Hospital: Malnutrition in the hospital makes healing difficult

Martin Rücker*

Every fourth patient in hospitals is considered malnourished, that is, not necessarily underweight, but critically deficient in such important nutrients as proteins, vitamins and minerals. In cancer medicine, this proportion is even higher. A few years ago, American oncologist Declan Walsh complained that malnutrition is the “elephant in the room.”

Everyone sees that he is there, but no one cares about him. The far-reaching consequences have been well studied: malnourished patients stay in hospital longer than those who are well-nourished, have more complications and are at higher risk of death. Up to 20 percent of cancer patients who died were not caused by cancer, but by the effects of malnutrition.

According to expert medical societies, cancer patients are exposed to unnecessary risk if they are given the wrong food in hospitals. The warnings are growing louder, but so far they have not been heard in many institutions, a survey of German university hospitals found.

As a precaution, clinics do without large amounts of food

The background is a discussion about the concept of low-microbial food. For a long time, this has been standard for patients undergoing chemotherapy or stem cell transplants: to protect immunocompromised people from foodborne infections, fungal spores or bacteria such as salmonella. should be avoided at all costs. Many clinics not only rely on prolonged heating, but also avoid numerous foods that are considered susceptible to bacterial contamination, including raw meats, as well as nuts and many fresh fruits and vegetables.

But good intentions are not automatically good. Since studies have found no evidence of a reduced risk of infection compared to standard hospital food, science has clearly moved away from this concept. “Anyone who still relies on a low-microbial diet is moving into the field of alternative medicine,” says Jutta Hübner, professor at Jena University Hospital and chair of the German Cancer Society’s (DKG) Working Group on Preventive and Integrative Medicine in Oncology. ).

Moreover, according to experts, neglected nutrition even causes considerable damage. A few weeks ago, the Cancer Society, along with other specialist societies and associations, issued an urgent warning against a low-germ diet.

According to the statement, it brings “no benefit but significant risk” to cancer patients, and is a “substantial mistreatment” of those affected.

With this knowledge, missing out on many nutritious and delicious foods can backfire as it contributes to malnutrition. This is how professional communities justify the promoted shift away from low-microbial diets. In 2021, the Robert Koch Institute also warned that “such a diet significantly affects the quality of life of patients.”

However, this knowledge has not yet reached many clinics, even flagship university hospitals. When asked, twelve of the 38 German university hospitals did not provide any information about their nutrition. Of the 26 institutions that were willing to provide information, some also did not respond to specific questions. At least 17 of the 26 hospitals said they would continue to routinely provide low-germ foods to patients undergoing chemotherapy or stem cell therapy.

Much has been left behind at the Dresden University Hospital

University Hospital Dresden also recognizes that there is a need to catch up. Upon request, a long list of foods to avoid for patients undergoing stem cell therapy is first provided, including lettuce, tomatoes, fresh mushrooms, berries, herbs, unfiltered tap water, fast food, and more. However, in one of the interviews, the director of the clinic, Martin Bornhauser, head of hematology and oncology, explains that this standard is outdated.

Instead of giving it up completely, the clinic now recommends a “normal mixed diet.” Internal guidance, updated in July 2021 and available to this newspaper, states that professional “rules of good nutrition” should be followed “as far as possible”, as well as particularly good kitchen hygiene.

Therefore, the advice to avoid still applies to foods such as raw fish, raw dairy products, certain types of cheese, nuts, muesli mixes, wholemeal bread and honey. That list will also be reviewed again starting in 2023, Bornhauser says. He thinks it is right to say goodbye to avoiding many foods, but admits that the abandonment of outdated standards is not yet complete: “The evidence is there, but some customs are slowly being destroyed,” says the chief physician.

A second area of ​​nutrition management in Dresden is also not yet adapted to the current state of research: screening. According to medical guidelines, all patients with tumors should be evaluated for the risk of malnutrition, so that they can then, if necessary, take targeted therapeutic measures. According to Bornheuser, the nutritional status of all cancer patients who are treated inpatients is already being investigated today, but not those who are treated on an outpatient basis.

Now, only one in two is screened here. “We’re constantly working to increase that number,” says Bornhauser. In addition, a senior dietitian team should be established to provide targeted patient care. Medical societies have been demanding this for a long time.

A large Swiss study involving 2,000 patients was able to impressively demonstrate the effect of such measures. Published in the specialist journal The Lancet in 2019, it proved that teams of nutritionists with a diet adapted to individual needs can improve the chances of recovery, shorten the time of suffering and increase the chances of survival.

Study participants came to the clinic with cancer and other serious illnesses and had signs of malnutrition.

Half received regular hospital food, for the second group nutritionists adjusted the food to their needs and advised the patients. The difference was significant: After 30 days, people who received the dietary therapy had fewer complications and a 35 percent lower risk of death compared to those who received the standard hospital diet. Other studies have confirmed such positive effects of diet therapy.

Malnutrition in clinics is a “current” problem

In 2019, the German Nutrition Society tried to bring the topic of malnutrition in hospitals to public discussion. It’s a “major health problem” with “serious consequences,” she warned, noting that most malnourished patients are not even recognized in clinics, let alone cared for by nutritionists or nutritionists.

According to estimates, there are at most such teams in every tenth hospital in Germany, and the number of nutritionist positions has been decreasing for years. But, despite all the warnings, this issue is not on the political agenda. The coalition agreement of the “Svitlofor” alliance does not mention this at all.

In 2003, everything was different. Then the Council of Europe, with the participation of the German federal government, adopted a resolution calling the number of malnourished hospital patients “unacceptable”. He included a long list of highly recommended courses of action. What has happened to it in the nearly 20 years since the resolution? The Federal Ministry of Health “does not know” about this.

  • *Until the end of 2020, the author was the managing director of Foodwatch and has since been working as a freelance journalist and author.

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