Reduced appetite with ageing is a key factor that may increase risk of undernutrition. The objective of this study is to determine the impact of innovative plant protein fibre (PPF) products within a personalised optimised diet (PD), a physical activity (PA) programme, and their combination on appetite, and other nutritional, functional and clinical outcomes in community-dwelling older adults in a multi-country randomised controlled intervention trial. One hundred and eighty community-dwelling adults (approximately sixty per trial centre in Germany, Ireland and Italy) aged 65 years and over will be recruited to participate in a 12-week, parallel-group, controlled trial. Participants will be randomised into one of four groups: 1, PD (incorporating two PPF products): 2, PA; 3, PD + PA; and 4, no intervention (control). The primary outcome is appetite measured by visual analogue scales and energy intake from an ad libitum test meal. Secondary outcomes include fasting and postprandial appetite-related gut hormones, Simplified Nutritional Appetite Questionnaire score, body composition, cardiorespiratory fitness, muscle strength, physical function and PA. In addition, self-efficacy, cognitive status, dietary restraint, depressive symptoms and compliance and acceptability of the intervention will be assessed. Metabolomic profiles, RMR, muscle motor unit properties and gut microbiome will also be assessed to explore potential underlying mechanisms. This multi-centre randomised controlled trial will advance knowledge on how PD (incorporating PPF products), PA and their combination influence appetite, nutritional status and related health outcomes in community-dwelling older adults and contribute to the prevention of undernutrition. Trial registration: Clinical Trials.gov Registry NCT05608707 (registered on 2 November 2022). Protocol Version: NCT05608707 Version 4 (registered on 29 September 2023).

Older adults (≥65 years) are the fastest growing population group. Thus, ensuring nutritional well-being of the ‘over-65s’ to optimise health is critically important. Older adults represent a diverse population – some are fit and healthy, others are frail and many live with chronic conditions. Up to 78% of older Irish adults living independently are overweight or obese. The present paper describes how these issues were accommodated into the development of food-based dietary guidelines for older adults living independently in Ireland. Food-based dietary guidelines previously established for the general adult population served as the basis for developing more specific recommendations appropriate for older adults. Published international reports were used to update nutrient intake goals for older adults, and available Irish data on dietary intakes and nutritional status biomarkers were explored from a population-based study (the National Adult Nutrition Survey; NANS) and two longitudinal cohorts: the Trinity-Ulster and Department of Agriculture (TUDA) and the Irish Longitudinal Study on Ageing (TILDA) studies. Nutrients of public health concern were identified for further examination. While most nutrient intake goals were similar to those for the general adult population, other aspects were identified where nutritional concerns of ageing require more specific food-based dietary guidelines. These include, a more protein-dense diet using high-quality protein foods to preserve muscle mass; weight maintenance in overweight or obese older adults with no health issues and, where weight-loss is required, that lean tissue is preserved; the promotion of fortified foods, particularly as a bioavailable source of B vitamins and the need for vitamin D supplementation.

Malnutrition is common among older adults and is associated with a progressive decline in overall health and increased mortality. With a rapidly ageing population, the detection, prevention and management of malnutrition require urgent attention within health service planning and delivery. Routine screening for malnutrition among older adults in community settings, which addresses aetiological as well as phenotypic factors, is considered an important step for prevention and early intervention. The aim of this review is to summarise current malnutrition screening literature and highlight research that seeks to understand and address community-based approaches to malnutrition screening and management. Key healthcare professionals (HCPs) that encounter community-dwelling older adults include general practitioners (GPs), community-based nurses, community pharmacists and a range of other health and social care professionals including dietitians, physiotherapists, speech and language therapists, and occupational therapists. The key barriers to implementing screening in primary care include lack of knowledge about malnutrition among non-dietetic HCPs, lack of resources allocated to managing malnutrition, lack of access to dietetic services, and poor GP knowledge about oral nutritional supplement prescribing. In addition, older adults have poor insight into the clinical condition and the associated negative health implications. Investment in education among HCPs and public awareness is required, as well as accompanying resources to successfully implement malnutrition screening programmes for community-dwelling older adults.

Malnutrition, arising from a deficiency of energy and protein intake, occurs commonly among community-dwelling individuals. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. However, previous research indicates that inappropriate prescribing of ONS occurs frequently in the community setting (30–70% prevalence). Moreover, it has been previously shown that the management of patients ‘at risk’ of malnutrition in the primary care/community setting in Ireland is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals (HCPs). In Ireland, general practitioners (GPs) are the main prescribers of ONS in primary care. They are also on many occasions the first point of contact for individuals in the community who are malnourished or at risk of malnutrition. Therefore, exploring their experiences and perceptions can provide insight into the complexities of managing malnutrition and ONS prescribing in the community. The aim of this qualitative study was to explore GPs’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Semi-structured interviews were conducted with nine GPs. The interview explored among others the following domains; Barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded interviews were transcribed and analysed using inductive thematic analysis. Three main themes were identified; i) Malnutrition a secondary concern, encapsulating the idea that malnutrition is not something that GPs screen for in isolation ii) Resources and support for managing malnutrition are needed in the community iii) Reluctance to prescribe ONS. GPs reported not screening for malnutrition, but viewed it as a consequence of other conditions and social factors. According to the GPs, they should not have sole responsibility for malnutrition management and more dietitians and trained community nurses would be desirable to support them to deal with malnutrition in the community. A preference to avoid supplementation and implement dietary changes first was expressed by GPs. As main prescribers, GPs thought that they should receive further independent trainingon the different ONS available in the market as currently they did not feel confident prescribing a range of them. Awareness of ONS cost and its misuse by certain patients were reported as reasons that made GPs reluctant to prescribe them, potentially leading to under prescribing.

Protein-energy malnutrition, or undernutrition, arising from a deficiency of energy and protein intake, can occur in developed countries both in hospitalised patients and in the primary care/community setting. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. Pooled data of older adults at risk of malnutrition indicate that ONS combined with dietary counselling is the most effective intervention. Previous Irish research has demonstrated that management of patients ‘at risk’ of malnutrition in the primary care/community setting is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals. Therefore, the aim of this qualitative study is to explore community nurses’ and dietitians’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Three focus groups were conducted with primary care dietitians (n = 17) and one focus group with community nurses (n = 5), one of the nurses had prescribing rights. The focus groups explored the following domains; the term malnutrition and patient population presenting as malnourished or at risk of malnutrition, barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded focus groups were transcribed and analysed using inductive thematic analysis. Both professional groups showed similar perspectives, and three preliminary main themes were identified; i) Malnutrition is a misunderstood term, ii) Delayed treatment of malnutrition, iii) Challenges with ONS prescription in the primary care/community setting. Both dietitians and community nurses agreed that the term malnutrition had negative connotations for patients and preferred not to use it with them. Dietitians identified the need for a multidisciplinary approach to manage patients at risk of malnutrition in the community, and community nurses agreed on their pivotal role identifying the risk of malnutrition and providing first line advice to clients. However, community nurses expressed the urgent need for training to provide first line advice to patients to improve their nutritional status to prevent malnutrition. Both groups also agreed on the need for access to more dietitians in the community, and suggested that giving dietitians prescribing rights would improve appropriate ONS prescribing. Community nurses identified a gap in their knowledge of the different ONS products, and the need to receive independent generic education on nutritional supplements.

‘Food sustainability’ is now acknowledged as integral to the achievement of food security, a healthy community and protection of the environment. Understanding consumers’ knowledge of and attitudes towards food sustainability is poorly understood in Ireland. This study aimed to explore the knowledge and attitudes towards food sustainability among visitors to an Irish restaurant, known to prepare foods in a sustainable way. A cross-sectional study was conducted on 426 visitors at the Overends Kitchen, Airfield Estate, Dublin, Ireland using a short questionnaire informed by previously collected data on Irish consumers’ attitudes towards food purchasing and a Department for Environment, Food and Rural Affairs (UK) questionnaire. Information on demographics, food choice motives, food preferences, basic nutritional knowledge, awareness and attitudes toward food sustainability was obtained. Data were analysed using the Statistical Package for Social Science (IBM, v23, Chicago, Ill, USA). Quality (98%) and health (92%) were the most important motives for food choice. Females (P = 0.001) and older (P = 0.029) participants had greater interest in health as a motivating factor for food choice compared to males and those who were younger. Free-range (eggs) and fresh vegetables and fish were most frequently purchased. Poor knowledge of recommendations about saturated fat, and daily fruit and vegetables intakes was demonstrated though this was better in female (P = 0.005) and younger (P = 0.007) participants. Participants demonstrated positive attitudes towards food sustainability and over half (57%) were aware of GLAS principles (Go with the seasons, Local for produce, Avoid food waste, Sustainably produced) although only 37% reported that these principles influence their dietary choices. Misinformation about the environmental sustainability and nutritional value of farmed vs. organic or wild fish and fresh vs. frozen vegetables was apparent. This research provides some understanding of Irish consumers' knowledge and attitudes towards food sustainability. The need to enhance understanding of how diets can be made more sustainable is clear.

The home environment is acknowledged as an important setting that can shape dietary habits in early childhood. For instance, parents influence their children's dietary intakes through the foods they make available to their children, their own eating habits and their parenting practices. The aim of this cross-sectional study was to determine the associations between home environmental characteristics and children's fruit, vegetable and confectionary/sugary drink intakes. A total of 332 children aged 3–5 years old and their parents/guardians participated in the study. Home environmental characteristics, including mealtimes, child television viewing, parental control feeding practices, food availability and accessibility, were explored using questions from validated questionnaires. Parent and child food consumption was also measured. The data were analysed using bivariate and multivariate binary logistic regression. Independent variables (home environment and parental diet) were included in the multivariate analysis if they were significant in the bivariate analysis. An association between household income and children's fruit intake was observed with children from lower income households being 54% less likely to eat fruit daily (95% CI 0.22–0.96, p < 0.040) compared with those from higher income households. Home food availability also influenced children's fruit intake. Greater variety of fruits available in the home increased the likelihood of fruit consumption in children (OR 1.35, 95% CI 1.09–1.68, p < 0.005). Watching television for ≥ 1 hour per day had a negative impact on children's diets, decreasing their probability of eating vegetables on a daily basis (OR 0.38 95% Cl 0.22–0.72, p < 0.003) and increasing by 2.7 times their likelihood of consuming confectionary/sugary drink more than once a week (95% CI 1.11–6.36, p < 0.027). Those children whose parents had lower vegetable consumption and higher confectionary intake were 59% less likely to eat vegetables, and 4.42 times more likely to consume confectionary/sugary drinks (OR 0.41, 95%Cl 0.21–0.82, p < 0.012) and (OR 4.42, 95% CI 1.69–11.59, p < 0.002) respectively. Pressure to eat from parents was associated with lower fruit intake only (OR 0.67, 95% CI 0.47–0.96, p < 0.032). This study has demonstrated that modifiable home environmental characteristics were significantly associated with decreased fruit and vegetable intake and increased confectionary/sugary drink consumption among children aged 3–5 years. These findings may help in the development of intervention strategies to encourage a healthier diet for this age group.

Sarcopenia is a muscle disease rooted in adverse muscle changes that accrue across a lifetime. It is an independent risk factor for numerous adverse health outcomes. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition for the identification of people with sarcopenia (EWGSOP1). In 2018, this definition was updated based on the newest evidence (EWGSOP2), with the focus now on low muscle strength rather than low muscle quantity as the key characteristic of sarcopenia. In addition, EWGSOP2 provides clear cut-off points for measurements of variables that identify sarcopenia. The aim of this study was to determine the prevalence of sarcopenia among community-dwelling older adults in Ireland for the first time and to assess agreement between the EWGSOP1 and EWGSOP2 definitions. In a cross-sectional analysis, 490 community-dwelling adults (age 78.4 ± 8.0 y, body mass index 27.6 ± 5.1 kg/m2) were assessed. Skeletal muscle mass was estimated using bioelectrical impedance analysis, muscle strength was measured via handgrip dynamometry and physical performance via the Short Physical Performance Battery. Sarcopenia was defined according to both the 2010 criteria (EWGSOP1) and the updated 2018 criteria (EWGSOP2). Using the EWGSOP1 criteria, the prevalence of sarcopenia was 7.1% (2.6% sarcopenia, 4.5% severe sarcopenia) and 3.6% were classified as pre-sarcopenic (low muscle mass without a decrement in strength or physical performance). Using the EWGSOP2 criteria, the prevalence of sarcopenia was 5.5% (1.6% sarcopenia, 3.9% severe sarcopenia) and 23.4 % were classified as having low strength but without a decrement in muscle mass. Five of the participants who were classified as sarcopenic (2 sarcopenia, 3 severe sarcopenia) by EWGSOP1 were classified as “normal” using the EWGSOP2 criteria. In conclusion, the prevalence of sarcopenia in community-dwelling older adults in Ireland is in line with the prevalence reported in other European countries using the EWGSOP1 criteria (3.3–11.4 %). To our knowledge this is the first study to compare the prevalence based on the EWGSOP1 and the EWGSOP2 criteria. We report a slightly lower prevalence using the EWGSOP2 definition compared to the EWGSOP1 definition. Importantly however, in contrast to EWGSOP1, the EWGSOP2 definition identified a substantial proportion of older adults with poor strength in the absence of overt sarcopenia (23.4%). These older adults represent a group who would benefit from further clinical investigation and intervention.

Cancer patients experience many diet and nutrition-related problems, which are often under-recognised and under-treated. Research suggests few healthcare professionals discuss dietary information with cancer patients. Consequently, patients may seek information from other sources. It is unknown what these information sources are or what types of advice patients obtain and follow. The aim of this study was to determine the source and type of diet information cancer patients obtain before their first dietetic assessment and the degree to which this is followed. This was a prospective, multi-center, cross-sectional observational study. Ethical approval was obtained for each centre. Consecutive cancer inpatients and outpatients were recruited for six months at seven tertiary centers. Patients were screened for eligibility. Inclusion criteria included solid tumour, over 18 years of age, new dietetic referral and ability to sign consent. Data collection was carried out by a dietitian during initial routine dietetic assessment. Participants were asked four questions about dietary advice since cancer diagnosis. To date, 74 participants (50% female) with a median age 60 (range 23–80) have been recruited. Forty percent reported weight loss of ≥ 5%. The median time from diagnosis to initial dietetic assessment was 3 months (range 0–242). Patients who obtained advice did so from several sources (median 2 sources per patient, range 0–6) prior to dietetic referral. In rank order these were; 1) family or friend (n = 31), 2) health professional (n = 24), 3) online forums or websites (n = 16) and 4) media (n = 14). Twenty-one (28%) had received no dietary advice. The most frequent advice obtained related to avoidance of certain foods; particularly dairy, meat and sugar. Fruit, vegetables, protein, juices and wholegrain were advised. Fifty-one percent followed the advice fully and 4% partially. Seven expressed disappointment at not having a dietetics referral earlier and identified the need for the hospital “to introduce good information early”. In conclusion, the majority of dietary and nutritional advice prior to dietetic referral came from friends, family, media and online forums and websites. Most advice related to the avoidance and/or promotion of particular foods. Cancer patients want dietary advice from dietitians at diagnosis to prevent unnecessary avoidance of certain foods and to reduce the risk of unintentional weight loss.

Horse racing is a unique weight-making sport which requires jockeys to maintain a chronically low body weight throughout an extended racing season. These athletes typically eat one main meal per day when racing and often depend on racecourses for food provision. To date, racecourse catering provision to jockeys in Ireland has not been assessed. The aims of this study were to evaluate food provision at racecourses in Ireland, assess jockeys’ satisfaction with current food provision and to explore key stakeholders’ perceptions of current food provision. An audit tool was used to evaluate current food provision at 25 of the 26 Irish racecourses. The audit was scored out of 44.5 points and each racecourse was categorised as < 50% ‘Requires nutritional guidance from a dietitian/sports nutritionist’, 50–60% ‘Bronze’, 61–75% ‘Silver’, 76–90% ‘Gold’, > 90% ‘Platinum’. Semi-structured interviews were conducted with jockeys (n = 125), racecourse managers (n = 2), racecourse catering managers (n = 2), and race day caterers (n = 1) to establish their perspectives on current food provision. Quantitative data were analysed using SPSS and qualitative data were analysed using thematic analysis. Audit scores ranged from 14.5–27.5. Based on their current food provision, nine racecourses were identified as ‘Requiring nutritional guidance from a dietitian/sports nutritionist’, 13 were categorized as ‘Bronze’ and two as ‘Silver’. Grade 3 racecourses achieved significantly lower audit scores than Grade 1 and 2 racecourses. Jockeys’ satisfaction ratings were positively associated with audit score. The main themes identified by jockeys included hot food, autonomy over food choices, and greater variety of foods. The main themes identified by managerial and catering staff were categorised under two domains, including perceptions of and factors influencing current provision, and barriers to and facilitators for improved provision. Support from a dietitian/sports nutritionist was identified in 22 of the 25 racecourses to improve food provision to support the needs of modern-day jockeys. Recommendations include development of minimum standards for weigh room food provision and basic training for catering staff on healthy, appetizing foods that are conducive to making weight. Guidelines endorsed by the Irish Horse Racing Regulatory Board (IHRB), Horse Racing Ireland (HRI) and the Irish Jockeys Association (IJA) should be developed and food provision at racecourses should be audited regularly. Achievable racecourse-specific interventions should be implemented to improve the provision of food and nutrient delivery to this athlete population.

Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally impacts on health, cognitive and physical functioning and quality of life. Given these negative health outcomes in the context of an ageing global population, the Healthy Diet for a Healthy Life Joint Programming Initiative Malnutrition in the Elderly (MaNuEL) sought to create a knowledge hub on malnutrition in older adults. This review summarises the findings related to the screening and determinants of malnutrition. Based on a scoring system that incorporated validity, parameters used and practicability, recommendations on setting-specific screening tools for use with older adults were made. These are: DETERMINE your health checklist for the community, Nutritional Form for the Elderly for rehabilitation, Short Nutritional Assessment Questionnaire-Residential Care for residential care and Malnutrition Screening Tool or Mini Nutritional Assessment-Short Form for hospitals. A meta-analysis was conducted on six longitudinal studies from MaNuEL partner countries to identify the determinants of malnutrition. Increasing age, unmarried/separated/divorced status (vs. married but not widowed), difficulties walking 100 m or climbing stairs and hospitalisation in the year prior to baseline or during follow-up predicted malnutrition. The sex-specific predictors of malnutrition were explored within The Irish Longitudinal Study of Ageing dataset. For females, cognitive impairment or receiving social support predicted malnutrition. The predictors for males were falling in the previous 2 years, hospitalisation in the past year and self-reported difficulties in climbing stairs. Incorporation of these findings into public health policy and clinical practice would support the early identification and management of malnutrition.

Traditionally only a small proportion of the workforce was engaged in shift work. Changing economic pressures have resulted in increased engagement in shift work, with approximately 17 % of the workforce in Europe engaged in this work pattern. The present narrative review aimed to summarise the data on the effects of shift work on the diet, lifestyle and health of employees, while addressing the barriers to, and opportunities for, improving health among shift workers. Shift work can result in low-quality diet and irregular eating patterns. Adverse health behaviours are also reported; particularly increased smoking and poor sleep patterns. These altered lifestyle habits, in conjunction with disruption to circadian rhythms, can create an unfavourable metabolic phenotype which facilitates the development and progression of chronic disease. Although the data are inconclusive due to issues such as poor study design and inadequate control for confounding factors; shift workers appear to be at increased mental and physical health risk, particularly with regard to non-communicable diseases. Information is lacking on the obstacles to leading a healthier lifestyle while working shifts, and where opportunities lie for intervention and health promotion among this group. In order to provide an informed evidence base to assist shift workers in overcoming associated occupational hazards, this gap must be addressed. This review highlights the unique nutritional issues faced by shift workers, and the subsequent effect on health. In societies already burdened with increased incidence of non-communicable chronic diseases, there is a clear need for education and behaviour change interventions among this group.

A pre-school offering a full-day-care service provides for children aged 0–5 years for more than 4 h/d. Researchers have called for studies that will provide an understanding of nutrition and physical activity practices in this setting. Obesity prevention in pre-schools, through the development of healthy associations with food and health-related practices, has been advocated. While guidelines for the promotion of best nutrition and health-related practice in the early years’ setting exist in a number of jurisdictions, associated regulations have been noted to be poor, with the environment of the child-care facility mainly evaluated for safety. Much cross-sectional research outlines poor nutrition and physical activity practice in this setting. However, there are few published environmental and policy-level interventions targeting the child-care provider with, to our knowledge, no evidence of such interventions in Ireland. The aim of the present paper is to review international guidelines and recommendations relating to health promotion best practice in the pre-school setting: service and resource provision; food service and food availability; and the role and involvement of parents in pre-schools. Intervention programmes and assessment tools available to measure such practice are outlined; and insight is provided into an intervention scheme, formulated from available best practice, that was introduced into the Irish full-day-care pre-school setting.

Protein-energy undernutrition, or the possibility of its development, has been documented to occur frequently in surgical patients admitted to hospital. Nutritional status is known to deteriorate over the course of the hospital stay, with poor awareness by medical and nursing staff as to the deleterious effects of impaired nutritional status on clinical outcome and hospital costs. While there is no consensus on the best method for assessment of the nutritional status of surgical patients pre-operatively, there are a number of techniques available. These techniques can be divided into two types, those suitable for screening for nutrition risk on admission to hospital and those used to fully assess nutritional status. Both techniques have their limitations, but if used correctly, and their limitations recognized, should identify the appropriate degree of nutritional intervention for an individual patient in a timely and cost-effective manner. The techniques currently available for nutritional screening and nutritional assessment are reviewed, and their applicability to the Irish setting are discussed in the present paper.

Anthropometric screening has been recommended for the detection of undernutrition as it is simple, inexpensive and non-invasive. However, a recent study estimating the prevalence of undernutrition on admission to hospital in Dublin, Republic of Ireland, highlighted that the anthropometric reference data currently available in the UK and Republic of Ireland are inadequate to accurately determine nutritional status. In order to provide current anthropometric data, we carried out a cross-sectional study of 874 free-living, apparently healthy Irish-born elderly individuals aged over 65 years. Height, weight, triceps skinfold thickness, mid-arm and calf circumference were measured, values for BMI, mid-arm muscle circumference and arm muscle area were calculated and smoothed centile data derived for each variable. One-third of these elderly individuals had a BMI between 20–25 k/2, approximately two-thirds (68·5 % of males and 61 % of females) were classified as overweight or obese, almost one-fifth having a BMI over 30 k/2 (17 % of men and 20 % of women). Very few were underweight, only 3 % having a BMI below 20 k/2. Height, weight, BMI and muscle reserves decreased with increasing age. The reduction in muscle size was associated with lower handgrip strength. Fat reserves declined with age in females only. Just over half of elderly Irish women reported participating in active leisure of 20 min duration four or more time/eek, although 13 % reported having no involvement in active leisure. These data for the Irish elderly extend the data generated from a recent countrywide survey of Irish adults aged 18–64 years, thus providing suitable reference standards for nutritional assessment of elderly Irish individuals.

Protein–energy undernutrition, or the possibility of its development, has been documented to occur frequently in patients on admission to hospital. Deterioration in nutritional status is known to occur in hospital. In a prospective study of 594 sequential hospital admissions, we aimed to assess the prevalence of undernutrition among patients on admission to two acute teaching hospitals in Dublin, Republic of Ireland using the widely-accepted anthropometric criteria applied in a large study from Dundee, Scotland, UK () and to determine changes in nutritional status in hospital. The mean prevalence of undernutrition (11 %) was considerably lower than was reported from Dundee (40 %). Unintentional weight loss before admission and functional impairment on admission occurred to a similar extent in both centres. Weight loss in hospital occurred in the same proportion of patients, but less frequently among those undernourished on admission to hospital, in Dublin compared with Dundee. The patients found to be undernourished on admission in this study had a mortality rate in hospital (6·5 %) over three times that of the adequately nourished group (2 %). The magnitude of the difference in prevalence of undernutrition between the two centres cannot be explained by ethnicity, case-mix or age distribution. With the secular increase in BMI in the population, the thresholds for classifying patients as undernourished or at risk of nutritional deterioration may need to be reviewed. For clinical use, recent weight loss and functional status may be more appropriate variables to use in the evaluation of nutritional status on admission to hospital.

Impaired nutritional status has been frequently reported in surveys estimating its prevalence amongst patients in hospital. While there is no doubt that protein–energy undernutrition has serious implications for health, recovery from illness or surgery and hospital costs, lack of nationally or internationally accepted cut-off points and guidelines for most nutrition-related variables make nutritional assessment difficult and proper comparisons between studies impossible. In reviewing published work in which the prevalence of undernutrition has been assessed, it can be seen that each study defined undernutrition, or nutritional risk, using different methodology. This present review aims to highlight the problems which arise when deciphering these studies, and the resulting difficulty in determining the true prevalence of undernutrition and nutritional risk, amongst both general and specific groups of hospital in-patients. It is widely agreed that routine hospital practices can further adversely affect the nutritional status of sick patients in hospital. How this occurs, and the potential effects of impaired nutritional status on clinical outcome are examined. The methods currently available to assess nutritional status are evaluated in the knowledge that such assessments are difficult in clinical practice. The review concludes by proposing that if we want the medical and nursing professions to consider the nutritional status of hospital patients seriously, definitions of undernutrition and nutritional risk, and cut-off values for the nutritional variables measured must be agreed to allow evidence-based practice. Outcome measures which allow clear comparisons between groups and treatments must be used in studies assessing the effects of nutritional interventions.