Malnutrition includes both the deficiency and excess (or imbalance) of energy, protein and other nutrients. In clinical practice, undernutrition, and inadequate intake of energy, protein and nutrients, is the focus. Undernutrition affects body tissues, functional ability and overall health. In hospitalized patients, undernutrition is often complicated by acute conditions (e.g. a trauma), infections and diseases that cause inflammation. Such complications worsen undernutrition and make it more challenging to correct due to extensive physiological changes and increased nutritional needs when appetite is decreased.
Adapted from AW McKinlay: Malnutrition: the spectre at the feast. J R Coll Physicians Edinb 2008:38317–21.
Recommendations for the best nutrition care
These recommendations are the result of consultation with stakeholders at the annual Canadian Nutrition Society conference in 2011. CMTF undertakes education and advocacy efforts with respect to the prevention, detection and treatment of malnutrition in Canada, focused on these recommendations. In 2017 the More-2-Eat Implementation project provided the research and best practices to support the implementation of these recommendations.
- Standardized screening protocols are mandatory in hospitals in Canada
- Best practice nutrition care processes involve an inter-professional team that starts with nutrition screening, subjective global assessment(for at-risk patients), a nutrition assessment(for malnourished patients)and determination of a nutrition care plan by a Registered Dietitian
- Staff (from nursing unit and food/nutrition services) provides patient-focused mealtimes that are consistent with patient-focused care; treating food as medicine
- A national standard for menu planning promotes quality, nutrient dense food that meets the diverse nutritional and cultural needs of patients
- Hospital administrators, physicians, nurses and allied health professionals integrate nutrition care as standard inter-professional practice
- Oral nutrition supplementation, enteral nutrition and parenteral nutrition are used appropriately to prevent and/or treat malnutrition