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Increase in malnutrition among patients entering hospital

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Increase in malnutrition among patients entering hospital

Patient nutrition now better managed within hospitals

Mandatory malnutrition screening should be extended to all oncology settings

More than a third of patients are malnourished when being admitted to hospitals in Ireland and the level is increasing – according to a new survey being launched today by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN).

The survey carried out in November 2023 with data from 3,662 patients across 26 public hospitals in Ireland found an increase in hospital admission malnutrition to 34%, compared to previous surveys in 2011 (32%) and 2010 (28%).

However, it also found a significantly reduced rate of malnutrition in patients in long stay or rehabilitation wards, 21% compared to 36% on all other wards, and also in those admitted from other hospitals rather than from home at 26% compared to 35%.

This showed that mandatory national malnutrition screening and treatment protocols introduced in public hospitals in 2020 are working.

Launching the National Malnutrition Screening Survey 2023, IrSPEN is calling for malnutrition screening to be expanded to other clinical settings such as in outpatients, daycare and primary care settings, particularly for cancer patients and frail older people.

Report Co-author and IrSPEN Director Niamh Rice said the survey identified two major reasons for the rise in patients with risk factors for malnutrition: “The first is an increase in the age demographic of patients presenting at hospitals, with older people more likely to be malnourished and secondly a higher incidence of cancer, resulting in more cancer patients within the general hospital population (22% in November 2023 versus 16% in 2011), with this patient cohort also more likely to suffer nutritional problems resulting in malnutrition.

“The level of malnutrition presenting at our public hospitals remains too high and some is preventable if we pay more attention to improving the nutritional status of patients in the community. We need to expand screening and treatment for malnutrition to all settings where cancer patients receive care, particularly in day wards where they receive systemic anti-cancer therapy (SACT), to facilitate rapid access to specialist cancer dietitians, of whom we have just a handful across the country.

“A secondary recommendation is to resource an expansion of targeted malnutrition screening and treatment for older people living with frailty, particularly those living alone and requiring home care support.

“These patients typically present to their GP and to hospital emergency departments more frequently, and at significant cost to the healthcare system, due to falls and an increasing need for care. In many cases, loss of muscle due to increased nutritional requirements or poor dietary intake – malnutrition – is a key factor resulting in poorer quality of life, increasing frailty and an increased healthcare costs.”

IrSPEN has also today made a 2025 pre-budget submission on these recommendations – calling for additional malnutrition interventions to be supported and funded.

Meaning of malnutrition

Co-Author and King’s College London Lecturer & Cancer Research Dietitian Dr. Erin Stella Sullivan RD, said there is also a lot of confusion regarding what malnourished means, which she knows first-hand from supporting patients with cancer.  

“It is often incorrectly thought of as meaning being underweight or ‘skinny’. However, if patients are not eating what they need during illness, muscle is broken down in an attempt to keep the tissues supplied with the protein building blocks needed to keep everything functioning normally. This happens even if patients have higher BMI and can even be hidden in those cases.

“The effect of a screening and treatment programme is that patients who are losing weight or failing to eat sufficient protein, energy or other nutrients, which are typically required in higher amounts during illness – are identified early, so that appropriate nutritional supplementation or support can be provided.

“The impact of an improved nutritional status is significant health gain for these patients – improving their resilience, ability to complete treatment courses and enhancing their quality of life. There are also benefits to the healthcare system as healthier, stronger patients, have fewer complications and better outcomes.”

Screening works

A welcome finding in the survey is significantly lower rates of malnutrition in hospital long-stay patients (21% in 2023 compared 35% in 2011), pointing to the impact of mandatory malnutrition screening and treatment protocol in all public hospitals, following introduction of National Clinical Guideline 22 in 2020.

Ms Rice said: “Thankfully this points to Ireland bucking the international trend of worsening nutritional status within hospital patients. We need to build on this positive impact and expand it into other settings targeting those which the survey has identified as most at risk.”

Further survey details:

  1. Older people now represent 15.6% of our population, at 806,300 over 65s in 2023, an increase of 50% since 2011, when the last survey of malnutrition in hospitals was conducted. This upward shift in median age of the inpatient population, explains the higher prevalence of malnutrition in those entering the hospital system, since old age is an independent risk factor for disease related malnutrition.

  1. The higher proportion of patients reported to have cancer (one in five in the survey) is also a significant contributor to malnutrition rates on entry into hospital, with the risk of malnutrition detected in 44% of those with cancer, versus 30% of those without, irrespective of age.

  1. Lower rates of malnutrition in those admitted from other hospitals and in rehabilitation or long stay hospitals is very positive and reflects improvements in nutritional care, from earlier detection on point of entry into the hospitals due to screening and better follow through with appropriate nutrition support (from oral nutrition support to tube feeding or even intravenous / parenteral nutrition where needed).

The survey was carried out by IrSPEN with the support of the Irish Nutrition and Dietetic Institute (INDI) which is the professional organisation for registered dietitians in Ireland. The National Malnutrition Screening Survey Republic of Ireland 2023 is available to view HERE


INDI Statement of Values 2024

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The Irish Nutrition and Dietetic Institute (INDI) is the nationally recognised independent professional association for over 900 registered dietitians/ dietetic students in Ireland. INDI restructured in 2013 to transition  from an organisation that was volunteer run to a more business structure. This provides oversight, governance and accountability via the INDI Board.  At that time, we took the decision to not accept sponsorship of any kind, including funds, from companies who manufacture commercial foods that are high in sugar, salt and fat. 

Regulated Profession

Dietetics became a regulated profession here in Ireland in 2014 and are Dietitians are the only profession regulated to give nutrition advice to patients and the public. To ensure that we maintain the high standards of ethical and professional conduct expected of registered dietitians, we in INDI have further limited commercial activities over the last decade.

Commercial Relationships

Since 2017 we only engage with companies who employ registered dietitians and registered nutritionists, and we operate under very strict criteria. Our current partners for 2024 are Abbott Nutrition, Fresenius Kabi, National Dairy Council, Nutricia Advanced Medical and safefood. This was a decision taken by the dietetic profession in Ireland who then supported INDI by paying higher membership fees to mitigate the shortfall of company sponsorship funds. The INDI have no investments or stocks/shares and no commercial relationships with any food companies.  

Conflict of Interest

In 2018 we updated our Code of Practice and we go further than the statutory regulators code and are more restrictive in terms of conflict of interest.  We clearly state that all information given to the public must be evidence based and that no dietitian should “endorse a product purely for reasons of personal or commercial benefit”.  Acceptance and observation of the provisions of the Code are a condition of membership of the INDI.

Trusted Source of Information

Our Code also stipulates that advice given by dietitians should be “balanced and unbiased.” INDI does not engage in promotion of branded products. Any advertising in our professional journal is compliant with the standards set by the Food Safety Authority of Ireland, 'Guidance for Foods governed under Regulation (EU) No 609/2013'. INDI employs a part-time registered dietitian who does not undertake any commercial work as a media spokesperson. This helps to ensure the integrity of and trust in the information coming from the profession.

We have worked hard in the INDI over the last decade to advocate for the recognition of dietitians as the experts in nutrition.  We have had success with numerous dietitians now volunteering on and contributing to national clinical programmes and health policy in Ireland and beyond.

Into the Future 

INDI looks forward to hosting The 20th International Congress of Nutrition and Dietetics in Dublin in 2028. Our theme is Food, Integrity and Sustainability  and our conference partners will reflect  this theme and our organisational values. When ICND2024 concludes in Canada on 15th June 2024, we will launch our ICND2028 expression of interest website and further information on themes and details will be available.


Renal Nutrition Course 2

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We are delighted to announce that Renal Nutrition Course 2: Chronic Kidney Disease (CKD) Stages 3b to 5 (not on kidney replacement therapy)is now open.  This course has been developed to build on the foundation knowledge you received in RIG course 1 or equivalent. Couse 2 will provide you with knowledge from both a medical and nutritional perspective and how to incorporate into overall care plans with co-existing comorbidities. 

Course content has been developed by nephrologists and dietitians specialising in nephrology. This online course will be available to participants on demand for a period of 10 weeks from log in date and will be complemented with an interactive live workshop on completion of the online component. 

In order to get the most out of this course we strongly recommend that you have completed course 1, or a similar renal nutrition course, before progressing to course 2 and likewise for course 3.

What is the aim of the course?

To educate the Dietitian regarding the appropriate medical and dietetic management of patients with Chronic Kidney Disease (Stages 3b to 5, not on kidney replacement therapy). 

Who is this course suitable for?

Dietitians in general, as well as those working in the area of  community dietetics, endocrinology, cardiology and care of the older person.

Dietitians working in the area of nephrology or dietitians with an interest in this area.

How long will it take to complete the course? 

The course consists of 7 modules (including medical and nursing management, nutrition assessment and how to prescribe and educate on energy, protein, potassium, and phosphate requirements as well as diabetes and mineral bone disorder management). Also included, a comprehensive range of supportive resources and a post course assessment. It takes approximately 8 hrs to complete the online component and we would recommend that you assign one to two hrs per week over 4-6 weeks to complete this. 

How much does the course cost? 

The course is competitively priced at €200 for INDI members and €300 for non-members.

Reduced group rate also available: for 3 or more simultaneous registrations within the same department, 

A 15% reduction for INDI members (€170) & 10% reduction to non-INDI members (€270).

Manual registrations available also, please request a registration form from" data-outlook-id="4983dfca-e81c-4d64-82e9-a62f105afd6b">

When will the live interactive workshops be available?

Once you have registered for the online course you will receive your date for the next available interactive live workshop (2.5 – 3 hours) after your online access period has elapsed. It is recommended to print module handouts from the online course so that they are available to you for the interactive workshop.

The next interactive live workshop will be on Friday 20th September 9.30-12.30.

Will I get a certificate of completion when I do the course? 

A certificate will be available to you on completion of all online modules and the post course assessment as well as on completion of your interactive live workshop.


**NEW** Patient Guide for Living with Arthritis

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A new guide for patients living with arthritis is now available on Arthritis Ireland's website. Covering exercise, stress, nutrition, sleep, goal setting, sleep and an overall lifestyle medicine approach this will be a very useful guide to dip into for patients and carers alike.

The booklet was produced by Nurse specialist Una Martin and supported by INDI, RCSI, University Hospital Waterford, IRNF and Arthritis ireland.

Click on the link below to download your copy.

Living Your Best Life with Arthritis

REGISTRATION NOW OPEN for the 9th INDI Fresenius Kabi Research Symposium

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Click Here For Registration Form

The 9th Annual INDI Fresenius Kabi research Event will take place on Wednesday 20th March.

Call for Abstracts now open! Closing date January 19th!

Upload your abstract using the following link: CLICK HERE TO UPLOAD YOUR ABSTRACT

Nominations are also open for research Dietitian of the Year and Research & Quality Improvement in Dietetic Practice Award. Get your nominations in soon using the nomination forms below.

More T

MheM9th Annual INDI Fresenius Kabi Research Symposium will take place onhursday 20th March 2024



NEW Vitamin D Resources

Vitamin D Supplements

The Department of Health, in association with Healthy Ireland and with support from FSAI, safefood and the INDI has launched new guidance on Vitamin D supplements. The resources include a flyer for the general public and posters and reference sheets for Pharmacies, GP surgeries and clinics. The new resources can be viewed at the links below.