Malnutrition: 
The Public Health Issue 
overshadowed by Obesity 
A multidisciplinary initiative to close the 
gap on malnu...
Malnutrition: 
A global Public Health Issue 
Malnutrition is a condition that occurs when a person’s diet does not contain...
Causes of Malnutrition 
Cause Example 
Increased nutritional requirements • Infection 
• Involuntary movement 
• Trauma 
•...
Causes of malnutrition: 
Additional risk factors 
Risk factor Example 
Poverty • Inability to access good food 
• Inabilit...
Clinical effects of Malnutrition 
Immunity – Increased risk 
of infection 
Decreased Cardiac output 
Hypothermia 
Impaired...
Consequences of Malnutrition 
• Increased risk of 
– Pressure sores 
– Respiratory infections 
– Falls 
– Complications fo...
Treatment
Financial implication 
• £13 billion in the UK in 2007 
• More than DOUBLE the amount spent on obesity and overweight 
• C...
Oral Nutrition 
£12 
£10 
£8 
£6 
£4 
£2 
£0 
2009 
2010 
2011 
UK regions: spend per head 
2009 
2010 
2011 
2009/10 
201...
Oral Nutritional Supplements 
In certain conditions some foods have characteristics of drugs and the Advisory 
Committee o...
Joint Initiative 
Delivery of enhanced outcomes for patients, ensuring appropriate use of Oral 
nutritional Supplements & ...
Target Population 
Targeted sample of GP practices: 
0.5- 1.94 % of patients registered with these GP practices are on ONS...
Food First 
The ‘food first’ approach is the term used for general dietary guidance to improve food 
intake. It includes s...
Measurable Outcomes 
Quality 
■ 72 practices complete 
■ 1605 patients assessed 
■ ‘Food first’ where appropriate 
Patient...
Malnutrition - The Public Health Issue Overshadowed by Obesity - Joanne Casey
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Malnutrition - The Public Health Issue Overshadowed by Obesity - Joanne Casey

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Malnutrition - The Public Health Issue Overshadowed by Obesity - Joanne Casey

IPH, Open, Conference, Belfast, Northern, Ireland, Dublin, Titanic, October, 2014, Health Public

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  • On Behalf of the team who developed the vision, manage and operationalise the MMDI
  • Malnutrition - The Public Health Issue Overshadowed by Obesity - Joanne Casey

    1. 1. Malnutrition: The Public Health Issue overshadowed by Obesity A multidisciplinary initiative to close the gap on malnutrition
    2. 2. Malnutrition: A global Public Health Issue Malnutrition is a condition that occurs when a person’s diet does not contain the right amount of nourishment. It means ‘poor nutrition’ and can refer to: • under nutrition – when you don’t get enough nutrients • over nutrition – when you get more nutrients than you need Promoting Good Nutrition Strategy 2011 DHSSPSNI The prevalence of malnutrition of patient admitted to hospital in NI is 29%
    3. 3. Causes of Malnutrition Cause Example Increased nutritional requirements • Infection • Involuntary movement • Trauma • Major surgery Reduced nutritional intake • Dysphagia • Pain Increased nutritional losses • Malabsorption • Diarrhoea • Wound exudate Those at greater risk of malnutrition include people: • Over the age of 65 years • With long-term conditions e.g. kidney disease, chronic lung disease • With chronic progressive conditions e.g. dementia, cancer • Who abuse drugs or alcohol • Who use multiple prescriptions and over-the-counter medications (Polypharmacy)
    4. 4. Causes of malnutrition: Additional risk factors Risk factor Example Poverty • Inability to access good food • Inability to afford good food Psychosocial factors • Isolation / Loneliness • Confusion • Depression • Anxiety • Dementia • Bereavement Mobility • Poor mobility • Disability • Poor transport links • Difficulty accessing local shops Functional constraints • Inability to prepare food • Poor dental / oral health • Sensory disability • Difficulty using food containers • Difficulty reading food labels
    5. 5. Clinical effects of Malnutrition Immunity – Increased risk of infection Decreased Cardiac output Hypothermia Impaired gut integrity and immunity Renal function - loss of ability to excrete Na & H2O Ventilation - loss of muscle & hypoxic responses Psychology – depression & apathy Anorexia Loss of strength liver fatty change, functional decline necrosis, fibrosis Impaired wound healing Adapted from Nutrition Now Workshop
    6. 6. Consequences of Malnutrition • Increased risk of – Pressure sores – Respiratory infections – Falls – Complications following surgery – Poor quality of life • Tripled risk of mortality in older patients in hospital • More than quadrupled risk of mortality 6 months after discharge
    7. 7. Treatment
    8. 8. Financial implication • £13 billion in the UK in 2007 • More than DOUBLE the amount spent on obesity and overweight • Clinical costs include – 65% more GP visits – 82% more hospital admissions – 30% longer hospital stay 14 12 10 8 6 4 2 0 NHS expendature on Obesity and Malnutrition 2007 Obesity Malnutrition £ billion • Better nutritional care 3rd largest potential cost-saving to NHS
    9. 9. Oral Nutrition £12 £10 £8 £6 £4 £2 £0 2009 2010 2011 UK regions: spend per head 2009 2010 2011 2009/10 2010/11 2011/12 2009 2010 2011 England Wales Scotland NI
    10. 10. Oral Nutritional Supplements In certain conditions some foods have characteristics of drugs and the Advisory Committee on Borderline Substances (ACBS) advises as to the circumstances in which such substances may be regarded as drugs Oral nutrition supplements are prescribable products that can be used as a simple, effective method of providing nutrition support to people who are malnourished.
    11. 11. Joint Initiative Delivery of enhanced outcomes for patients, ensuring appropriate use of Oral nutritional Supplements & management of malnutrition which has delivered prescribing efficiencies which can be redirected into patient care MEDICINES MANAGEMENT DIETITIAN INITIATIVE The Public Health Agency Health & Social Care Board
    12. 12. Target Population Targeted sample of GP practices: 0.5- 1.94 % of patients registered with these GP practices are on ONS • People who are prescribed oral nutritional supplements who are not under the care of trust dietitians Intervention • Offered a individual Nutritional Assessment to targeted individuals • Provide nutritional advice , education and care plan • Training
    13. 13. Food First The ‘food first’ approach is the term used for general dietary guidance to improve food intake. It includes strategies such as: • Increasing food frequency • Modifying food intake • Fortifying foods to increase the consumption of energy and nutrient-dense foods and nourishing drinks. Strategy Example Increasing food frequency Little and often, small frequent meals: 3 small nourishing meals and 2-3 nourishing snacks daily Modifying food intake Swap : • 1 pint of semi skimmed milk to full cream milk for an extra 100kcals • Low fat margarine to butter for an extra 50kcals per slice of buttered bread • Light / diet yoghurt to rich creamy yoghurt for extra 100kcals per pot Fortifying foods Extra 100-150kcals: 2 teaspoons jam / honey Matchbox size grated cheese Tablespoon butter / margarine Tablespoon double cream Extra 150-200kcals 1 Tablespoon chocolate spread 1 Tablespoon peanut butter 1 Tablespoon mayonnaise 1 Tablespoon desiccated coconut
    14. 14. Measurable Outcomes Quality ■ 72 practices complete ■ 1605 patients assessed ■ ‘Food first’ where appropriate Patient Experience Questionnaire: ■ 92% of patients reported comparable or improved wellbeing following appointment with the dietitian GP Questionnaire: ■ 94% GPs very satisfied with communication with the practice before the initiative and what the initiative entails Efficiency £ 1,008,565 annual efficiency to date in 2014 Safety 87% patients with MUST ≥2 had stable or increased BMI @ 8/52 94% patients maintained or increased BMI 8/52 after ONS stopped Patient perception of ONS GP Comment: “A very worthwhile project undertaken with little or no disturbance in the practice. The admin was well organised and the expertise of the dietitian was very appreciated.”

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