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The Health Council of the Netherlands presented last May 29 its advisory report on ‘Undernutrition in the elderly’ in the Netherlands. The report evaluates the scientific basis for the way protein-energy undernutrition in the elderly is dealt with.

Short description

Characteristic of undernutrition (low body weight, weight loss) are often heavily interwoven with illness. Therefore, it is difficult to determine to what extent an increased risk of illness and mortality is caused by undernutrition. Over the long term, inadequate protein and energy intake is known to be harmful to health. However, it is not clear exactly where the boundary lies. No golden standard exists to establish undernutrition.

As a result of this, the scope of this problem is unclear and the validity of screening instruments cannot be specified. Furthermore, many questions still remain to be answered concerning the effectiveness of dietary interventions in the undernourished elderly. While a great deal of research has been published in this area, the quality of the research in question is substandard. Intervention studies of good quality and sufficient scope are needed to identify the most effective way of dealing with undernutrition in the elderly.

Abstract

In recent years, there has been an increasing focus on the issue of undernutrition in the elderly. Hospitals and care institutions are alert to the risk of protein and energy deficiency in the elderly and provide nutritional supplementation where this is deemed to be necessary. This is considered to be a necessary step to improve the health of elderly people. The Minister of Health, Welfare and Sport has asked the Health Council of the Netherlands to provide a scientific basis for the way undernutrition is dealt with. What is the exact scope of the problem, what is the best way of identifying cases of undernutrition, and how can this condition best be treated? The Health Council has now collated the available data on this issue.

When can someone be said to be undernourished? In practice, a range of methods is used to measure undernutrition (such as recent weight loss, and a low Body Mass Index). There is no “gold standard” (i.e. a reliable method). While various studies have demonstrated the existence of a link between undernutrition and mortality rate, for example, it is not known whether a causal connection exists. In other words, are elderly people at greater risk of dying as a result of undernutrition, or is their higher mortality risk mainly due to other factors, such as disease? As long as there is no clarity on this issue, there will be no reliable data on the severity and scope of the problem of undernutrition in the elderly.

Furthermore, many questions still remain to be answered concerning the effectiveness of dietary interventions in the elderly. While a great deal of research has been published in this area, the quality of the research in question is substandard. According to the Health Council, nutritional supplementation with extra protein and energy should produce clear health gains, such as shorter hospital stays or a lower mortality risk. However, it is impossible to identify those cases to which this would apply.

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The Health Council of the Netherlands (Gezondheidsraad) is an independent scientific advisory body. Its remit is to advise the [Dutch] government and Parliament on the current level of knowledge with respect to public health issues and health (services) research.

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