Malnutrition - public health people are lying to us about its incidence

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The Guardian writes this:

Doctors and hospitals are seeing a rise in children suffering from ailments caused by poor diet and the faculty has linked the trend to people's inability to afford quality food. Latest figures show there has been a 19% increase in people hospitalised in England and Wales for malnutrition over the past 12 months but experts say this is only the extreme end.

From this you would conclude, would you not, that there are hordes of starving children with distended stomachs filling up our hospitals? Whether the author did this deliberately is unclear but the truth is that all of that increase in malnutrition relates to the elderly. Every year, for as far as records of malnutrition go back, there are around 200 children admitted to hospital with conditions related to malnutrition.

The main reason - here from 'fullfact' -is this:

People with certain long-term health conditions can’t always retain all the nutrients they need – particularly the elderly, who might also struggle to make the trip to the supermarket. With this in mind, the higher incidence of malnutrition might also reflect broader demographic trends, including the fact that the UK’s population is ageing. The most recent Nutrition Screening Survey showed that those aged 65 plus were more likely to be malnourished than those who were younger. In addition, it may also be that hospitals are now more likely to screen a patient for symptoms of malnourishment.

So the Faculty for Public Health (and Tracey McVeigh in The Guardian) are misleading us about malnutrition because it suits their political agenda. There has been no increase in child malnutrition and the numbers are very small (200 hundred cases in a cohort of nearly 12 million) but we continue to be told that there is a problem. That is, of course, when the Faculty for Public Health isn't telling us that all our children are obese because of "junk food" and fizzy drinks.

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Today's public health lies...the Faculty of Public Health on rickets and malnutrition

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The Faculty of Public Health - a sort of training institute for health fascists - is on about rickets:

The Faculty of Public Health said conditions like rickets were becoming more apparent because people could not afford quality food in their diet.

This is of course the same Faculty of Public Health that urges us never to go out in the sunshine without first daubing ourselves in Factor 100 cream. And then we should only go out in the sun for a few fleeting moments or else we will all die a horrible death from skin cancers.

So what is it that causes rickets? Ah, yes! It's a lack of Vitamin D. And where does the Vitamin D come from:

The main sources of vitamin D are: 

Sunlight – your skin produces vitamin D when it is exposed to the sun. We get most of our vitamin D this way
Food – vitamin D is also found in some foods such as oily fish, eggs and fortified breakfast cereals. 

So rickets is caused by lack of a vitamin we get from going out in the sunshine, eating eggs and eating cornflakes. I don't think for a second that either eggs or cornflakes don't feature in the diet of most kids - so it's our obsession with covering children from head to toe to protect them from the sun that's causing the problem not 'food poverty'.  And I also know that the people from the Faculty of Public Health know this - indeed they could discover these fascinating truths from NHS Choices. They prefer instead to lie so as to make a political point.

Their second lie is a more subtle one, it's about malnutrition.

It comes after health figures recently revealed a 19% increase in the number of people admitted to hospital with malnutrition over the past year.

Now there has been a sharp increase in hospital admissions for malnutrition in the UK and this is something that should concern us. But, just like rickets, it really hasn't got very much to do with 'food poverty'. Rather, it is connected to changed diagnosis and to an increasing elderly population:

People with certain long-term health conditions can't always retain all the nutrients they need - particularly the elderly, who might also struggle to make the trip to the supermarket. With this in mind, the higher incidence of malnutrition might also reflect broader demographic trends, including the fact that the UK's population is ageing. The most recent Nutrition Screening Survey showed that those aged 65 plus were more likely to be malnourished than those who were younger. In addition, it may also be that hospitals are now more likely to screen a patient for symptoms of malnourishment.  

This makes a great deal more sense and tells us that perhaps we should be considering how to ensure that single elderly people living in the community are eating properly (and drinking enough fluid - dehydration is a common factor in cold-related deaths in older people). But again, it doesn't fit with the political agenda of the Faculty of Public Health - they want to have us believe that the problem is the result of welfare reform and rising food prices rather than more complex issues relating to an ageing society or the unintended consequence of public health campaigns around skin cancer.

What I get most annoyed about here is that public health professionals know full well what the underlying factors are for the increase in rickets and for the rising incidence of malnutrition but then chose to ignore these factors and make misleading claims - lies - about food poverty and ill-health. It may well be the case that many poorer people are eating a less than healthy diet but the figures on rickets and malnutrition do not tell us this - they have other causes.
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Malnutrition and public health - it's not austerity that's the problem

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Some "Doctors" have written a letter to the British Medical Journal expressing concerns about malnutrition:

In a letter to the British Medical Journal, David Taylor-Robinson from the University of Liverpool and six other academics warn: "This has all the signs of a public health emergency that could go unrecognised until it is too late to take preventive action."

They say they are particularly worried about the number of children with malnutrition because it can cause cardiovascular and other chronic diseases in adulthood.

And the newspapers and broadcasters lap it up without asking some simple questions - ones like "how many cases of child malnutrition are there?"

To help them, here are the figures from an answer to a Parliamentary question  - in 2008/9 there were 201 cases of children admitted to hospital where  the primary or secondary diagnosis was malnutrition. In 2012/13 this figure had soared to 205 admissions.

There is absolutely no evidence at all - other than anecdotes from teachers - to support the contention that child malnutrition is rising. The thing that should concern us is malnutrition among the elderly because this has risen significantly. The question is why?

Here's one stab at assessment that followed a report in The Independent earlier this month:

People with certain long-term health conditions can't always retain all the nutrients they need - particularly the elderly, who might also struggle to make the trip to the supermarket. With this in mind, the higher incidence of malnutrition might also reflect broader demographic trends, including the fact that the UK's population is ageing. The most recent Nutrition Screening Survey showed that those aged 65 plus were more likely to be malnourished than those who were younger. In addition, it may also be that hospitals are now more likely to screen a patient for symptoms of malnourishment. 

The reasons for increased malnourishment may be entirely unrelated to the current economic climate. Since the elderly are largely protected from the impact of welfare reform and make up the overwhelming majority of malnutrition cases, we should perhaps look elsewhere for the causes of the problem. There may be consequences from 'austerity' - reductions in social care visits, for example - that impact on the elderly eating properly but equally the rise may be a simple reflection of people living longer.

All this may not suit the political agenda of the people writing to the BMJ but we should perhaps pay more attention to the real challenges rather than write ill-researched and polemical letters that serve only to misdirect (and get a nice headline).

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