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  • Nutrition

FORGOTTEN NOT FIXED is the leading message of the recently published British Specialist Nutrition Association (BSNA)* report, which highlights the increasing burden of malnutrition in England.

Three million people in Britain are estimated to be malnourished, or at risk of malnutrition – that’s nearly 5% of the entire population.1 The number of deaths from underlying malnutrition, or where malnutrition was named as a contributory factor, has risen by more than 30% in the last decade.2 However, new research commissioned by the BSNA found that not all Trusts collect and report data in the same way – these inconsistencies mean that the overall incidence of malnutrition is likely to be significantly under recorded.

Malnutrition occurs when the body is not getting enough of the nutrients it needs to stay healthy and can develop if a person is unable to eat properly, or if the body needs more nutrients than normal (e.g. due to chronic disease or infection). It can have an impact on both physical and mental health symptoms including weight loss, lack of energy and poor wound healing. Malnutrition is also a key risk factor for loss of muscle health and strength – elements that can reduce a person’s risk of falls and help maintain their independence.

In England alone, disease-related malnutrition costs £19.6 billion per year. However, it may be surprising to know that not treating malnutrition costs more than treating the condition. It is estimated that £5,000 per patient could be saved3 through better nutrition management. The appropriate use of oral nutritional supplements (ONS) and associated dietetic support ensure that patients nutritional needs are properly managed and that further complications do not arise.

Focus needs to be on prevention and early action – better screening and effectively managing patients is fundamental. Therefore, the BSNA is calling for the following:

  1. New clinical pathway: the introduction of a new, comprehensive jointly developed and delivered clinical care pathway for the frail elderly, across all systems
  2. Guidelines to be implemented and followed in all healthcare settings: NICE Clinical Guideline 32 (CG32) which should be mandatory, QS24 and the Managing Adult Malnutrition in the Community Pathway
  3. Additional incentives: these should be considered to transform clinical practice including how malnutrition is identified, recorded and managed, perhaps by the introduction of a new Quality and Outcomes Framework (QOF), or equivalent, on malnutrition
  4. Recognition of the integral role of oral nutritional supplements (ONS): these should be accessible to all patients who need them and all care pathways should clearly identify when and how ONS should be used to help manage patients’ conditions.

The ‘Forgotten not Fixed’ report demonstrates that malnutrition is a growing and costly problem - however, with the right tools and resources in place, it could be largely preventable.


* The British Specialist Nutrition Association (BSNA) is the trade association representing manufacturers of products designed to meet specialist nutritional needs. To find out more please click here.


  1. Elia M, Russell CA (eds), Combating malnutrition; Recommendations for Action. A report from the Advisory Group on Malnutrition, led by BAPEN. Redditch: BAPEN, 2009.
  2. Office for National Statistics (2018) Deaths where malnutrition was underlying cause or mentioned on death certificate, NHS England, 2001 to 2016.
  3. Elia, M, (on behalf of the Malnutrition Action Group of BAPEN and the National Institute for Health Research Southampton Biomedical Research Centre), The cost of malnutrition in England and potential cost savings from nutritional interventions, 2015.

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