We’ve all been there. A splitting headache comes out of nowhere. You reach for the Tylenol, pop a couple pills, and down them with a glass of water. Ah, relief. The pain subsides.
What you may not know, however, is that it may not have been the Tylenol that delivered you from misery, but the water. Dehydration headaches are incredibly common. Yet in our haste to reach for pharmacological intervention, we often ignore our body’s most elemental needs.
This is a small example of an enormous problem. The West is blessed with the most advanced medicine the world has ever known. Doctors in Maryland recently transplanted a pig’s heart into a human body. Vaccines for a once-in-a-century pandemic were designed in days, rolled out within months, and saved millions of lives!
Yet in the shadows of these advances, we’re failing to meet patients' most basic needs. They’re starving, and it is happening in the least likely of places: hospitals.
Hospital malnutrition is rampant and it’s expected to get worse. It’s estimated that one-third of the 33 million people admitted to US hospitals each year are already suffering from malnutrition. Once there, another fifth can fall victim to the condition.
The numbers are shocking but understandable once they’re picked apart. Virtually any time the body gets an infection, whether it’s a seasonal flu or COVID-19, or suffers trauma like a broken limb, its need for energy, proteins, vitamins, and minerals spikes. Yet intake of those vital fuels typically falls just when the body needs them most because of symptoms ranging from shock to reduced appetite and loss of bodily fluids. It’s a fact that’s often overlooked in the rush to treat the primary malady, contributing to underdiagnosis and lack of treatment. Only 5% - 9% of hospital patients are diagnosed with the condition, resulting in untold suffering, avoidable deaths, and billions of dollars in additional healthcare costs.
Population demographics are also driving the problem. Every day, 10,000 baby boomers turn 65. That age bracket – the over-65’s – are the most prone to malnutrition. A host of age-related issues, from loss of appetite to incontinence and gastrointestinal conditions, lead to a lower intake or absorption of nutrients, loss of muscle mass and subcutaneous fat, and increased susceptibility to conditions that will land them in the hospital. Over-65’s are twice as likely as middle-aged people to have a hospital stay in a given year.
Once there, clinical interventions can put the body’s natural healing mechanisms under added duress. After surgery, a patient’s protein needs can double as the body heals. Ventilated COVID-19 patients may benefit from a higher fat diet because metabolizing fat generates less CO2, lightening the load on damaged lungs. Malnutrition deprives the body of the raw materials to power these vital processes. Matrix metalloproteinases, for example, are enzymes that help heal wounds. Their catalytic effect is powered by zinc, a lack of which can dramatically slow wound repair.
Studies found that those diagnosed with malnutrition have a three to five times higher risk of mortality during their hospital stay. And the problem is getting worse.
Clinical nutrition is a relatively young science that’s in the process of being more deeply integrated into the chain of patient care. Most people, when they think of hospitals, think of doctors, nurses, orderlies, and pharmacists. Yet clinical dietitians play a central and growing role in delivering care that optimizes outcomes and speeds recovery.
Standing in their way, however, is technology – or the lack of it. The growing complexity of care, paired with a rapidly-expanding population of patients who require it, has outpaced the current tools to handle the workload.
The nutrition director of one hospital group said that dietitians on his staff see half the patients each day that they did a decade ago because so much of their time is spent on patient charts. They must manually trawl through electronic health records to find at-risk patients, assess a greater number of factors once they find them, and then create a feeding plan that can change by the hour based on the treatments they provide.
So intense are the demands that dietitians regularly resort to creating their own spreadsheet-based aids to speed their calculations, which they then share with colleagues. But these are imperfect, limited solutions. Clinical nutrition has been virtually untouched by the march of technology, and the result is rampant under-nourishment: a silent killer lurking in America’s hospitals.
But what if there were a way to automate the monotonous, laborious aspects of this work? This would free up dietitians to spend time on what is most important: matching feeds to needs.
Enter HealthLeap. The company has developed a digital assistant, called NutriLeap, which solves several problems at once. The app uses machine learning to enhance the assessment of a patient’s needs and suggests the mix of nutrients they require based on medical history, body measurements, lab results, and symptoms. By plugging directly into the hospital electronic health record system, it can flag patients who are showing more subtle signs of risk that a harried dietitian, nurse, or doctor might otherwise miss. It then helps dietitians to match the precise patient needs with an optimal combination of nutrition products (based on available stock), which can consist of hospital diets, oral supplements, tube feeds, or intravenous solutions.
Typically, all of this work is done by hand: scanning charts to assess risk and carrying out complex manual calculations to come up with a precise plan for each patient. HealthLeap reduces those hours of arduous, painstaking work to seconds, unlocking a productivity revolution for dietitians while helping them deliver best-in-class treatment.
Take the case of a person with acute kidney failure. The dietitian uses age, sex, weight, symptoms, type of dialysis, electrolytes, and other tests to determine the levels of protein, fluid, magnesium, phosphorous, and potassium their kidneys can handle. The patient's kidneys improve, say, over the space of a week, during which time the dietitian continually recalculates and adjusts the tube feed composition to match improving kidney function. At the same time, the patient might be transitioning back to an oral diet. That means more calculations to prescribe a reduction in tube feeding amounts and an increase in oral intake.
HealthLeap’s recommendations get better over time. That’s because adjustments that dietitians make to its suggestions, the stream of studies and research that can influence clinical best practice, and patient health outcomes, are constantly fed into the algorithm. HealthLeap, in short, hands dietitians a superpower. Fewer patients will fall through the cracks, and those receiving treatment will be ensured a more optimal level of care.
Once patients leave the hospital, the app can also provide a critical bridge for aftercare, keeping them informed of their changing nutritional needs and providing a link to their dietitian. This is crucial to reducing hospital readmissions, a key incentive for hospitals because insurers can claw back reimbursements if certain patients are readmitted within 30 days of discharge.
Longer-term, HealthLeap aims to become the fulcrum of a new era of nutrition research. While a growing body of academic studies have highlighted the importance of nutrition in hospital care, the field is ripe for further investigation. A key blocker, however, has been a paucity of accessible data. HealthLeap’s trove of patient data could become the key resource for future scientific exploration, while also delivering immediate benefit to millions of patients.
HealthLeap is led by Jemima Meyer, Josiah Meyer, and Ray Botha. Jemima is a clinical dietitian who saw first-hand the tragic effects of widespread and untreated malnutrition in hospitals. Frustrated, she built a rudimentary version of NutriLeap for herself and shared it with her colleagues, for whom it swiftly became a vital tool. She then showed it to her brother Josiah, and his close friend, Ray, both serial entrepreneurs. Josiah studied statistics and machine learning and has been starting profitable ventures since his teens. Ray was previously the founder and technical brains behind a successful $250M AI-powered crypto trading startup, where Josiah was the product manager until they both quit to start HealthLeap.
At Fifty Years, our sweet spot is supporting founders at the earliest stages building deep tech companies that can generate huge financial outcomes and create massive positive impact.
Deep tech: Nutrition is a critical component of patient care but is dramatically under-resourced. A machine-learning enabled tool that can process the dizzying number of factors that go into screening at-risk patients, creating feeding plans, and updating them as patients travel through treatment and recovery would address one of the most complex and vexing problems in modern medicine.
$1B yearly revenue potential: America spends more than $4 trillion annually on healthcare. Malnutrition is a significant, silent contributor to that sum. It leads to worse patient outcomes, longer hospital stays, and higher morbidity and hospital readmission rates. A company that effectively addresses the problem will generate not only billions of dollars in industry savings but become a vital cog at the heart of an industry that represents one-fifth of US GDP.
Massive positive societal impact: Hospital malnutrition affects tens of millions and is getting worse as the population ages. By 2030, one in five Americans will be over 65, the part of the population most prone to both malnutrition and hospitalization, where the former often gets worse. HealthLeap can save millions of lives by enabling dietitians to find at-risk patients sooner, treat them faster, and help them maintain healthy habits after treatment.
Inspired by their vision and incredibly fast execution, Fifty Years was proud to lead HeathLeap’s pre-seed round and we’re looking forward to continuing to help Jemima, Josiah, and Ray radically improve health outcomes by enabling more people to get the nutrition they need.
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Great article! Looking forward to what the future holds for the app. As a dietitian myself I can attest to the need for technology to improve efficiency and patient care.
Good to see talented people focusing on true underlying problems rather than the symptoms.