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Mar/Apr 2025
March/April 2025
Malnutrition in the UK, and its impact on oral health Learning objectives • To recognise symptoms of malnutrition in dental patients • To understand the interdependent relationship between poor oral health and malnutrition • To learn how to support patients with some common oral health symptoms associated with malnutrition GDC Development Outcome: C
A
fter years of decline, hospital admissions due to malnutrition more than doubled between 2007 and 2017 in the UK. This is attributed to many factors, including a rise in socioeconomic inequality, food insecurity, the ready availability of low-cost, caloriedense, low-nutrient, ultra-processed foods, and an ageing population.i Deficiencies in protein, calories, vitamins and minerals can all have an effect on the oral health of patients. Malnutrition is associated with conditions such as salivary gland atrophy, an increased risk of caries, periodontal disease, delayed tooth eruption, abnormal alveolar bone patterns, alterations to dentine and pulp, and enamel hypoplasia.ii Equally, poor oral health is known to contribute to an inadequate intake of essential nutrients. For example, tooth loss is associated with lower levels of protein, fruits and vegetables in the diet, particularly among older people.i As a clinician, it is important to develop an awareness of the relationships between poor nutrition and poor oral health. Developing an understanding of the many different risk factors for malnutrition can enhance the clinician’s approach to problem-solving, as well as their communication with patients.
What is malnutrition? Malnutrition is the imbalance between the supply of nutrients and the body’s demand for them to ensure cellular growth, repair, and the maintenance of specific functions.ii It affects every organ system, and if occurring over an extended period, can impact cardio-
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respiratory and gastrointestinal health, impair immunity and wound healing, as well as psychosocial health.iii There is also evidence that malnutrition can lead to impaired cognitive function.iv The National Institute for Health and Care Excellence (NICE) defines the condition as: • A body mass index (BMI) of less than 18.5 kg/m2. • Unintentional weight loss greater than 10% within the last 3–6 months. • A BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.v However, malnutrition is not only associated with weight loss or a reduced BMI. A significant proportion of overweight or obese patients lack essential levels of vitamins, minerals, antioxidants and various macronutrients and micronutrients. In addition, obesity
causes systemic inflammation, which alters the capacity to absorb, distribute and excrete nutrients. Furthermore, excessive adipose levels impact the body’s ability to absorb vitamin D. vi
Prevalence and risk factors Malnutrition is considered to be one of the biggest threats to public health worldwide, and various clinical trials have shown a prevalence of between 20–60% in patients admitted to hospital.vii More than 3 million people in the UK are malnourished or at risk of malnutrition at any given time. A 2022 surveyviii revealed that nearly half of all adults screened across health and care settings in the UK were found to be at risk of diseaserelated malnutrition. Of these, 24% were underweight, 17% were obese and 26% had unplanned weight loss.
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