1b// Malnutrition and Nutritional Assessment Flashcards
What is the definition of 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
Who is most at risk of malnutrition?
chronic illness e.g., diabetes
over 65 y/o
any gastrointestinal dysfunction
progressive disease e.g., cancer
misuse of alcohol or drugs
What happens to 1 in 3 patients who are malnourished at acute admission?
hospitalisation exacerbates nutrition risk
70% have lost weight at discharge- mainly muscle
What are the causes of malnutrition in hospital? (3)
Reduced intake
Maldigestion/ malabsorption
Altered metabolism
What are reasons for reduced intake in hospital?
*Contraindicated
* Disease related anorexia
* Taste changes
* Nil by mouth
* Food options
* Depression
* Inactivity
* Oral health
* Fatigue
What are reasons for maldigestion, malabsorption in hospital? (4)
- Function
- Length
- Losses
- Drug-nutrient interactions
Describe the altered metabolism in hospital?
Figure 1. Metabolic response to injury proposed by Cuthbertson et al. A short ebb phase characterized by hypometabolism occurs immediately after the injury and is characterized by a decrease in metabolic rate, oxygen consumption, body temperature, and enzymatic activity. The ebb phase is followed by a longer hypermetabolic flow phase marked by an increased catabolism, with a high oxygen consumption and an elevated REE rate.
What is the impact of malnutrition on mortality?
postoperative mortality 10x greater in those who had lost >/20% bodyweight preoperatively, compared to those who had lost less
direct cause of hospital deaths
and a contributory factor in hospital deaths
What is the impact on the patient of malnutrition?
increase= 6
decrease= 4
Physical and functional decline and poorer clinical outcomes
↑ Mortality, septic and post surgical complications, length of hospital-stay, pressure sores, re-admissions, dependency
↓ Wound healing, response to treatment, rehabilitation
potential, quality of life
What is an economic negative of malnutrition?
£ 19.6 billion 15% of the total public expenditure on health and social care.
What will a dietician need information on to assess a patient to see if they are malnourished?
Ø Anthropometry
Ø Body composition Ø Function
Ø Biochemistry
Ø Clinical
Ø Dietary
Ø Social
Ø Physical
Ø Requirements
screen-> assess-> diagnose
What types of people will need nutrition support?
malnourished
at risk of malnutrition
What are the indications for nutrition support for malnourished people according to NICE 2006?
BMI < 18.5 kg/m2 or
Unintentional weight loss >10 % past 3 - 6 / 12 or
BMI<20kg/m2 +unintentional weight loss >5% past 3–6/12
What are the indications for nutrition support for people at risk of malnutrition according to NICE 2006?
Have eaten little or nothing for > 5 days and / or are likely to eat little or nothing for the next 5 days or
longer or
Have a poor absorptive capacity, and / or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism.
What is the algorithm for the treatment of malnutrition?
*always aim for oral nutrition
What is artificial nutrition?
The provision of enteral or parenteral nutrients to treat or prevent malnutrition.