2.2:3 Undernutrition

Question 1

What is undernutrition?

Answer 1

A state of nutrition in which a deficiency of energy, protein and other nutrients cause measurable adverse effects on tuissue/body structure and function and clinical outcome

Question 2

What groups are at risk of undernutrition?

Answer 2

Children 
Elderly 
Disabled 
Mental health
Diseased

Question 3

What is the difference between nutrient specific and generalised undernutrition?

Answer 3

Nutrient specific: Vitamins, Proteins, Minerals

General: food

Question 4

What is the difference between primary and secondary undernutrition?

Answer 4

Primary: Inadequete intake
Secondary: Disease infection, increased requirements

Question 5

What is the bodies adapation to starvation?

Answer 5

Early starvation- Liver glycogen used to provide energy

Stores used up within 24 hours
Glucose synthesised by proteins
Fat metabolised to release FA

Long term- Lipolyssis is prefered, sparing protein

Question 6

What are the consequences of undernutrition?

Answer 6

Muscle function:

• Muscle wasting (sarcopenia)
• Increases muscle fatigability
• Leads to deterioration in respitory function
• Exacerbates pre-existing respiratroy disease eg COPD

Cardiovascular function:
- Loss of cardiac muscle with reduced cardiac output, poor tissue perfusion, hypotension

Gastrointestinal tract:

• Impaired gastric and pancreatic exocrine function reduced digestion
• Mucosal cell atrophy- reduced absorption
• Increased intestinal permeabilioty to bacteria

Immune system:
- Impaired immune response, poor healing, increased sickness
- Reduced survval
Increased requirements for repair
Long hospital stay
- Pos-operative complicxations more common in those who had lost more than 10% of their body weight
- Potentially increased risk of readmission

Increased risk of hypothermia

• Loss subcutaneous fat
• Reduced thermogenic response to cooling

Question 7

What are the phycological consequences to undernutrition?

Answer 7

• Fatigure/ weakness
• Deterioration in intracellular function
• Lack of initiative
• Bedrideen
• Apathy
• Depression
• Changes in behaviour and personality
• Exhaustion

Question 8

What is the treatment of undernutrition?

Answer 8

Increase nutrient intake to reverse effects of undernutrition

Question 9

What is something that we have to be cautious with when reversing effects of undernutrition?

Answer 9

Refeeding syndrome
Sudden administation of high glucose load in undernourushed patients can lead to

• Hypokalaemia
• Hypophosphataemia
• Hyperglycaemia
• Respiratory faliure (raised production of co2)
• Cardiac faliure

Initiate feeding slowly