Prevalence of malnutrition in The Netherlands

The prevalence of malnutrition is high in all sectors of the Dutch healthcare system. On average, one in four or five patients in hospitals, healthcare institutions and home care is malnourished. Risk groups for malnutrition are vulnerable elderly, chronically ill patients, oncological patients, patients who have undergone major surgery (or are about to undergo it), and patients with a major physical injury. When interpreting prevalence figures, we must realise that they are based on different sets of criteria. The criteria used are presented in the figures below.

Residential care

Since 2004 the prevalence of malnutrition in the Netherlands has been measured annually as part of the National Prevalence Measurement of Care Problems (LPZ, figure 1). In the residential, care and welfare institutions (nursing and retirement homes), the prevalence of malnutrition has varied between 15% and 20% in the past few years.

Figure 1 – Prevalence of malnutrition in the Netherlands in 2004-2015, LPZ (home care, residential, care and welfare institutions)

Criteria used: A client is malnourished if he or she meets one of the following two criteria: BMI (Body Mass Index) less than 18.5 (clients aged 65 years plus BMI ≤ 20.0); unintentional weight loss exceeding 6 kg in the last 6 months or exceeding 3 kg in the last month. (1)

Hospital

In 2016 the Malnutrition Steering Group and the Dutch Association of Dietitians (NVD) analysed the screening results (SNAQ and MUST) upon admission of 564,063 patients from 13 hospitals in the period 2007 to 2015. On the first day of admission, the screening outcome revealed 14 – 15% of the patients were “malnourished”. This percentage varied according to medical specialism from 2% to 38%. The prevalence of the screening outcome “malnourished” was highest among patients from the specialisms geriatrics (38%), oncology (33%), gastroenterology (27%) and internal medicine (27%) (figure 2). (2)

Figure 2 – Prevalence upon hospital admission of screening outcome malnourished by medical specialism. Criteria used: SNAQ and MUST score malnourished (2)

Children

The prevalence of malnutrition in children upon admission to the hospital in Europe and the Unites States was 6 –  14%, whereas in the Netherlands is was about 10% and increased to 19% during hospitalization (3). At present, no prevalence data for malnutrition among children in primary care is available.

Primary care

The prevalence of malnutrition in the home situation has hardly been examined. In a study from 2012 of a large group of community-dwelling elderly, 30-40% of those with home care had a red SNAQ65+ score (screening outcome malnourished). Among community-dwelling elderly who visited their GP for a flu shot and community-dwelling elderly in the LASA cohort (Longitudinal Aging Study Amsterdam), the prevalence of a red SNAQ65+ score (screening outcome malnourished) rose with increasing age to a prevalence of 20% in the oldest age group. (4)

 

Figure 3 – Screening outcome malnourished according to SNAQ65+ Home care n=814, GP practice n=1878, Longitudinal Aging Study Amsterdam (LASA) n=1267

Criterion used: SNAQ65+ score malnourished (red) (3)

 

  1. Halfens RJG, E. Meesterberends, JCL N, AALM, Rondas, S, Rijcken, S, Wolters JS. Landelijke prevalentiemeting zorgproblemen: Rapportage resultaten 2015. Maastricht: Universiteit. 2015.
  2. Kruizenga H, van Keeken S, Weijs P, Bastiaanse L, Beijer S, Huisman-de Waal G, et al. Undernutrition screening survey in 564,063 patients: patients with a positive undernutrition screening score stay in hospital 1.4 d longer. Am J Clin Nutr. 2016;103(4)(Apr):1026–32.
  3. Joosten KF, Zwart H, Hop WC, Hulst JM. National malnutrition screening days in hospitalised children in The Netherlands. Arch Dis Child 95:141-5, 2010.
  4. Schilp J, Kruizenga HM, Wijnhoven HAH, Leistra E, Evers AM, van Binsbergen JJ, et al. High prevalence of undernutrition in Dutch community-dwelling older individuals. Nutrition. 28(11–12):1151–6.