Common factors that lead to malabsorption and malnutrition - Revisiting the healthy diet

Question 1

List the groups of people most likely to suffer from malnutrition

Answer 1

Poor dietary intake
Excessive energy dense/nutrient light diets
Extreme diets (removal of one or more food groups)
In addition concerns about people in care or in hospital
Being malnourished due to age, long term ill health
Being housebound
Disease related

Question 2

Which diseases cause maldigestion?

Answer 2

Chronic pancreatitis, cystic fibrosis, pancreatic carcinoma

Question 3

Which diseases cause inadequate absorptive surface?

Answer 3

Intestinal resection, gastro colic fistula, jejuno-ileal bypass

Question 4

Which diseases cause bile salt deficiency?

Answer 4

Cirrhosis, cholestasis, bacterial overgrowth, impaired ileal reabsorption, bile salt binders

Question 5

Which diseases cause lymphatic obstruction?

Answer 5

Lymphoma, Whipple’s disease, intestinal lymphangiectasia

Question 6

Which diseases cause vascular disease?

Answer 6

Constructive pericarditis, right sided heart failure, mesenteric arterial or venous insufficiency

Question 7

Which diseases cause mucosal disease?

Answer 7

Infection (giardia, Whipple’s disease, tropical sprue, Inflammatory diseases, radiation enteritis, eosinophilic enteritis, ulcerative jejunitis

Question 8

What does energy demand depend on?

Answer 8

Energy demand – age, gender, size and activity

Question 9

In health how is glucose the primary energy fuel?

Answer 9

Metabolism and citric acid cycle

Question 10

In absence of food glucose how is energy gained by the body?

Answer 10

In absence of food glucose maintained through mobilisation of stores of glycogen and if prolonged gluconeogenesis - body mass conserved

Question 11

When is energy requirement reduced?

Answer 11

In disease age, gender, size and inflammatory response – activity and appetite reduced

Question 12

How does malnutrition develop in acutely unwell patients?

Answer 12

Failure to recognise nutritional need on admission –
Increased energy demand during inflammatory responses
Prolonged periods of time ‘nil by mouth’ prior to treatment or investigations
Impact of cognitive impairment on eating
Reduction in appetite

Question 13

What is the main factor we should consider in an unwell patient?

Answer 13

Energy

Question 14

Where do public nutrition guidelines come from? Who decides?

Answer 14

Public health england decides

Scientific advisory committee on nutrition

Question 15

Name some different dietary models

Answer 15

Eatwell plate- This is designed for as a general guide for public health
Not appropriate for all people.
Need to offer more specific guidance for individuals with unique health needs (Often with help of dietitian).
Mediterranean diet
DASH diet- dietary action stop hypertension
Low carb diets
Intermittent fasting
Time Restricted eating

Question 16

Why do the models change?

Answer 16

Research is ongoing:
No evidence to suggest one diet will work best for all.
Patient choice and clinical judgement is key.