Malnutrition Overview

What is Malnutrition

Malnutrition is a complex issue that presents in various forms across all health settings. It is often seen as undernutrition which results when there is imbalance between nutrient intake and nutrient requirements or if there is inadequate intake, impaired nutrient absorption and/or increased energy expenditure. This sustained imbalance leads to functional change in tissues of the body e.g., muscle loss, weakness, immune function, capacity for recovery, cognition. This is also further complicated by acute conditions (e.g. trauma, surgery), infections and diseases that cause inflammation. (Adapted from AW McKinlay: Malnutrition: the spectre at the feast. J R Coll Physicians Edinb 2008:38317–21).

Disease-related malnutrition (DRM) is a type of malnutrition that is caused by inflammation from disease and reduction in food intake, absorption and digestion of food and nutrients that is commonly associated with disease. DRM can be caused by almost any acute or chronic disease and older adults and individuals with non-communicable diseases are at an even higher risk.

Prevalence of Malnutrition

More than 4.1 million older Canadians, or 34% overall, are on the cusp of malnutrition (Lange-Chenier H, CMAJ 2013). 

CMTF conducted several studies looking at nutrition care in Canadian hospitals and found that up to 1 in 3 children  and 1 in 2 adult patients (Allard J et al, JPEN 2016) were malnourished upon admission. In Canada, after being discharged from the hospital, 1 in 4 adult patients lose weight  and 1 in 3 adults aged 65 years and older living in the community are at nutrition risk.   Additionally, in a study conducted in long-term care homes, up to 1 in 2 residents were identified as malnourished or at risk (Keller H et al, J Nutr Gerontol Geriatr 2019).

Malnutrition is not always visible and can go undetected and undiagnosed.

Impact of Malnutrition 

Malnutrition is reported to cost $2 billion annually to the Canadian healthcare system, due to an extra two to three day hospital stay (pre-COVID-19) (Curtis L et al, Clin Nutr. 2017). Malnutrition is associated with negative health consequences and poor clinical outcomes.

Recommendations for Best Nutrition Care Practices

Best nutrition care practices vary according to the health care setting and population. Generally, these would include recommendations from standards and evidence-based pathways that provide details on screening; assessing or diagnosing malnutrition; treating food as medicine and promoting quality, nutrient-dense food that meets the diverse nutritional and cultural needs of patients; following a patient/resident centred approach to food and mealtimes; treating with nutrition interventions; promoting roles of multidisciplinary teams; and planning for follow up.

Refer to CMTF’s Focus Areas for recommendations, tools and resources specific to each health care setting. 

Refer to our whitepaper, Malnutrition in Canada: Unveiling the Need for Priority and Policy for a list of recommendations for governments and stakeholders.