Care indicators - Malnutrition


‘Malnutrition’ refers to a physical condition in which the body has a shortage of nutrients, leading to disruption of the body’s biological function. Malnutrition is also described as: ‘a deficiency or imbalance of energy (carbohydrates and fats), protein and other nutrients that causes measurable adverse effects on the body (body shape, size and composition), bodily function and clinical outcome.’(Elia, 2000).

Malnutrition resulting from illness, also known as clinical depletion, can be subdivided into a chronic form (marasmus form), occurring chiefly in patients in long-term care (nursing homes and home care), and an acute form (kwashiorkor form) which occurs chiefly in hospitals. Marasmus involves a physical condition initially characterized by clearly reduced fat mass while retaining the body proteins; however, this is later followed by a reduction of muscle mass. Marasmus may be the consequence both of an insufficient food intake or of a (chronic) disease. The acute form of malnutrition (kwashiorkor = protein malnutrition) is caused by a rapidly occurring lack of protein while sufficient carbohydrates and fats are still available as energy source (Stratton et al. 2003). This form of malnutrition occurs during an acute illness or a major operation. It involves strong and rapid tissue decomposition with the breakdown of many body proteins even if sufficient food is ingested.

Malnutrition is chiefly associated with developing countries and is then mostly a result of poverty or famine. One would not tend to assume that malnutrition also often occurs in Western healthcare institutions. But ever since 2004 the results of the LPZ have shown that malnutrition is and remains a relevant and important problem, in home care, hospitals and long-term care institutions (including nursing homes). In recent years, thanks in part to the LPZ measurements in all types of Dutch care institutions, greater attention has been given to timely flagging and treatment of illness-related malnutrition.

Besides proper treatment of the underlying illness, good and varied nutrition and/or correct nutrition therapy can combat states of malnutrition, support the process of recovery and prevent complications (Stratton et al. 2003). This is important because malnutrition leads to slower recovery from illness. Moreover, it can weaken the body’s immune defences and delay wound healing, for instance after an operation. This can all lead to a negative health spiral with longer admission periods, increased use of drugs, an increase in the complexity of care and a reduction in the quality of life. Moreover, it has been scientifically proven that malnutrition is also an independent risk factor for mortality. So all the more reason to focus and maintain attention on malnutrition in the care sector by means of the LPZ and other national initiatives.

National activities initiated by Vilans in the care sector and by the Malnutrition Steering Group ( in areas such as the cure sector focus on improving malnutrition screening and, linked to this, timely use of appropriate nutrition interventions. These activities also promote the development and implementation of an effective nutrition policy in care organizations, whereby the LPZ can be used as an evaluation and monitoring instrument. The Dutch Healthcare Inspectorate (IGZ) is also keeping an eye on this issue because it wants an annual overview of how things stand regarding the care problem malnutrition. This concerns both the prevalence of malnutrition and the applied nutrition policy.


Ever since 2004 the prevalence of nutrition and the relevant nutrition care quality indicators have been measured in the LPZ. The measurement results give the participating care organizations targeted information on how they can improve their nutrition care.


  • Elia M (2000). Guidelines for detection and management of malnutrition. Malnutrition Advisory Group (MAG), standing committee of BAPEN: Maidenhead.
  • Stratton RJ, Green CJ, Elia M (2003). Disease-related malnutrition: an evidence based approach to treatment. CABI publishing, Cambridge (ISBN: 0851996485).

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