Hiding in Plain Sight

Have you noticed that your mum’s wedding ring is looser? Has your father started using a tighter notch on his belt? Do your clothes feel baggy? Are your dentures rattling? Why doesn’t your sister have as much energy? Has granddad been sleeping more? Think… could it be malnutrition? It was my granny Eileen, could it be yours?

Laura S 1People develop malnutrition (undernutrition) as a consequence of various physiological, psychological, socioeconomic and institutional factors such as COPD, Dementia, IBD, Depression, substance abuse and poverty. Malnutrition has serious consequences for a person’s quality of life if unidentified and untreated.

As part of Dietitian’s Week 2019 we are hoping to raise awareness of malnutrition, an often hidden or forgotten problem. Remember an overweight patient can be at high risk of malnutrition too.

Surely malnutrition is not a big problem for the developed world?

It may surprise you to know that it is a major clinical, public health and economic problem in the UK which is estimated to cost us £23.5 billion annually in part related to frequent hospital admissions, increased dependency, longer hospital stays, more GP visits and increased prescription costs (BAPEN, 2015). Malnutrition is common in hospitals, care homes and the community. It is estimated there are about 3 million people who are malnourished in the UK at any time with about 1.3 million being over the age of 65.

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Follow the hyperlink to Lyn’s story which shows how malnutrition can affect anyone and can often be missed in those of us who are lonely or socially isolated:


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Messages from our dietetic teams across NHS Dumfries and Galloway

Community Nutrition Support Dietetic Team

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Diabetes Dietitians

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Stephen has type 1 diabetes and Gastroparesis, he describes how he feels living with these conditions using the UWS Image cards. Stephen picked the following cards and explained his reasons for these choices

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Stephen reflected that what makes a difference to him is the information provided in our locally produced leaflet ‘Gastroparesis, Diet and Diabetes’ which outlines the above advice in an easy to follow format as unfortunately there is very little information available online. http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/singlepageview.aspx?pii=264&row=1023231&SPVPrimaryMenu=5&SPVReferrer=Sitesearch

Renal Dietitian

Laura S 8The malnourished person with kidney disease is at risk of weight loss, metabolic acidosis, muscle wasting, frailty, increased infections and recurrent hospital admissions. In particular protein energy wasting (PEW), a state of metabolic and nutritional derangement is a major concern in patients with Chronic Kidney Disease (CKD) undergoing dialysis. This results in muscle wasting, with increased morbidity and mortality. It has serious consequences for a patient’s quality of life.

Within NHS Dumfries and Galloway, a specialist Renal Dietitian carries out a nutritional assessment of CKD patients at least 6 monthly. This is critical for the identification and management of PEW and is considered an integral part of care for patients. The purpose being to obtain, verify and interpret data needed to identify nutrition related problems, their causes and significance.

Acute Dietetic Team

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What is on the Catering Dietitian’s menu?

There are simple steps we can take to try and help maintain and improve nutritional status for those at risk in the hospital setting.

  1. Add the ‘Fortified’ Catering flag on Cortix in DGRI or mark the menu Fortified in Community Hospitals.
  2. Offer snacks between meals
  3. Offer milk with meals
  4. Provide the ‘Food First’ leaflet from Beacon.

The ‘little and often’ approach is an old one, but tried and tested and for those experiencing poor appetite and early satiety this can aid recovery.

We don’t and we can’t manage this alone! The Dietetic department work alongside Speech and Language Therapy, Occupational Therapy, other Allied Health Care Professionals, Doctors, Nursing staff, Support Services, Catering, Carers and Patients. It takes a team approach to provide gold standard care! There are also some great community initiatives too such as assisted shopping, meals on wheels, lunch clubs, food banks and many more…

What can you do to better tackle the issue?

Laura S 9.1Nutritional screening should be an integral, embedded part of assessments in our organisation. A MUST (Malnutrition Universal Screening Tool) for every patient!

For more information and useful resources visit Beacon; Teams; Food, Fluid and Nutritional Care. If you think that you or your staff would benefit from MUST training or further education on managing malnutrition please get in contact.

If you are concerned that you, or someone you are caring for may be malnourished speak with your GP or Healthcare Professional. BAPEN offers a free self screening tool you can use at home – https://www.malnutritionselfscreening.org/self-screening.html

Useful food first approach resources which can assist with the first line management of malnutrition:



Contributed by:

Laura Shanahan, Acute Dietitian at Dumfries and Galloway Royal Infirmary

If you’d like to know more, please get in touch: laura.shanahan@nhs.net

This blog was originally posted on DGHealth: https://dghealth.wordpress.com/ on May 31st 2019


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