All hospital patients should be routinely screened for malnutrition and offered specialist nutritional support if required, new guidelines say. 

The National Institute for Health and Clinical Excellence (Nice) issued the guidance designed to improve the way the NHS deals with the problem. 

It is thought as many as 40% of hospital patients are at risk. 

A report published in December estimated that malnutrition costs the NHS £7.3bn a year. 

The report, by the British Association for Parenteral and Enteral Nutrition, said this was more than double the annual bill for obesity-related problems. 

Testing for malnutrition is already mandatory in Scotland and Nice is calling for the guidelines to be extended to England and Wales. 

The problem is particularly serious among the elderly. It is thought more than 10% of people aged over 65 are malnourished, and as many at 60% of pensioners who are admitted to hospital. 

Need for support 

The Nice guidelines were developed in collaboration with the National Collaborating Centre for Acute Care. 

They recommend all hospital and care home patients should be weighed and measured on admission, and all outpatients should be similarly checked at their first clinic appointment. 

Checks should be repeated weekly for inpatients, and where there is clinical concern for outpatients, say the guidelines. 

Nice says specialised nutritional support should be considered for people who are malnourished. This is defined as: 

• Having a body mass index (BMI) of less than 18.5. BMI is calculated by dividing your weight in kilograms by your height in metres squared. 

• Unintentional weight loss greater than 10% in the last three to six months.

• a BMI of less than 20 coupled with unintentional weight loss greater than 5% within the last three to six months. 

It also recommends that nutrition support be considered for people at risk of malnutrition - such as those who have eaten little or nothing for more than five days, or who are unable to take in nutrients properly. 

All acute hospitals are advised to employ at least one specialist nutrition support nurse. 

Andrea Sutcliffe, who took the lead role in drawing up the guidelines, said they could save the NHS at least £45m a year. 

Malnourished patients stay in hospital for longer, have a higher mortality rate and are three times as likely to develop complications during surgery. 

She said: "This guideline should help reassure patients and give confidence to their relatives and carers, that all at-risk patients, no matter where they live or what their underlying condition, will now be screened and if necessary offered appropriate nutritional support." 

'Incredibly welcome' 

Dr Mike Stroud, of the Institute of Human Nutrition at the University of Southampton, also worked on the guidance. 

He said: "Ensuring patients receive adequate nutrition is an essential part of basic patient care, yet we know malnutrition is still a big problem for the NHS. 

"The guideline contains one obvious and simple message - do not let your patients starve and when you offer them nutrition support, do so by the safest, simplest, most effective route." 

Shadow Health Secretary Andrew Lansley welcomed the guidance. 

He said: "Far too many patients leave hospital less nourished than when they were admitted. 

"Patients are often unable to feed themselves effectively because of lack of continuity of care and observation failures." 

Dr Lorna Layward, of the charity Help the Aged, said the guidelines were "incredibly welcome". 

"Our preoccupation with obesity means that malnutrition of our most vulnerable members of society has been swept under the carpet." 

EFFECTS OF MALNUTRITION

• Impaired immune responses

• Reduced muscle strength and fatigue

• Increased difficulties in breathing

• Impaired thermoregulation

• Impaired wound healing

• Apathy, depression and self-neglect

• Poor libido