Intended for healthcare professionals

Letters Nutrition and fluid balance

Malnutrition: the hidden killer in healthcare systems

BMJ 2013; 346 doi: (Published 13 March 2013) Cite this as: BMJ 2013;346:f1547
  1. Maurizio Muscaritoli, associate professor of internal medicine1,
  2. Alessio Molfino, postdoctoral fellow1
  1. 1Department of Clinical Medicine, Sapienza University of Rome, 00185 Rome, Italy
  1. maurizio.muscaritoli{at}

Leach highlights that access to appropriate nutrition and hydration is still largely unmet in healthcare facilities in the UK.1 This is amazing, not only for ethical reasons, but also because of the dramatic effect of malnutrition and dehydration on outcomes and healthcare costs.1

The results of Krumholz’s study on the post-hospital syndrome pointed in the same direction: most patients discharged from hospital have a high risk of complications, which can lead to readmission.2 A detrimental role is played by malnutrition,2 an insidious and costly comorbidity.3 The average cost of hospital admission is 24% higher for malnourished patients and the risk of readmission within 15 days is increased by 60%.3

Malnutrition has a complex pathophysiology, in which altered metabolism, anorexia, and decreased food intake play a role.4 Recent data indicate that decreased food intake and malnutrition are independently associated with inhospital mortality and readmissions.3 5

Why is this prevalent comorbidity commonly neglected, despite its detrimental effects on outcomes and healthcare costs? One possible answer is that malnutrition is not yet recognised as a clinical risk factor because of insufficient knowledge about nutrition. Alternatively, given its pathophysiological complexity, phenotypic variability, and lack of simple diagnostic criteria, malnutrition may not be recognised at all.

Strategies proposed to mitigate post-hospital syndrome and its accompanying risks include promoting good nutrition and hydration and rectifying nutritional deficiencies.1 2 This goal will be achieved only if early recognition and treatment of malnutrition become an integral part of good clinical practice.

Unmasking the hidden killer represented by malnutrition will not only reduce healthcare costs but, above all, will improve patients’ vulnerability and quality of life.


Cite this as: BMJ 2013;346:f1547


  • Competing interests: None declared.


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