South Africa carries one of the highest burdens of hospital malnutrition in the world. Here is what clinicians and patients need to know — and what we are doing about it.
- 70–80% of hospitalised SA patients are malnourished or at risk
- 61% of patients arrive at hospital already malnourished
- 4 x higher mortality in nutritionally compromised patients
- 8% of at-risk patients receive nutrition support on admission
Sources: Blaauw et al. 2019; Van Tonder et al. 2018; MNI Dossier 2018 — cited in ENASA, MedicalBrief, May 2026
Malnutrition is not a condition confined to famine or poverty. It is happening right now, in hospitals across South Africa, to patients who arrived seeking treatment for something else entirely. It is called Disease-Related Malnutrition (DRM) — and it is one of the most underdiagnosed, underreported, and under-addressed challenges in our healthcare system.
Our partners at ENASA (the Enteral Nutrition Association of South Africa) recently published a powerful reminder of this reality in MedicalBrief. As a company built around medical nutrition, we feel a responsibility to amplify this message and explain where our products fit into the solution.
What is disease-related malnutrition?
DRM is distinct from the malnutrition we associate with food insecurity. It is triggered by the disease process itself — the inflammatory and catabolic responses to illness or injury. These responses deplete the body of protein, key amino acids, NAD⁺ precursors, and trace elements faster than any ordinary diet can replenish them.
Critically, anyone with an active disease process is at risk — regardless of their weight, BMI, or nutritional status on admission. A patient who appears well-nourished can be malnourished in ways that are clinically significant and prognostically important.
"A patient who appears well-nourished can be malnourished in ways that are clinically significant and prognostically important." ENASA — Disease-Related Malnutrition in South African Hospitals, MedicalBrief, May 2026
The scale of the problem in South Africa
South Africa carries a substantially higher burden of DRM than comparable high-income settings. For context: the equivalent at-risk figures in the USA sit at 35–45%, and around 45% in the EU. Our 70–80% prevalence is not just significant — it demands a proportionate response.
The clinical consequences compound rapidly:
- 2 X higher rate of infections in malnourished patients
- 3 X more clinical complications overall
- 2 X longer average hospital stays
- 1.5 X more unexpected readmissions
- 4 X high mortality in nutritionally compromised patients
- 2 - 10 X higher cost to treat a malnourished patient versus a well-nourished one
The economic case for addressing DRM is as strong as the clinical one. Oral Nutrition Supplements (ONS) alone can reduce mortality by up to 24% and lower complication rates by 18%.
The conditionally essential amino acid problem
At the biochemical heart of DRM lies a concept central to everything we do at Glutamed: conditional essentiality. Under normal circumstances, the body synthesises adequate quantities of certain amino acids — including L-glutamine — from dietary precursors. Under the sustained inflammatory and metabolic stress of disease, that synthesis collapses.
In patients with sickle cell disease, cancer, severe wounds, neurodegeneration, or post-surgical recovery, ordinary dietary intake simply cannot meet the increased metabolic demand for glutamine and NAD⁺ precursors. This gap — the difference between what the body needs and what food alone can provide — is precisely where medical nutritional supplementation becomes essential, not optional.
ENASA recommends that all patients be asked three questions at admission. A "yes" to any one of them should trigger early dietitian involvement:
- Is there any unintentional weight loss or low BMI?
- Are there visible signs of underweight or wasting?
- Is there early anorexia, low intake, or poor appetite?
Only 36% of patients identified as nutritionally at risk are ever referred for nutrition support. Only 8% receive that support on admission. These are the gaps that clinical practice — and the right nutritional tools — must close.
Where Glutamed fits into the solution
Glutamed is a range of medical nutritional supplements developed in conjunction with Rigi Care, Switzerland and distributed by Azela Health in South Africa. Each product is formulated to address the specific metabolic deficiencies that arise in defined clinical populations. Together, they represent a comprehensive response to DRM across the hospital care pathway. Every product formulation is built around L-glutamine as its core, supplemented with condition-specific co-nutrients to address the distinct metabolic challenges of each patient population.
All products are available under medical supervision only. For NAPPI codes, ordering information, and to find a representative in your area, visit glutamed.co.za or contact your healthcare provider.
Supporting the ENASA mission
ENASA — the Enteral Nutrition Association of South Africa — advocates for the recognition and treatment of disease-related malnutrition across South African healthcare settings. We are proud to support their work. Read the full MedicalBrief column and explore ENASA's resources at enasa.org.
Statistical references cited in this article are sourced from the ENASA MedicalBrief article (May 2026), which draws on: Blaauw et al. 2019; Van Tonder et al. 2018; Norman et al. 2008; Burgos et al. 2020; MNI Dossier 2018; Correia et al. 2003; Elia et al. 2016; Freijer et al. 2013; Gomes et al. 2019; Cederholm et al. 2015, 2019; WHO/EURO:2023-8931-48703-72392. Glutamed clinical references available at glutamed.co.za. All Glutamed products are for use under medical supervision only and do not constitute a balanced diet.
