The recent Audit Commission review of national findings on hospital catering services (news, pages 4-5, 27 September) is welcome since it identifies a number of inadequacies in the nutritional care of patients in hospital and suggests ways to deal with them while patients are in hospital.

But continuity of care between hospital and the community needs further consideration. The length of hospital stay is usually short: on average patients spend as little as 5 per cent of their illness in hospital. Malnutrition usually arises in the community, and many deteriorate further during hospital stay. Between 20-40 per cent of patients in hospital are malnourished.

During a patient's short stay in hospital, time is usually inadequate to fully treat malnutrition. However, studies show that malnutrition is not detected in 70 per cent of malnourished patients during their hospital stay. It is vital that health professionals diagnose malnutrition and that there is continuity of care so that it is treated when the patient returns to the community. Without a unified approach to nutritional management that ensures communication and continuity of care between different settings, malnutrition will continue to adversely affect well-being and clinical outcome, with huge cost to individuals and society.

Marinos Ella Professor of clinical nutrition and metabolism and Chair of the Malnutrition Advisory Group