malnutrition

Question 1

what is malnutrition?

Answer 1

a state in which a deficiency of nutrients causes measurable adverse effects on body composition, function or clinical outcome

Question 2

what diseases is malnutrition higher in? 2

Answer 2

• > 40% of patients with GI/liver disease

- 80% of patients with GI malignancy

Question 3

what is malabsorption?

Answer 3

impaired nutrient digestion and processing

Question 4

what is the mechanism of malnutrition? 4

Answer 4

• inadequate intake of nutrients
• impaired nutrient digestion and processing
• excess losses
• altered requirements

Question 5

what is malnutrition caused by? 4

Answer 5

dysfunction of stomach
dysfunction of intestine
dysfunction of pancreas
dysfunction of liver

Question 6

what are excess losses for malnutrition? 6

Answer 6

• vomiting
• NG tube for drainage
• diarrhoea
• surgical drains
• fistulae
• stomas

Question 7

what can cause an increase in metabolic demands? 5

Answer 7

• inflammation
• cancer
• wounds
• burns
• brain injury

Question 8

what are the types of simple starvation? 2

what is the other type of starvation?

Answer 8

• uncomplicated fasting (12-24 hours)
• uncomplicated fasting (7 days)
• stress starvation

Question 9

what is the impact of malnutrition in healthy people? 3

Answer 9

• decreased skeletal muscle mass and function after day 5
• 18% loss of mass leads to physiological disturbance- 45% reduction in CO, respiratory and diaphragmatic muscle mass and contractility is decreased
• 40% weight loss is fatal

Question 10

what are the effects of malnutrition? 10

Answer 10

• ventilation: loss of muscle and hypoxic responses
• psychology: depression/ apathy
• impaired liver: function and fatty change
• impaired gut integrity
• decreased immunity and resistance to infection
• impaired wound healing
• reduced CO
• impaired renal function
• reduced strength
• hypothermia

Question 11

why do malnourished patients cost more money for the NHS? 5

Answer 11

• visit the GP more often
• admitted to hospital more frequently
• succumb to infections
• discharged to long term change
• costs exceeding 1.3 billion a year

Question 12

how do hospitals cause malnutrition? 12

Answer 12

• inadequate/ unsuitable food
• can’t reach for food or feed themselves
• altered taste/ poor appetite
• NBM
• pain/nausea
• dysphagia
• depression
• physical disability and inability to feed self
• unconsciousness
• inadequate food availability
• no protected meal times
• inadequate training and knowledge of medical staff

Question 13

how do we prevent people becoming malnourished in hospital? 2

Answer 13

• find all patients who are at risk

- screen all patients weekly (MUST screening)

Question 14

what indicators are there for people who are potentially malnourished? 6

Answer 14

• low weight
• weight loss
• poor intake or predicted to become poor
• poor absorptive capacity
• high nutrient losses
• increased nutritional needs

Question 15

describe the MUST screening tool? 5

Answer 15

• step 1- BMI score
• step 2- weight loss score
• step 3- acute disease effect score
• step 4- overall risk of malnutrition
• step 5- management guidelines

Question 16

what has been done to address the problem of malnutrition in hospitals so far? 7

Answer 16

• MUST screening rolled out nationwide
• yearly MUST screening
• educating staff
• protected mealtimes
• volunteers at mealtimes
• improving recording food and fluid intake
• dedicated nutrition support teams and dieticians