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Mangelernährung in Deutschland: unbeachtet, unbehandelt, gefährlich

Malnutrition is something many people associate with conditions in developing countries. But it is also widespread in Germany, especially in clinics. Experts talk about a scandal over German hospital food.

Every fourth or fifth person hospitalized in this country suffers from malnutrition. Mostly elderly people, cancer patients or patients with certain gastroenterological diseases suffer. Such malnutrition negatively affects the prognosis of diseases, increases the frequency of complications, length of stay and, as a result, costs. However, in Germany, patients are not systematically screened for malnutrition upon admission to the hospital, and hospitals do not have standard nutrition groups.

To make matters worse, clinic meals exacerbate the problem even further. Experts from the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) speak of the scandal over long-unnoticed conditions – and finally call for effective measures.

Many triggers, few decisions

There are many causes of malnutrition: very old or seriously ill people often suffer from loss of appetite. Degenerative diseases such as dementia are also the cause of insufficient or one-sided food intake. Nursing homes usually do not have enough staff to help people with cognitive or physical impairments to eat.

“If victims are admitted to a clinic with illness, malnutrition is not routinely considered an important prognostic factor in this country—it often goes unnoticed and is exacerbated by nutrition and clinical processes,” says Dr. Birgit Terjung, DGVS Advisory Board Member and Chief Physician for Internal Medicine/Gastroenterology at GFO Kliniken Bonn. Food in the hospital is usually inexpensive, low in germs, and not very tasty, and many patients reject it. According to annual systematic surveys with data from hospital wards and treatment facilities, only about a third of patients ate a full meal.

Malnutrition is expensive

Malnutrition has painful and costly consequences: those affected are at higher risk of complications such as infections or bedsores. According to studies, the length of stay in the hospital of malnourished patients increases by 2.4–7.2 days. The readmission rate is also higher. The result: higher costs per patient.

“Measures to prevent and treat malnutrition, such as better quality hospital meals tailored to the needs of patients and trained staff, are not properly paid for in the DRG system and are therefore usually kept in hospitals,” says Professor Thomas Freeling, Chief Medical Officer. Medical Clinic II of the Helios Krefeld Clinic. “But: the staff and costs that are saved at this stage end up leading to higher costs due to complications and longer treatment – ​​an absurd and unbearable situation.”

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Therefore, experts who face the consequences of malnutrition in the hospital every day call for concrete measures:

  • Structures for regular monitoring of the nutritional status of patients should become standard in all clinics. The so-called Krefeld model can provide an orientation in which awareness raising and employee training are combined with mandatory office instructions.
  • Greater accessibility of personnel trained in nutritional medicine should be made available. According to the 14th DGE Nutrition Report (2018), only ten percent of German clinics and 30 percent of nursing homes have a nutritionist in their department, in other participating European countries these figures were 63 and 86 percent respectively. In Germany, 58 per cent of clinics and 45 per cent of nursing home accommodations in Germany had a nutritionist or nutrition contact, in Europe the figures were 82 and 71 per cent, respectively.
  • The prevention and treatment of malnutrition, including through high-quality hospital food and medical staff, must finally be given due consideration in the health system’s reimbursement system.

“Currently, it is not yet clear to many health policy experts whether diet therapy can, in a simple and inexpensive way, save lives, reduce suffering, and save huge costs in the health care system,” Freeling says. Terjung adds: “For many years, the professional communities have pointed out the problem that arises from the unnoticed and unresolved problem of malnutrition – here, finally, action is needed. Other European countries are far ahead of us.”

This article is based on Press release in Visceral Medicine 2022.

Image Source: Catalog of thoughts, unsplash

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