Medical aids and hospital administrators must urgently adjust their approach to identifying and treating malnutrition in their hospitalised patients, to reduce the overall cost of care and improve patient outcomes, says Naazneen Khan, chairperson of the Enteral Nutrition Association (ENASA) of South Africa.
“Dieticians and other healthcare workers in public and private sector hospitals have found that a significant number of in-patients suffer from malnutrition. This often major implications in increased mortality, morbidity, length of stay and hospital readmission rates,” she says.
Prioritising patient malnutrition
Apart from negative medical outcomes for the patients and their families, hospital malnutrition also has important cost implications for both medical aids and hospital administrators with tight budgets.
“Prioritising this, from a purely economic, cost-saving point of view, should therefore become a priority for both hospitals and medical aids,” Khan adds.
Hospital malnutrition is by no means a purely local phenomenon. Major international studies show this to be a worldwide problem. Williams et al (1), concluded that, “Perioperative malnutrition is the least often identified surgical risk factor and is among the most treatable to improve outcomes … It has been determined that malnourished surgical patients experience higher postoperative mortality, morbidity, length of stay, hospital readmission rates and hospital costs … For hospitals and medical aids, apart from caring better for their patients, reducing costs is a critically important outcome.”
Reducing the risk of readmissions
Another important study conducted in the USA by Schuetz, et al (2), concluded: “For medical inpatients who are malnourished or at nutritional risk, our findings showed that in-hospital nutritional support is a cost-effective way to reduce risk of readmissions, lower the frequency of hospital-associated infections and improve survival rates.
“The added cost of providing nutritional support is low compared with the associated reductions in costs of hospitalisation and medical treatments. The results from our economic health cost modelling study show that in-hospital nutritional support is a highly cost-effective intervention.”
There have been few published studies undertaken in South Africa. However, Janke Wessels et al at Standerton Hospital looked at the nutritional status of 100 patients with HIV and/or TB (3). They conclude: “Nutritional screening with validated malnutrition screening tools is seldom performed in public sector hospitals in South Africa and underlying malnutrition may not be identified at admission.
Comprehensive protocols required
“The findings of this study provide evidence for recommendations to apply a comprehensive protocol for the nutritional screening and management of patients with TB, to identify patients at increased risk of mortality and to provide adequate nutritional support.”
There is no shortage of tools available to address the problem. In 2018, GLIM, the Global Leadership Initiative on Malnutrition, established a list of core diagnostic criteria for diagnosing malnutrition in clinical settings (4). “Locally, SASPEN, ENASA and the Hospital Dietitian Interest Group have established a tablet-based diagnostic Medical Nutrition Therapy Tool (MNTT) to measure the metabolic and nutritional progress of patients.
“This specifies three clinical findings (non-volitional weight loss, low body mass index and reduced muscle mass) and two aetiologic findings (reduced food intake or assimilation and disease burden/inflammatory conditions) which can be used in local hospitals.”
Both training and funding required
“Years of local anecdotal experience, backed by major international studies, clearly point to an undeniable economic fact: patient malnutrition increases overall costs of hospitalisation and impacts patients’ recovery. This can be addressed both by medical aid funding and hospital administrators who need to ensure staff are adequately trained to identify and treat malnutrition among their hospitalised patients,” Khan says.
(1) “The Malnourished Surgery Patient: A Silent Epidemic in Perioperative Outcomes?” (Curr Opin Anaesthesiol. 32(3): 405–411) (2019)
(2) “Cost savings associated with nutritional support in medical inpatients: an economic model based on data from a systematic review of randomised trials.” BMJ Open 2021;11:e046402. doi:10.1136/bmjopen-2020-046402
(3) “A nutritional profile of patients with tuberculosis at Standerton Tuberculosis Specialised Hospital, Mpumalanga, South Africa.” Health SA Gesondheid ISSN: (Online) 2071-9736, (Print) 1025-9848 July, 2021
(4) Clinical Nutrition (2018) 1-9.
(5) Dietiticans Week, 20-24 June, 2022
Issued by Enteral Nutrition Association (ENASA) of South Africa