Intended for healthcare professionals


Nutrition and fluid balance must be taken seriously

BMJ 2013; 346 doi: (Published 08 February 2013) Cite this as: BMJ 2013;346:f801
  1. Richard M Leach, chair, Royal College of Physicians nutrition committee1,
  2. Ailsa Brotherton, honorary secretary, British Association for Parenteral and Enteral Nutrition 2,
  3. Michael Stroud, chair, NICE fluid guideline committee3,
  4. Richard Thompson, president 4
  1. 1Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2NHS Quest, Salford Royal NHS Foundation Trust, Salford, UK
  3. 3Gastroenterology and Nutrition, Southampton University Hospitals NHS Trust, Southampton, UK
  4. 4Royal College of Physicians, London, UK
  1. Correspondence to: R M Leach richard.leach{at}
  • Accepted 1 December 2012

Richard Leach and colleagues explain why ensuring adequate nutrition and hydration makes both clinical and financial sense and requires the attention of everyone involved in healthcare

Provision of appropriate nutrition and hydration is a hallmark of compassionate care but is often neglected in all types of healthcare.1 2 3 4 5 These problems are not new and have been reported in the medical literature for nearly four decades.6 7 The consequences are clinically and financially costly. The estimated excess UK health related costs of malnutrition are at least £13bn (€15bn; $20bn) annually.1

Patients with malnutrition have a deficit of energy, protein, vitamins, or minerals, and this has measurable adverse effects on the body.2 Those at risk include patients with poor intake or appetite, dysphagia, chronic disease, or poor functional and social or cognitive ability. Defining adequate hydration is complex. It is estimated by the synthesis of clinical indicators (such as confusion, tachycardia, blood pressure, and thirst), serum biochemistry (such as urea and creatinine), tissue perfusion markers (such as urine output, lactate levels), and urine specific gravity. We examine the scale of malnutrition and poor hydration in our hospitals and communities, explain why it matters, and put forward proposals for change.

Big problem with bad press

The UK national nutrition surveys estimate that over three million people are either malnourished or at risk of malnutrition, of whom more than 90%, or 2.7 million, are cared for in the community (box 1).1 2 3 5 8 One in three patients admitted to hospital or a care home, and one in five of those admitted to mental health facilities were malnourished or at risk of malnutrition, according to four national surveys (31 646 people admitted to hospital, 3404 to care homes, and 1206 to mental health facilities).8 Nutritional status often declines further after …

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