  • 25% of patients receiving home help/home care packages are at risk of malnutrition, and
  • 10% people who require care from a general practitioner are at risk of malnutrition.
Reference: Rice & Normand (2012) The cost associated with disease-related malnutrition in Ireland. Public Health Nutrition: 15(10), 1966–1972

Introduction

Symptoms of malnutrition

When to see your GP

How to calculate Body Mass Index (BMI)

Malnutrition: Who is at risk?

Signs and symptoms of malnutrition in adults

Vitamin and mineral deficiency

When to see your GP

Factors contributing to malnutrition

Diagnosing Malnutrition

Treatment for malnutrition

Treatment at home

Tube Feeding

Total Parenteral Nutrition (TPN)

Treatment in hospital

Preventing Malnutrition

Useful Websites

Introduction

Malnutrition is a serious condition that occurs when a person's diet does not contain enough nutrients to meet the demands of their body. This can affect growth, physical health, mood, behaviour and many of the functions of the body.

You can also become malnourished if your diet does not contain the right balance of nutrients. It is possible to eat a diet high in calories but containing few vitamins and minerals. This means you can become malnourished, even though you might also be overweight or obese. Being malnourished does not always mean that you are very thin.

Symptoms of malnutrition

The most common symptom of malnutrition is unplanned weight loss. Depending on your current weight, if you lose between 5-10% of your body weight in the course of three to six months without trying to, it could be a sign that you are at risk of becoming malnourished.

Other symptoms include:

  • lack of strength or energy to undertake routine activities, or poor physical performance
  • lack of energy and breathlessness (due to anaemia)
  • changes to skin and nails

When to see your GP

If your BMI is lower than 18.5* or you have lost some weight unintentionally and/or you experience the symptoms listed above, it is recommended that you see your GP.

*How to calculate Body Mass Index (BMI)

In adults, a useful method of assessing whether you are malnourished is to measure your body mass index (BMI). This is your weight (in kilograms) divided by your height (in metres) squared.

For most adults, a healthy BMI is between 18.5 and 24.9. This means that:

  • a BMI between 17 and 18.5 could suggest you are mildly malnourished
  • a BMI between 16 and 17 could suggest you are moderately malnourished
  • a BMI below 16 could suggest you are severely malnourished

BMI is affected by factors that also affect weight. It should only be used as a measure for people in the following groups with the oversight of a trained healthcare professional:

  • athletes – people with high muscle mass
  • patients with fluid retention/oedema
  • people who are post-amputation
  • women who are pregnant or breastfeeding

Malnutrition: Who is at risk?

People at high risk of malnutrition include:

  • older people over the age of 65, particularly if they are staying in a care home or nursing home
  • people with long-term conditions such as dementia or kidney disease
  • people with cancer
  • people who abuse drugs and/or alcohol
  • people on low incomes

Older people may become malnourished gradually if poor health begins to affect their ability to feed themselves properly. Malnutrition then, in turn, makes their health worse.

The estimated cost of care for patients with malnutrition has been estimated at €1.4 billion, representing 10% of total healthcare costs (€13.7 billion based on 2007 data)*.

*Data Source: Rice N & Normand C (2012) The cost associated with disease-related malnutrition in Ireland. Public Health Nutrition. 15(10), 1966-1972.

Read more about the causes of malnutrition.

Signs and symptoms of malnutrition in adults

The most common symptom of malnutrition is unplanned weight loss. If you lose 10% of your body weight in the course of three to six months and you are not dieting, it could be a sign that you are at risk of becoming malnourished.

Other symptoms include:

  • weakening of the muscles, which then begin to waste away
  • feeling tired all the time and lacking energy
  • increased vulnerability to infection
  • delayed wound healing
  • dizziness
  • irritability
  • your nails become brittle
  • your skin becomes dry and flaky
  • persistent diarrhoea
  • depression
  • in women of child bearing age, periods may become irregular or stop altogether

Vitamin and mineral deficiency

Even if your BMI is in the healthy range you may still not be getting enough vitamins and minerals from your diet. Physical signs that you may have a vitamin or mineral deficiency include:

  • skin problems or rashes
  • swelling of your tongue
  • poor vision at night or in dim light
  • you feel out of breath and tired all the time (due to anaemia)
  • you experience a constant ringing or buzzing in your ears (tinnitus)
  • paleness inside the mouth or eyelids (due to anaemia)
  • pain in the bones or joints

When to see your GP

If your BMI is lower than 18.5 or you experience the symptoms listed above, it is recommended that you see your GP.

Factors contributing to malnutrition

Malnutrition is caused by a person not receiving enough nutrients, which stops the body functioning as it should.

In developing countries, this is often the result of lack of food. In Ireland malnutrition can be caused by several different circumstances and conditions. These are listed below.

Physical factors

There are a number of physical factors, which can contribute to malnutrition. These include:

  • if your teeth are in a poor condition, eating can be difficult or painful.
  • you may find swallowing food difficult or painful. The medical term for this is dysphagia and there are a range of causes, such as a blockage in your throat, damage to the nerves used in swallowing or sores in your mouth.
  • you may lose your appetite as a result of losing your sense of smell and taste. This can sometimes occur after a severe head injury or brain tumour or while undergoing chemotherapy.
  • you may have a physical disability or other impairment that makes it difficult for you to cook for yourself.

Social factors

Social factors that can contribute to malnutrition include:

  • low income
  • limited knowledge about nutrition
  • living alone and being socially isolated
  • having reduced mobility and lack of transport
  • abusing drugs
  • abusing alcohol
  • recent discharge from hospital

Medical conditions

Medical conditions that can contribute to malnutrition include:

  • Conditions such as cancer, liver disease, active infection, persistent pain or nausea may cause a lack of appetite
  • Mental health conditions such as depression or schizophrenia which, if severe, may affect your ability to look after yourself
  • Crohn's disease, ulcerative colitis or similar conditions, which disrupt your body's ability to digest food or absorb nutrients
  • Eating disorders such as anorexia nervosa, which mean that the amount of food you eat is very small
  • Dementia
  • Persistent diarrhoea
  • Persistent vomiting

Other related factors include:

  • Taking many different types of medication at the same time can disrupt the body's ability to absorb and use nutrients
  • Your body may have an increased demand for energy at times, e.g. if it is trying to heal itself after a serious injury such as a severe burn

Diagnosing Malnutrition

A diagnosis of malnutrition is made following a nutritional assessment by a trained healthcare professional, usually a dietitan, based on the following factors:

  • Body mass index (BMI), which is your weight in kilograms divided by your height in metres squared
  • Whether you have unintentionally lost weight in recent months
  • Your ability to feed yourself
  • Whether something, such as a health condition, has meant that you are no longer able to absorb nutrients from your diet
  • Taking into account your medical condition and the results of any medical tests or investigations including blood tests.

You would normally be considered malnourished if:

  • You have a BMI of less than 18.5 or you have unintentionally lost more than 10% of your body weight during the last 3-6 months, or
  • You have a BMI of less than 20 and you unintentionally lost more than 5% of your body weight during the last 3-6 months

 You would normally be considered at high risk of becoming malnourished if:

  • You have eaten little or nothing for the last five days or are likely to eat little or nothing for five days or longer
  • You do not absorb nutrients from food well, for example you have a condition such as Crohn's disease that is causing inflammation inside your digestive system
  • You have an underlying condition or other factor that means your body is likely to use up nutrients at a higher rate or have an increased need for nutrients. For example, people recovering from serious burns have a higher demand for nutrients as their body requires extra energy to help it repair itself.

A vitamin or mineral deficiency may need to be diagnosed with a blood test.

Treatment for malnutrition

The main treatment option for somebody who is able to eat normally is to increase the energy calorie and protein content of their diet. Consideration should also be given to the need for extra vitamins or minerals. It is important any dietary changes are made under the supervision of a trained healthcare professional.

For more information on a high protein high energy diet, read our Making the most of every bite dietary information booklet.

In addition to dietary changes, oral nutritional supplements may also be prescribed.

In cases where people are unable to eat there are two main treatment options:

  • A feeding tube can be used to provide nutrients directly into the digestive system. This is known as enteral tube feeding.
  • A drip can be used to provide nutrients and fluids directly into one of the blood vessels. This is known as total parenteral nutrition or TPN.

Treatment for malnutrition varies depending on a number of factors, such as:

  • whether you are mildly, moderately or severely malnourished
  • the underlying cause of your malnutrition
  • whether you are able to shop for food and cook for yourself
  • whether you are able to eat and digest food normally

Depending on these factors you will either be treated at home under the supervision of a dietitian or other qualified healthcare professional. Admission to hospital is usually not required to but may be required for more serious cases or to treat the underlying causes of malnutrition.

If you are able to swallow food without any difficulty then you can be treated with a high energy high protein diet. Your healthcare professional may also recommend or prescribe oral nutritional supplements for a period of time.

If you are unable to swallow food, you may require either a feeding tube (if your digestive system is working properly) or parenteral nutrition (if your digestive system is not working properly).

You may also require additional treatment for the underlying cause(s) of your malnutrition.

Treatment at home

The dietitian or other healthcare professional will discuss with you what changes you should make to your diet. A dietitian can develop a recommended diet plan depending on your individual circumstances, but it is likely you will be advised to gradually increase your intake of protein, carbohydrates, water, minerals and vitamins. Your healthcare professional may also prescribe oral nutritional supplements.

Your body mass index (BMI) will be regularly measured to monitor your improvement.

If you find it difficult to swallow food or drink you may need to be referred for an assessment by a speech and language therapist .

Tube Feeding

It is estimated that there are about 2,500 people (adults and children) who require tube feeding in Ireland.

There are different types of feeding tubes .The most common types are :

  • a tube that is passed down your nose and into your stomach (nasogastric tube)
  • a tube that is placed directly into your stomach (for example a percutaneous endoscopic gastrostomy or PEG tube, a radiologically inserted gastrostomy tube (RIG) or a replacement gastrostomy tube ).
  • a tube placed directly into your jejunum which is part of the small intestine

Nasogastric tubes are designed for short-term use and may be considered if you are likely to need a feeding tube for up to six weeks.

PEG tubes are designed for long-term use and last for around two years before they need to be replaced.

Replacement gastrostomy tubes are typically replaced very 3-6 months .

Total Parenteral Nutrition (TPN)

If you have a condition that severely affects your ability to digest food, or your digestive system has been damaged, then you may need to be fed nutrients through a tube directly into your veins. This is known as parenteral nutrition.

It is estimated that there are 40-60 patients in the community in Ireland who require TPN treatment at home.

While it is possible to have parenteral nutrition at home, you may be required to visit the hospital regularly .

Your GP or doctor will be able to advise on the treatment that will be best for you.

Treatment in hospital

If you are admitted to hospital with malnutrition you may be seen by a number of different health professionals who will be involved in your care. This may include:

  • a doctor who specialises in treating digestive conditions (a gastroenterologist)
  • a dietitian
  • a nurse
  • a pharmacist
  • a psychologist
  • a social worker

Useful Links

http://www.indi.ie/

Preventing Malnutrition

As a lack of essential nutrients is one of the main causes of malnutrition, the best way to prevent the condition is to eat a balanced diet following the Food Pyramid. Find out more about healthy eating on Healthy Ireland.

For otherwise healthy people who are not malnourished or at risk of malnutrition healthy eating guidelines should be followed. Information can be found at http://www.healthyireland.ie

Useful Websites

www.indi.ie

www.irspen.ie

http://www.healthyireland.ie