Avoiding Malnutrition Through Personalised Nutritional Guidelines
When we talk about public health crises, obesity is often the first to be named – this is no surprise, considering obesity levels in the UK have more than trebled in the last thirty years. However, there is another, growing epidemic in this country: malnutrition.
It’s estimated that over three million people in the UK are malnourished or at risk of malnutrition. Our elderly population is particularly at risk: over one million of those affected are over 65. The dangers of malnutrition cannot be overstated, particularly amongst the elderly. Those who are malnourished are slower to heal, have weaker immune systems, and struggle to absorb medication. Ensuring our elderly patients are getting the right nutrients is one way we can help them live a healthier, better life.
Malnutrition is a natural consequence of poor diet, but a “poor diet” means different things for different people. In the UK, we commonly refer to the traffic light labelling system to quickly identify items which are good and bad: items with a red label are high in fat, sugar, or salt – ingredients traditionally to be avoided– while those marked as green are said to be healthier due to their low fat, sugar, or salt content.
For people who are in generally good health, the traffic light labelling system works. However, those at risk of malnutrition may be told to eat a diet that is higher in fat; a person with low blood pressure may find increasing salt intake will improve their health. By following the general guidelines in the traffic light labelling system, some people will actually be exacerbating existing conditions or putting themselves at greater risk.
This points to our society’s confused conversation around nutrition. Good nutrition is a basic right for everyone in society, but not everyone knows how to attain this. As dietitians, we are aware that each patient requires individualised nutritional advice. A survey conducted as part of The Knowledge, a recent study from apetito and Wiltshire Farm Foods3 has identified five calls to action to help health and social care professionals to ensure everyone can enjoy food that is right for them and their nutritional requirements.
“Eating for health”
Eating for health is not the same as so-called “healthy eating,” which assumes a person is nutritionally well. Instead, eating for health is about recognising there are differing nutritional needs across different groups. It requires us to see nutrition ‘as a whole,’ and understand that an individual’s health is dependent on a combination of their bespoke nutritional needs and personal preferences.
Hydration is easily overlooked as one of the key nutrients needed to preserve health. It is paramount that patients understand how important it is to stay hydrated throughout the day, and that they have easy access to water at any time and place.
Nutrition for recovery
Food and drink are a vital part of the recovery process, however, it is often easy to overlook for a number of reasons, which can result in longer stays in hospital and increased complications. To combat this, diet and nutrition must become more prominent in healthcare professional training.
Meeting individual needs, not just campaign standards
It is incumbent on care homes and hospitals to recognise that the system used – cook-serve, cook-freeze, or cook-chill – is irrelevant: it is about delivering the right nutrients in an appealing format, to ensure patients receive the right nutrients necessary for their individuals' needs, instead of just meeting campaign standards.
The dining experience
The dining experience is just as important as the meal itself when combating malnutrition. Social interaction, flexible meal times, and receiving help and assistance when needed play a big role in ensuring people are enjoying their meals. Several studies have shown being part of a group is a rewarding experience and can enhance our enjoyment of the meal, which improves our relationship with food.
These five calls to action are intended as the first steps in a new conversation about nutrition for older people and those with high dependencies.
Our relationship with food is a complex issue. While people must recognise healthy eating advice from government campaigns, very few have a good understanding of how to eat for their individual health needs. By taking the right steps towards eating for health, we can ensure that every older person has a diet that meets their needs – and protects them from the risk of malnutrition.
 Britain: ‘the fat man of Europe’. NHS Choices. 06 November 2015. https://www.nhs.uk/Livewell/loseweight/Pages/statistics-and-causes-of-the-obesity-epidemicin-the-UK.aspx Accessed 08 December 2016.
 “Introduction to Malnutrition,” BAPEN, accessed Apr 2016, https://www.bapen.org.uk/malnutrition-undernutrition/introduction-to-malnutrition?showall=&start=4
3 ”The Knowledge: Issue Two”, apetito and Wiltshire Farm Foods. 01 December 2016. https://www.apetito.co.uk/about-us/news-and-events/the-knowledge-issue-2/