More than 800,000 patients were admitted to hospital with malnutrition and nutritional deficiencies last year, a threefold increase on 10 years ago, according to NHS figures that have prompted warnings about the devastating health impact of food insecurity.
Hospital data for England and Wales, obtained by the Guardian, reveals a startling rise in diagnoses linked to poor diet in the past decade, with nearly half a million admissions of patients with iron deficiencies, hundreds of thousands suffering from vitamin deficiencies and more than 10,000 cases of malnutrition last year.
Senior doctors said the trend mirrored their clinical experiences, with a growing number of patients whose health problems are rooted in poverty.
Prof Kamila Hawthorne, chair of the Royal College of GPs (RCGP), said doctors were facing “moral distress” because of a limited ability to help. “It’s not like you can prescribe money or food,” she said.
“As a nation we shouldn’t be having malnourished children. We shouldn’t be having children with rickets. We should not be having people with iron deficiencies or low folic acid,” Hawthorne added. “There’s that sense of this isn’t right; what’s happening here?”
RCGP is calling for an expansion of free school meals and for stronger policies to improve the affordability of healthy food in supermarkets. Hawthorne said: “I have a reluctance to giving people supplements in a rich country, where they should be able to afford food. It’s so counterintuitive.”
She added: “There are definitely cases we hear about of parents going without meals so their children can eat. We’re hearing of a lot of people going to food banks who would never have dreamt of going to a food bank before.”
The Guardian analysed rates of 25 conditions linked to poor nutrition, including vitamin and mineral deficiencies, scurvy, rickets and malnutrition. Over the past decade, there was a steep increase across nearly all of the conditions, based on primary and secondary diagnosis in hospital patients in England and Wales.
Admissions with a diagnosis of iron deficiency more than doubled from 196,685 in 2013-14 to 490,005 in 2022-23, including thousands of child admissions last year. Cases of patients being treated for vitamin B deficiencies (B12, folate and other B vitamins) tripled from 57,406 a decade ago to 167,562 last year. Protein energy malnutrition, caused by insufficient calories or protein, rose from 5,746 to 9,390 cases. In total, there were 824,519 admissions with a diagnosis of at least one of these conditions in 2022-23, up from 293,686 a decade ago.
Prof Sir Michael Marmot, of UCL, who led a landmark review into health inequalities, said that the figures, if representative of an underlying increase in illness, were “really shocking”.
“The sceptic in me always asks: is this real, or increased recognition of the problem?” he said. “But that massive increase – wow. It seems likely that there’s got to be a real component.”
The hospital data does not account for the possibility of increased testing. And experts said this may explain increases in rarer deficiencies, such as vitamin A and thiamine, which are typically monitored in the growing population of bariatric surgery patients. However, experts said that these explanations, and the increase in people following meat and dairy-free diets, were unlikely to fully explain such substantial increases in iron and B vitamin deficiencies.
Rebecca McManamon, a consultant dietitian and spokesperson for the British Dietetic Association, said testing for iron deficiency was very common. “It’s a first-line test in A&E for anyone presenting with fatigue or breathlessness. Most GPs would be requesting these tests on a daily basis. It’s fair to say there is more awareness, but not enough to explain this increase.”
The trend also tracks a stark increase in food insecurity over the same period, with 5.9% of adults reporting not eating for a whole day because they could not afford or access food, 15% of adults reporting skipping meals and 21% of households with children experiencing food insecurity, according to a recent Food Foundation survey.
“As a clinician I’m not surprised,” said McManamon. “I see people that have very limited diets. We all know the increasing use of food banks. Food access and food insecurity is a huge thing.”
The link between hunger, food insecurity and health is complex, with some people simultaneously being overweight or obese and suffering deficiencies because of diets that are high calorie but lacking in essential nutrients.
Prof Monica Lakhanpaul, a consultant paediatrician at Whittington health NHS trust, said she was encountering more children with iron and vitamin deficiencies and rickets, caused by a lack of vitamin D and calcium, describing the problem as a “hidden crisis”.
While there has been a focus on reversing these deficiencies in low- and middle-income countries, she said, children in the UK were increasingly at risk. “We don’t screen for it, we actually don’t know the scale of the problem on a population basis. That’s my worry,” she said. “What’s on our doorstep we forget about very quickly. We need to know as a nation that people’s health in this country is deteriorating.”
Nutritional deficiencies are particularly concerning in children, with iron and B12 being critical for brain development; calcium and vitamin D (from sun exposure and dietary intake) are crucial for bone development. “They’re going to have health problems further down the line, like brittle bones when they’re older,” said Lakhanpaul. “We’re storing up health problems for later in life.”
