Basics in Clinical Nutrition: Organization and Legal Aspects of Nutritional Care

e-SPEN, European e-Journal of Clinical Nutrition. 2009 February; doi 10.1016/j.eclnm.2008.07.003
Allison, S., Stanga, Z.


Studies have shown that between 15 and 60% of hospital admissions are undernourished, half severely so. Furthermore such malnutrition is associated with increased complications and costs of illness, longer hospital stay and slower convalescence. In many cases appropriate nutritional support can improve all these parameters. Unfortunately the condition goes largely unrecognised since few hospitals have a nutritional care policy or any system of nutritional screening and assessment of patients on admission. McWhirter and Pennington showed that the majority of patients continue to lose weight in hospital, but that the few that are referred for some form of nutritional care gain weight (average 7%). In their study, only 23% of patients had been weighed and in less than 50% of cases was there any nutritional information in the notes concerning change in appetite or weight. Although the prevalence of undernutrition in the community in European countries is less than 5%, it is higher than this in particular groups, e.g. in those suffering from disease or old age. In a survey of a large General Practice database in the South of England, Edington showed a U shaped relationship between consumption of health care resources and BMI. Below a BMI of 20 and above 30, there was a steep increase in consultations, prescriptions and hospital admissions.

In view therefore of the serious clinical and economic consequences of undernutrition, health services and hospital authorities should be urged to develop proper strategies for managing nutrition in hospital and the community.

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List of abbreviations

DGEM German Society for Nutritional Medicine (German Deutsche Gesellschaft für Ernährungsmedizin)
GESKES  Swiss Society for Clinical Nutrition (German Gesellschaft für klinische Ernährung der Schweiz) 
ESPEN European Society of Clinicl Nutrition and Metabolism