Starvation in hospital Ethically indefensible and expensive
Authors: A Avenell, L George, S Miller, J M Miller, M Lock, V Vald, C Royce, M Taylor, G Mackay
Journal: BMJ (1994)

EDITOR, - John Garrow is right to emphasise the neglect of nutrition in medical practice.1 The provision of a simple nutritional supplement to patients with hip fracture significantly lowers complications and deaths and reduces the length of stay in hospital from a median of 40 to 24 days.2 Poor vitamin C status is associated with the development of pressure sores,3 which prolong the stay in hospital. Even in fit elderly people modest supplementation of vitamins and trace elements significantly reduces the number of days of infectious illness. 4 Not only is nutritional neglect ethically indefensible but better nutrition will save the NHS money: it has been estimated that improved nutrition for hospital inpatients would alone save the NHS £266m a year.5 Nutrition influences every specialty inside and outside the hospital. We already have the nutritional skill of dietitians to call on. For doctors trained in both nutrition and medicine, such as myself, there are no positions within the rigid specialisation of medicine; such doctors have to try to rely on research grants. Much research on nutrition, however, is unappealing to pharmaceutical companies and does not carry the kudos of molecular biology. It is hard not to be tempted by the United States, where clinical nutrition is a specialty in its own right. 1. ↵1. Garrow J .Starvation in hospital.BMJ1994;308: 934. (9 April.) [OpenUrl][1][FREE Full Text][2] 2. ↵1. Delmi M, 2. Rapin C-H, 3. Bengoa J-M, 4. Delmas PD, 5. Vasey H, 6. Bonjour J-P .Dietary supplementation in elderly patients with fractured neck of the femur.Lancet1990;335: 1013–6. [OpenUrl][3][CrossRef][4][PubMed][5][Web of Science][6] 3. ↵1. Goode HF, 2. Burns E, 3. Walker BE .Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture.BMJ1992;305:925–7. 4. ↵1. Chandra RK .Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects.Lancet1992;340: 1124–7. [OpenUrl][7][CrossRef][8][PubMed][9][Web of Science][10] 5. ↵1. Lennard-Jones JE .A positive approach to nutrition as treatment.London: King's Fund,1992. # Screen patients on admission {#article-title-6} EDITOR, - Janet P Mc Whirter and Christopher R Pennington discuss the incidence and recognition of malnutrition in hospital.1 At Seacroft Hospital, Leeds, an audit of nutrition in 1992 yielded similar findings and resulted in measures being taken to improve the recognition of malnutrition. In March 1992 all patients in the medical unit (n=85) were assessed by a senior dietitian, who used a combination of objective measurements and clinical judgment to determine their nutritional status. 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