Economic Consequences of Malnutrition | Clinical Nutrition LAM Initiative

Economic Consequences of Malnutrition

Longer Hospital Stays and Increased Burden on Resources

In today’s cost-conscious health care environment, appropriate use of health care resources is an imperative. Disease-related malnutrition is the enemy of these cost-conscious efforts.

With malnutrition rates in the range of up to 50 percent in hospital patients in Latin America, it is obvious that the economic consequences of this problem are profound.1,2,3,4,5,6

Up to 50 percent of patients in LatAm hospitals are malnourished

Disease-Related Malnutrition Leads to Increased Health Care Resources

Malnourished patients tend to require longer hospitalization than well-nourished ones.7,8,9,10,11,12 Several studies have reported that disease-related malnutrition prolongs the hospital stay by an average of three days. In Latin America, studies have shown that malnourished patients stay on average five days longer in the hospital than well-nourished patients.12 In particular, a strong relationship has been established between nutritional status, clinical outcome, and length of stay amongst internal medicine patients or patients with gastric cancer.5

Disease-related malnutrition also increases readmission rates.10,13 As a result, malnutrition is associated with increased use of hospital resources.13,14,15,16,17 Typically, longer stays result in higher treatment costs.9 Additional costs are generated when patients return to the hospital for further treatment.

Overall, disease-related malnutrition can increase hospital costs by 30 to 70 percent.18 In the UK, the public expenditure on disease-related malnutrition in 2007 was estimated to exceed USD 20 billion* (£13 billion), corresponding to more than 10 percent of the total expenditure on health and social care.19 Based on this health economic evidence, the estimated costs of disease-related malnutrition in Europe were calculated to be USD 212 billion** (€170 billion).20

Putting these costs into perspective, the economic burden of disease-related malnutrition is estimated to exceed the costs of treating overweight and obese patients by two-fold.19,21 In comparison, the annual economic costs of obesity are estimated at USD five to six billion* (£3.3 to 3.7 billion); if the estimate includes obesity plus overweight (USD 10 to 12 billion* [£6.6 to 7.4 billion]),21 the figure is still only approximately half the cost of disease-related malnutrition.


* Calculated based on an exchange rate of 1.5674 (Source: Bloomberg 11/25/12)

** Calculated based on an exchange rate of 1.2462 (Source: Bloomberg 12/14/14)

  • 1. Correia MI, Campos AC. Prevalence of hospital malnutrition in Latin America: the multicenter ELAN study. Nutrition 2003;19(10):823–825.
  • 2. Fontes D, Generoso Sde V, Toulson Davidsson Correia MI. Subjective global assessment: a reliable nutritional assessment tool to predict outcomes in critically ill patients. Clin Nutr 2014;33(2):291-295. 
  • 3. Garcia RS, Tavares LR, Pastore CA. Nutritional screening in surgical patients of a teaching hospital from Southern Brazil: the impact of nutritional risk in clinical outcomes. Einstein 2013;11(2):147-152.
  • 4. Prado C, Alvarez Duarte Bonini Campos, J. Nutritional status of patients with gastrointestinal cancer receiving care in a public hospital. Nutr Hosp 2013;28(2):405-411.
  • 5. a. b. Waitzberg DL, Caiaffa WT, Correia, MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition 2001;17(7-8):573-580.
  • 6. De Souza VC, Duradob KF, Limaa ALC et al. Relationship between nutritional status and immediate complications in patients undergoing colorectal surgery. J Coloproc 2013;(33)2: 83–91.
  • 7. Leandro-Merhi VA, de Aguino JL, Sales Chagas JF. Nutrition status and risk factors associated with length of hospital stay for surgical patients. JPEN 2011;35(2):241-248.
  • 8. Pressoir M, Desné S, Berchery D et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 2010;102(6):966-971.
  • 9. a. b. Pirlich M, Schütz T, Norman K et al. The German hospital malnutrition study. Clin Nutr 2006;25(4):563-572.
  • 10. a. b. Lim SL, Ong KC, Chan YH et al. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 2011;31(3):345-350.
  • 11. Marco J, Barba R, Zapatero A et al. Prevalence of the notification of malnutrition in the departments of internal medicine and its prognostic implications. Clin Nutr 2011;30(4):450-454.
  • 12. a. b. Pernicka E, Wilson L, Bauer P et al. Malnutrition assessed by BMI and weight loss causes increased length of hospital stay. Results of Nutrition Day study. Clin Nutr Suppl 2010;5(2):168.
  • 13. a. b. Planas M, Audivert S, Pérez-Portabella C et al. Nutritional status among adult patients admitted to an university-affiliated hospital in Spain at the time of genoma. Clin Nutr 2004;23(5):1016-1024.
  • 14. Elia M, Russell C. Nutrition screening survey in the UK in 2008. Redditch: BAPEN 2009.
  • 15. Cepton Strategies. Nutzen durch Innovation. Munich 2007.
  • 16. Freyer K, Tan SS, Koopmanschap MA et al. The economic costs of disease related malnutrition. Clin Nutr 2013;32(1)136-141.
  • 17. Rice N, Normand C. The cost associated with disease-related malnutrition in Ireland. Public Health Nutr 2012;15(10):1966-1972.
  • 18. Elia M. The economics of malnutrition. Nestle Nutr Workshop SerClin Perform Programme 2009;12:29-4.
  • 19. a. b. Elia M, Stratton RJ. Calculating the cost of disease-related malnutrition in the UK in 2007 (public expenditure only) In Combating Malnutrition: Recommendations for action. Report from the Advisory Group on Malnutrition, Led by BAPEN. Redditch: BAPEN 2009.
  • 20. Ljungqvist O, de Man F. Under nutrition - a major health problem in Europe. Nutr Hosp 2009;24(3):368-370.
  • 21. a. b. House of Commons, Health Committee. Obesity. Third report of session 2003-04. London: The Stationary Office Limited 2004;1.

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