evidence-based blog of Filippo Dibari

Assessing knowledge of recognition and treatment of malnutrition among healthcare professionals

In Under-nutrition on May 29, 2012 at 5:53 pm

J G Powell-Tuck, J Connelly, H Haboubi, P Eadala

Gut 2012;61:A33


Introduction Malnutrition is common in hospitals, affecting up to 40% of patients (1). Malnourished patients are vulnerable to ill health and are known to be at increased risk of complications during inpatient stays (2). In 1999 Nightingale et al studied healthcare professionals’ knowledge of nutrition and despite recognition of its importance, understanding was found to be poor (3). We aim to assess whether there has been any improvement in healthcare professionals’ knowledge of nutrition.

Methods We approached healthcare staff from a tertiary referral centre and two district general hospitals to complete questionnaires to evaluate their understanding of assessment and treatment of under nutrition. The questionnaire contained 18 multiple choice questions in which staff were asked to select the correct answer from five possibilities. All questions were constructed from the 2006 NICE guidelines: Nutrition Support in Adults (2).

Results We obtained 114 responses from 67 doctors, 10 nurses, 12 pharmacists, 10 dietitians and 15 final year medical students. Dietitians’ average score was significantly higher than all other groups (81.7%, p<0.001). Medical students scored lowest (25.4%). Pharmacists averaged 42.6%, doctors 35.8% and nurses 25.4%. There was no statistically significant difference between medical and surgical specialties (36.6% vs 33.6%, p=0.4). Consultants and registrars both averaged 43.8%, SHOs 32.4% and F1s 28.8%. Only 8.9% of doctors felt that they had received adequate nutritional training. 90.0% of nurses and 30.0% of doctors surveyed did not know how to calculate body mass index (BMI). Only 34.8% of doctors could correctly identify the BMI below which one would be considered underweight. 50.0% of doctors did not know an average person’s daily fluid requirements. Knowledge of parenteral feeding and the nutritional needs of septic patients was also particularly poor among all health professionals except dietitians.

Conclusion These results suggest that basic understanding of nutrition remains poor. There needs to be greater emphasis on both undergraduate and postgraduate training in nutrition to ensure that recognition and treatment of malnutrition can be improved.

Competing interests None declared.



1. Barker L, et al. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health 2011;8:514–27.

2. National Collaborating Centre for Acute Care. Nutritional Support in Adults, Oral Nutritional Support, Enteral Tube Feeding and Parenteral Nutrition. London: National Collaborating Centre for Acute Care, 2006.

3. Nightingale J, Reeves J. Knowledge about the assessment and management of undernutrition: a pilot questionnaire in a UK teaching hospital. Clin Nutr 1999;18:23–7.

  1. Wow Fil, what a great perspective, of how things are at home for those of us working with health professionals on assessment and treatment of undernutrition overseas. i was shocked… but then coincidently took Ella (18 months old) to the baby clinic the same day. They had this new scale that I had never seen before which was like a little baby chair fixed to the edge of the table which you just sit the child in (so easy! i thought, and was of course immediately wondering how much it cost!). There was a button on it to take weight and then another that said BMI. I commented to the health visitor on how handy the scale was and that I’d never seen one like that before. I then asked if they actually used the BMI function for kids rather than weight for height and how you inputted in the height measurement. She looked at me rather blankly and said, “no I think it just calculates the BMI from the weight”.


    • Hi there, thanks for sharing your experience. That is a pretty remarkable example likely to confirm the content of this paper. This may change in the future?


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