Economic Burden of Disease-Associated Malnutrition in China

Abstract

Disease-associated malnutrition (DAM) is a well-recognized problem in many countries, but the extent of its burden on the Chinese population is unclear. This article reports the results of a burden-of-illness study on DAM in 15 diseases in China. Using data from the World Health Organization (WHO), the China Health and Nutrition Survey, and the published literature, mortality and disability-adjusted life years (DALYs) lost because of DAM were calculated; a financial value of this burden was calculated following WHO guidelines. DALYs lost annually to DAM in China varied across diseases, from a low of 2248 in malaria to a high of 1 315 276 in chronic obstructive pulmonary disease. The total burden was 6.1 million DALYs, for an economic burden of US$66 billion (Chinese ¥ 447 billion) annually. This burden is sufficiently large to warrant immediate attention from public health officials and medical providers, especially given that low-cost and effective interventions are available.

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“…The following diseases/conditions associated with malnutrition were identified from a search of articles estimating the burden of disease from malnutrition: breast cancer, COPD, CRC, CHD, dementia, depression, musculoskeletal disorders, stroke, chronic pancreatitis, and head and neck cancers.…”

“…Malnutrition has been defined as the presence of any 1 of the following 3 risk factors relating to underweight, ie, protein–energy deficiency and anemia as respectively measured by body mass index (BMI) ≤18.5, serum albumin <35 gm/L, and hemoglobin <120 gm/L in men or <110 gm/L in women.…”

“…Previous calculations of the burden on malnutrition have focused on the increase in cost related to malnutrition in the following diagnostic groups: breast cancer, chronic obstructive pulmonary disease (COPD), colorectal cancer (CRC), coronary heart disease (CHD), dementia, depression, musculoskeletal disorders, stroke, chronic pancreatitis, and head and neck cancers. These burden of disease studies refrained from trying to calculate the disease‐specific population at risk of malnutrition, which is calculated from the difference in the incidence of these diseases in a population that contains some people who are malnourished and a theoretic population that has absolutely no malnourished persons.…”

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“…It includes an inability to ingest or absorb nutrients, as well as the increased energy needs related to the disease or restricted diet as a result of the treatment. 6 Table 1 shows that malnutrition accounted for 15% (42/274) of the health conditions described in the studies reviewed. The study classification by condition mirrors the health circumstances frequently associated with nutritional problems.…”

“…5 Other definitions of malnutrition include the presence of any of the three risk factors: underweight (ie, BMI <18.5 kg/m 2 in adults or <5 th percentile of a standardized distribution among children), anemia (ie, hemoglobin <110 g/L for females or 120 g/L for males), or protein-energy malnutrition (ie, serum albumin <35 g/L). 6 Many studies have shown that the prevalence of malnutrition in North American, European, Asian, Australian, and Latin American hospitals can range from 20% to ≥50%. 4,7 However, malnutrition is not limited to patients in hospitals; a UK study found that 93% of the estimated 3 million people malnourished or at risk of malnutrition live in the community.…”