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Nutritional deficiency in general practice: a systematic review

European Journal of Clinical Nutrition volume 59, pages S81–S88 (2005)Cite this article

Abstract

Objective:

Nutritional deficiency is an independent risk factor for mortality. Despite its clinical relevance, the prevalence in a primary care setting is poorly documented. We performed a systematic review of reported prevalence and clinical assessment of nutritional deficiency in general practice.

Methods:

From MEDLINE, Current Contents and EMBASE, we derived articles and checked the initially included ones for references on prevalence data. Of the eligible articles, we assessed the quality of research and results.

Results:

We finally included eight studies. The prevalence ranged from 0 to 13%. However, the study populations were heterogeneous and all studies contained methodological flaws, especially selection bias. In addition, the clinical assessment differed between studies.

Conclusion:

Literature on the prevalence of nutritional deficiency within general practice is rare and provides disputable prevalence assessments.

Sponsorship:

The Dutch Dairy Association, Zoetermeer.

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Acknowledgements

We thank the Dutch Dairy Association for the financial support, Rob Scholten for the EMBASE contribution and Caroline Roos for translating the Spanish articles.

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Authors and Affiliations

  1. Department of General Practice, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    C A M van Wayenburg, F A van de Laar, C van Weel & J J van Binsbergen

  2. Division of Human Nutrition, University of Wageningen, Wageningen, The Netherlands

    W A van Staveren

Authors
  1. C A M van Wayenburg
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  2. F A van de Laar
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  3. C van Weel
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  4. W A van Staveren
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  5. J J van Binsbergen
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Corresponding author

Correspondence to C A M van Wayenburg.

Additional information

Guarantor: JJ van Binsbergen.

Contributors: CAMvW: protocol development, searching for articles, abstract and article assessment for eligibility, quality assessment, data extraction, and review development; FAvdL: protocol development, abstract and article assessment for eligibility, quality assessment, data extraction, and review development; WAvS: review development (editing); JJvB: protocol development and review development; CvW: protocol development (advisor) and article development.

Discussion after Van Wayenburg

Kolasa: Could you explain in more detail how the coding was done? The patient who may come to see you gets a diagnostic code? Are you encouraged or paid to do more than one? Because in the USA that would impact how many codes we see.

Van Wayenburg: I can only answer that question for myself when I am working in the general practice. I only try to aim at one illness, and to relate most complaints to that illness. But nutrition deficiency or weight loss does need a specific treatment, so it could be an entity on its own, like we discuss also obesity. We say someone has heart disease or cancer, and with that illness comes nutritional deficiency.

Helman: I guess that weight loss is seen as a symptom for which another diagnosis would be sought. I think the last thing that would occur to a GP is a nutritional deficiency.

Van Wayenburg: If you look at nutritional deficiency as being an independent risk factor for mortality, should we then be more aware to treat it as a separate illness? What do you think?

Helman: If most GPs understood the prevalence of deficiency in hospitals and nursing homes and they understood the impact on morbidity and mortality we would be a long way.

Van Wayenburg: So our next question will be in COPD patients to see how many of the patients are nutritionally deficient. That would be maybe good to emphasise it.

Pond: Picking up on this from the Australian point of view. We now have a 75+ y health assessment, and we have a GP version of a scale for being at risk of nutrition deficiency, which includes whether they eat alone, how many meals they eat a day and so on. I think the studies up till now are taken up very well by GPs, but so far we have not been able to prove that they act on this information. And there is no information on what to do.

Van Wayenburg: The definition of nutritional deficiency is unclear, and for that reason also not workable in practice. So that is something that we should maybe work on, to make this definition more clear. For example, it has been said that weight and height, BMI should be registered just as blood pressure, but I should say we should also define weight loss in the electronic system, so we get a better picture.

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van Wayenburg, C., van de Laar, F., van Weel, C. et al. Nutritional deficiency in general practice: a systematic review. Eur J Clin Nutr 59 (Suppl 1), S81–S88 (2005). https://doi.org/10.1038/sj.ejcn.1602178

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