Beyond Toast: Dietitians New Zealand Highlights Concerns Of Increased Malnutrition Risk Amongst Budget Cuts

Thursday 5th September 2024

Recent media reports have raised concerns about the removal of toast from the Labour ward at Wellington Hospital, due to questions regarding its nutritional adequacy. While more nourishing menu choices are available for mother’s post-delivery, Dietitians recognise that the value of food often extends beyond the nutrients it provides. After labour, many women seek comfort and familiarity in their food choices and these aspects can be more important than nutritional content alone.

Healthy eating is a “most of the time” activity. There will always be occasions when food choices are less than nutritionally optimal or where foods are eaten for reasons other than nutrition. These kinds of meals or snacks are OK, provided that more nourishing options are available at other times.

Looking beyond recent controversies around toast, there are larger factors at play when it comes to a patient’s nutrition. The food provided during hospital stays requires a delicate balance between nutritional value and acceptability.

A typical hospital stay in Aotearoa, New Zealand is around three (3) days. Due to the short timeframe, the risk of malnutrition is low; assuming the patient was well-nourished before admission. However, the risk of malnutrition increases the longer a patient remains in the hospital; especially if patients are admitted with poor nutritional status, stay longer than average or if they have experienced significant trauma. Malnutrition, which results in the loss of muscle and fat due to eating a nutritionally inadequate diet, can lead to longer hospital stays, higher rates of illness, and an increased risk of readmission, particularly in older adults.

Hospitals have protocols in place to identify patients at risk of malnutrition. However, if wards are short-staffed, the necessary care to prevent or manage malnutrition risk may be overlooked, due to other pressing clinical needs. This issue is compounded when patients require assistance with feeding and there are not enough staff available.

In 2021, a study conducted at Christchurch Hospital showed that 33% of patients screened within 48 hours of admission were at risk of malnutrition. It was also noted that not all high-risk patients were referred to a dietitian for care, which is the recommended course of action. In many hospitals, there are also not enough funded hours of dietitian input available to provide excellence of care. The gold standard of dietetic care within a hospital environment would ensure that a dietitian is included on ward rounds to identify nutritional needs across the whole ward population.

With ongoing cost-cutting measures and staff shortages within Aotearoa’s healthcare system, Dietitians New Zealand is concerned the risk of malnutrition will increase, especially for our most vulnerable patients. Reducing the food budget and understaffing could also ultimately lead to higher overall costs, as the consequences of untreated malnutrition are felt throughout the healthcare system.

Good nutrition and providing support for eating, where a patient is unable to do so independently, are critical components of healthcare. Dietitians and Dietitians New Zealand continue to advocate for adequate resources to ensure that patients not only receive medical treatment they need to recover their health, but also the nourishment and care needed to do so optimally.

References:

Diep-Pham H-T, Donald N, Wall CL. Malnutrition screening tool use in a New Zealand hospital: Reliability and rates of malnutrition screening on admission. Nutrition & Dietetics. 2023; 80(5): 530-537. doi:10.1111/1747-0080.12838

Eating and Activity Guidelines for New Zealand Adults - 2020 (tewhatuora.govt.nz)

About Dietitians NZ:

Originally established in 1943 as the New Zealand Dietetic Association, Dietitians New Zealand | Ngā Pukenga Kai Ora o Aotearoa is New Zealand’s professional association for registered dietitians.

Over the past 80 years the association has continued to grow and is now the peak body of dietetic and nutrition professionals, providing strategic leadership in food and nutrition through empowerment, advocacy, education and communication, and today represents over 500 members.

Unique Features About Dietitians in New Zealand

Dietitians work in partnership with individuals, whānau, communities and populations, in states of health and disease, to support optimal health and well-being.

Dietitians use their dietetic knowledge, skills, and judgement in a variety of contexts, which includes promoting and protecting public health, directing, and delivering medical nutrition therapy services, and managing food and health systems. They may perform a variety of functions, including policy development, leadership, management, research, education, and communication roles. Dietitians with a prescribing endorsement can prescribe nutrition-related medicines.

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