Malnutrition Awareness Week™ October 4–8, 2021
In recognition of Malnutrition Awareness Week¹, the Office of Nutrition Research (ONR) is highlighting a few of NIH’s ongoing activities in Malnutrition. These include malnutrition in clinical and other settings along with some of the underlying causes of malnutrition such as hunger, nutrition insecurity and nutrition disparities—which includes, but is not limited to access to healthy food. Good nutrition is essential for healthy development and basic survival, but it is also integral to well-being, disease prevention and treatment. Health conditions linked to poor diet constitute the most frequent and preventable causes of death in the United States and are major drivers of health care costs, estimated in the hundreds of billions of dollars annually.² Approximately 7 percent of non-maternal and non-neonatal inpatient stays in the United States are for patients with malnutrition (e.g., undernutrition).³ Malnutrition among hospitalized patients remains a serious issue affecting more than 30 percent of hospitalized patients in the United States.³ It is associated with high mortality and morbidity, functional decline, prolonged hospital stays, and increased health care costs.⁴ Finally, where we live or how much money we earn can affect our ability to access or afford healthy food choices. Ensuring food security and access to healthy food are key to preventing disparities in a variety of diet-related diseases and conditions, such as cardiovascular disease, obesity, diabetes, and cancer. Levels of hunger, worsened by the COVID-19 pandemic, are increasing – fueled by a weak supply chain that restricts access of nutritious food to underserved populations. The result is a rising incidence of nutrition insecurity, which like hunger, stems from many factors beyond food and aligns with lack of access to life-enhancing resources.⁵,⁶
Malnutrition in Clinical Settings and Community Settings
As many as 80 percent of people with cancer experience malnutrition, a condition caused by not getting the right balance of calories or nutrients. Malnutrition can interfere with cancer treatment and increase the risk of complications, hospitalizations, and death. The National Institute on Aging (NIA), Eunice Kennedy Shriver National Institute on Child Health and Human Development (NICHD), National Cancer Institute (NCI), and the ONR, are working with the Office of Disease Prevention (ODP) to develop a Pathways to Prevention workshop (P2P) to be held in the Summer 2022 to assess the scientific evidence on how nutritional interventions affect cancer health outcomes and identify future research priorities to move the field forward.
ONR’s Medical Nutrition Implementation Working Group is collaborating with the American Society for Nutrition’s Medical Nutrition Council, the American Society of Parenteral and Enteral Nutrition, and the Academy of Nutrition and Dietetics on a virtual workshop to identify research gaps and opportunities to address malnutrition in clinical settings. This workshop is planned for the Summer of 2022 and will dovetail with the P2P workshop and a recent Agency for Healthcare Research and Quality (ARHQ) systematic review “Malnutrition In Hospitalized Adults.”
The Office of Dietary Supplements (ODS) has collaborated with outside researchers to identify malnutrition in clinical and community setting and screening measures for national surveys that collect data on older adults and health ⁷,⁸, and conducted a survey on dietetic professionals to understand how often they use certain screening tools in practice.⁹
ODS is coordinating efforts to assess state/territorial plans on aging for Older Americans Act programs to determine if they mention conditions like malnutrition, frailty and sarcopenia. The goal is to make sure these important conditions are incorporated as part of measurable goals/objectives, defined strategies/actions, and outcomes in these state/territorial plans on aging. A manuscript has been submitted for peer review to a journal for publication.
Malnutrition in Adolescents, Children, and Pregnancy
The NICHD is organizing a comprehensive project to assess malnutrition in populations of interest to NICHD. The project, “Assessing Determinants of Malnutrition and Implications for Treatment – The ADMIT Project”, will be conducted in two phases. Phase 1 of ADMIT will address the current state of our understanding of how to best assess the existence and implications of malnutrition, and to develop a process to support the clinical care community’s efforts to define and diagnose malnutrition and to identify its consequences in clinical settings. Phase 2 will provide an opportunity for the stakeholder community input on how best to translate and implement those outputs.
The NICHD is also organizing a project entitled “Biomarkers of Nutrition for Development – Knowledge Indicating Dietary Sufficiency – The BOND-KIDS Project” to better understand the nutritional ecology of school-aged children. The primary objective of BOND-KIDS is to examine the relationships among developing school-aged child and their internal (biological, nutritional, and developmental) and external (diet, socio-demographic, and physical) environments to develop, support, and evaluate efforts to meet nutritional needs and optimize outcomes in children.
Hunger, Nutrition Security, and Nutrition Disparities
The ONR, in collaboration with the NCI, National Heart Lung and Blood Institute (NHLBI), National Institute on Minority Health and Health Disparities (NIMHD), National Institute on Nursing Research (NINR), ODP, Centers for Disease Control and Prevention (CDC), and the United States Department of Agriculture (USDA), convened a virtual workshop entitled, “Food Insecurity, Neighborhood Food Environment, and Nutrition Health Disparities: State of the Science” on September 21-23 to review the state of the science, identify research gaps and opportunities related to food insecurity and the neighborhood food environment, and suggest innovative research strategies that will inform policy and practice to address and prevent diet-related health disparities and promote health equity. The content from this workshop is accessible online for up to 1 year for those who register at no cost. ONR has also published a request for information (RFI): Research Opportunities to End Hunger, Food and Nutrition Insecurity that solicits input from a broad array of stakeholder communities to provide input on strategies to advance nutrition science, improve coordination of federal food and nutrition policy, along with tactics to integrate nutrition with healthcare.
For more information please contact nutritionresearch@nih.gov.
Footnotes
¹Malnutrition Awareness Week is a trademark of the American Society for Parenteral and Enteral Nutrition.
²https://www.cdc.gov/chronicdisease/about/costs/index.htm
³Weiss AJ, Fingar KR, Barrett ML, Elixhauser A, Steiner CA, Guenter P, et al. Characteristics of Hospital Stays Involving Malnutrition, 2013. HCUP Statistical Brief #210. September 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb210-Malnutrition-Hospital-Stays-2013.pdf
⁴Corkins MR, Guenter P, DiMaria-Ghalili RA, et al. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr. 2014 Feb;38(2):186-95.
⁵Pereira MHQ, Pereira MLAS, Campos GC, Molina MCB. Food insecurity and nutritional status among older adults: a systematic review. Nutr Rev. 2021 Aug 2:nuab044.
⁶https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/SDOH-workbook.pdf
⁷Dwyer JT, Gahche JJ, Weiler M, Arensberg MB. Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps. J Community Health. 2019.
⁸Gahche JJ, Arensberg MB, Weiler M, Dwyer JT. Opportunities for Adding Undernutrition and Frailty Screening Measures in US National Surveys. Advances in Nutrition. 2021.
⁹Weiler M, Arensberg M, Paul M, et al. Malnutrition and Frailty Screening in Older Adults: Challenges and Opportunities for Dietetic Professionals. Nutrition Today. 2020;55:244-253.