All patients admitted to hospital are to be screened for malnutrition, as part of a new National Clinical Guideline that has just been published by the Department of Health.

Malnutrition is a serious condition that occurs when a person's diet does not contain the right amount of nutrients. It can cause a range of health problems, including an impaired ability to fight infections, reduced muscle strength, impaired wound healing and depression.

Malnutrition can refer to undernutrition, when a person is not getting enough nutrients. There are many reasons why this may occur. Eating and maintaining a healthy weight can be difficult for people experiencing conditions such as cancer, Crohn's disease or advanced dementia. It can also affect older people living alone.

However, malnutrition also includes people who are overweight and obese, as their nutrition intake may be excessive or imbalanced. In other words, they may be consuming too many foods that are high in fat and sugar, but low in essential vitamins and minerals.

The number of adults estimated to be affected by malnutrition in Ireland is around 140,000 - 3% of the population. Around one-third of patients admitted to acute hospitals are malnourished and these patients spend an estimated 30% longer in hospital than those who are not malnourished.

This latest National Clinical Guideline from the Department of Health focuses on the screening of adults in the acute care setting, as well as the use of oral nutrition support.

It was developed by a guideline development group made up of healthcare professionals working in this area, including consultants, dietitians, nurses, and speech and language therapists. The group was led by clinical specialist dietitian, Carmel O'Hanlon.

It recommends that all patients on admission to an acute hospital should be screened for malnutrition, and screening should be repeated weekly for inpatients.

This screening for malnutrition should be carried out by healthcare professionals or other healthcare workers with appropriate skills and training. The guideline states that such training should be provided to all nursing staff, nursing students and/or other healthcare workers, such as healthcare assistants.

Those patients at high risk will be referred to dietitians for follow-up and assessment. Their treatment will include foods fortified with protein, carbohydrates and/or fat, and oral nutrition supplements as extra nutrition to regular meals.

The guideline has been mandated for implementation across hospitals by the Minister for Health, Simon Harris. Some hospitals already screen their patients for malnutrition, however others do not, leading to big differences nationwide.

The publication has been welcomed by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN). Its president, consultant surgeon, Prof John Reynolds, was co-chairperson of the guideline development group.

"Malnutrition is estimated to affect 3% of the Irish population including people who live with serious diseases, who have difficulty swallowing, people with dementia, and frail older people. However, this population accounts for 30% of public hospital admissions, has three times the rate of complications and stays 30% longer in hospital," Prof Reynolds noted.

While acknowledging the current pressures on the health service, he urged all hospitals to work towards implementing the guideline.

Meanwhile, this guideline also has a role to play in relation to COVID-19, Ms O'Hanlon said.

"Many patients admitted to hospital with the virus are likely to have been unwell for up to 10 days while at home and have had significant loss of appetite. Even patients with obesity are at risk, so all should be screened and potentially treated.

"Most of the post-ICU COVID-19 patients will also have difficulty getting back to full diet and need a nutritional follow-up. While acknowledging that our health services are under unprecedented pressure, the guideline presents an opportunity to support outcomes for COVID-19 patients," she explained.

This was backed up by the guideline development group's co-chairperson, consultant geriatrician, Dr Declan Byrne, who noted that the average age of people dying with COVID-19 is over 80.

"This is the same population with the most undernutrition and the group where this guideline can have the biggest positive impact.

"There is a likelihood that the prevalence of malnutrition on admission will be even higher than usual this year, because of delayed presentation of patients with non-COVID conditions. We therefore need to work towards applying screening and treatments across our hospitals," he said.

The guideline can be viewed here.