Opportunities to advance malnutrition care and health equity

This year, the Malnutrition Awareness Week is taking place in our country for the 10th time. We are Members of Congress and the National Coordinator of the Defeat Malnutrition Today Coalition. This year we are working together on a resolution that recognizes the importance of this week, with a special focus on nutrition as a patient’s right.

Malnutrition Awareness Week is expanded this year with the recent decision by the Centers for Medicare and Medicaid Services (CMS) to include a measure of malnutrition, the Global Malnutrition Composite Score, in Medicare’s inpatient reporting program for the first time in its history . The importance of this step cannot be underestimated. One in two older adults is either at risk of malnutrition or malnourished. Malnutrition affects 20 to 50 percent of hospitalized patients, but is diagnosed in only about 8 percent of hospitalizations. Malnutrition increases the frequency and length of hospital stays and leads to higher healthcare costs: in fact, the disease-related costs of malnutrition are estimated to exceed US$50 billion annually. A 2021 systematic review by the Agency for Healthcare Research and Quality reports that patient malnutrition is an “underappreciated threat to patient safety.”

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Addressing malnutrition, particularly in inpatient hospital settings, is also a fundamental health equity issue. CMS has found that readmission rates are significantly higher for Black and Hispanic, and for Native American and Alaskan Native people. And according to the United States Department of Agriculture, there is a higher prevalence of food insecurity among black, Hispanic, low-income and rural households, and elderly people living alone.

The next step in improving malnutrition treatment and health equity is for hospitals to connect patients who are malnourished or at risk of malnutrition with community-based nutritional services and resources that are available after discharge. There is still a need for Congress to take action here. Medical nutritional therapy (MNT), delivered by a licensed dietician or outpatient nutritionist, can help improve health outcomes. However, Medicare currently offers MNT coverage for very few conditions. The passage of the Health Equity and Accountability Act, which includes the Medical Nutrition Therapy Act and other improvements to federal nutrition programs, expands this coverage to include malnutrition and chronic diseases that commonly lead to malnutrition, such as cancer, HIV and diabetes.

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Congress must also strengthen programs that successfully fight hunger. Nutrition programs are the largest component of the Older Americans Act (OAA), a law that funds both meals on wheels and meals served in community settings such as senior centers. During the last update in 2020, we successfully incorporated “malnutrition reduction” into the purpose of OAA nutrition programs and added malnutrition screening for all meal attendees. Meals provided through OAA help combat malnutrition and isolation by also enhancing older adults’ connections to their communities.

Despite their importance, OAA programs remain significantly underfunded. The need for additional resources is fueled by unprecedented demand, accelerated by the COVID-19 pandemic and exacerbated by rising food prices due to inflation. Urgent congressional action is needed to adequately provide much-needed nutrition for vulnerable older adults, which is why we are committed to doubling funding for OAA nutrition programs in fiscal year 2023.

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Later this month, the White House will convene a White House Conference on Hunger, Nutrition and Health. It has been 53 years since the last conference and one of the main focuses of this conference is improving the quality of nutrition by 2030. This achievement would lead to lower rates of malnutrition, particularly among older adults. Caring for the most vulnerable populations in our country should be the goal of this Malnutrition Awareness Week and the following ones.

We look forward to hearing the President’s national strategy for improving nutritional health for all Americans from the upcoming conference. Let us all recognize this Malnutrition Awareness Week as a crucial opportunity to make progress towards ending hunger and disease-related diseases.

Suzanne Bonamici represents the 1st District of Oregon. Bob Blancato is the national coordinator for the Defeat Malnutrition Today coalition.

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