Malnutrition Flashcards
What is malnutrition?
A state in which deficiency, excess or imbalance, of energy, protein or other nutrients, results in a measurable adverse effect on body composition, function and clinical outcome
What is the NICE malnutrition definition?
1 of the following:
- BMI <18.5
- Unintentional weight loss >10% within the last 3-6 months
- BMI of <20 and unintentional weight loss >5% within the last 3-6 months
What is the epidemiology of malnutrition?
Around 10% of people >65 are malnourished, with majority living independently
What are the risk factors for malnutrition?
crohn’s disease, dysphagia, socially isolated, low income
What are the causes of malnutrition?
- Reduced intake:
- contraindicated
- disease related anorexia
- taste changes
- Nil by mouth (prolonged)
- Food options
- Depression
- Inactivity
- Oral health
- Fatigue - Maldigestion/ malabsorbtion:
- function
- length of bowel
- loss of bowel
- drug- nutrient interactions (e.g. bile salts) - Altered metabolism
What are the presenting symptoms/ signs of malnutrition?
- Unintentional Weight Loss
- Lack of interest in eating or drinking
- Feeling tired all the time
- Feeling weak all the time
- Getting ill often and taking long to recover
What investigations are used to diagnose/ monitor malnutrition?
- MUST (Malnutrition Universal Screen Tool)
- Should be done on admission to care/nursing homes or hospital, or if concern of malnutrition
- Takes into account BMI, recent weight change and the presence of acute disease
- Categorises patients into low, medium and high risk - Assessment by dietiatian
How is malnutrition managed?
- Dietician Support
- ‘Food First’ approach with clear instructions (before ONS)
- Oral Nutritional Supplements (ONS) → taken between meals (not a replacement)
- If Severe ⇒ Feeding Tube (Enteral Nutrition - food passes through GI tract) or Parenteral Nutrition (IV infusion into. central vein, eg. subclavian vein):
- Side effect of enteral feeding is diarrhoea
- Total Parenteral Nutrition → commonly used in nutritionally compromised surgical patients
Refeeding Syndrome ⇒ metabolic abnormalities which occur on feeding a person following a period of starvation
- Hypophosphataemia, hypokalaemia, hypomagnesiumaemia (may predispose to torasades de pointes)
- Prevention → if a patient hasn’t eaten for >5 days, aim to re-feed at no more than 50% of requirements for the first 2 days.
What general complications may arise from malnutrition?
- Immune system
- Reduced ability to fight infection - Muscles
- Inactivity and reduced ability to work, shop, cook and self-care
- Inactivity may also lead to pressure ulcers and blood clots
- Falls
- Reduced ability to cough may predispose to chest infections and pneumonia
- Heart failure - Impaired wound healing
- Kidneys
- Inability to regulate salt and fluid can lead to over-hydration or dehydration - Brain
- Malnutrition causes apathy, depression, introversion, self-neglect and deterioration in social interactions - Reproduction
- Malnutrition reduces fertility and if present during pregnancy can predispose to problems with diabetes, heart disease and stroke in the baby in later life. - Impaired temperature regulation
- This can lead to hypothermia
What are the consequences of malnutrition in children and adolescents?
- Growth failure and stunting
- Delayed sexual development
- Reduced muscle mass and strength
- Impaired intellectual development
- Rickets
- Increased lifetime risk of osteoporosis
What are the consequences of specific micronutrient deficiencies?
- Iron deficiency can cause anaemia
- Zinc deficiency causes skin rashes and decreased ability to fight infection
- Vitamin B12 deficiency can cause anaemia and problems with nerves
- Vitamin D deficiency causes rickets in children and osteomalacia in adults
- Vitamin C deficiency causes scurvy
- Vitamin A deficiency causes night blindness
