Lecture 1: Malnutrition

Question 1

What is malnutrition?

Answer 1

Malnutrition is a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome.

Individuals can be overweight or underweight.

Question 2

What is the prevalence of obesity globally?

Answer 2

More than 1.9 billion adults overweight, and of these, >650 million adults obese

Question 3

What is the prevalence of malnutrition globally?

Answer 3

Roughly 500 million people

Question 4

What is the prevalence of malnutrition nationally?

Answer 4

Affects roughly 3 million people; predominantly effects hospital inpatients and outpatients

Question 5

What is the mechanism of malnutrition?

Answer 5

• Inadequate intake
• Impaired nutrient digestion and processing- malabsorption due to dysfunction of stomach, intestine, pancreas, or liver.
• Excess losses- due to vomiting, diarrhoea, surgical drains, or stomas.
• Altered requirements- due to increased metabolic demands as a result of infections, wounds or brain injury.

Question 6

What is simple starvation? How does simple starvation change over time?

Answer 6

Process whereby the body breaks down small amounts of protein and fat, in the absence of dietary fuel, to provide glucose via gluconeogenesis in order to fuel the body.

Over time, less protein is broken down to provide glucose via gluconeogenesis, and more fat is broken down to provide ketone bodies via ketogenesis.

Question 7

What is stress starvation?

Answer 7

Physiological process in response to lactate build up from extreme stress and prolonged infection/disease. Body breaks down large volumes of protein from muscles, and small amounts of fat, in order to supply the body with ample amounts of glucose via gluconeogenesis and ketogenesis processes

Question 8

What is the impact of malnutrition on the body?

Answer 8

• Reduced cardiac output
• Renal impairment
• Reduced strength
• Impaired wound healing
• Decreased immunity and poor gut integrity
• Impaired liver function

Question 9

At what point does malnutrition and weight loss begin to cause serious harm?

Answer 9

A 18% (or greater) loss of mass will lead to physiological disturbances. A 40% loss of mass is considered fatal.

Question 10

What is the physical cost of malnutrition to patients?

Answer 10

Patients attend their GP surgery more often, admitted to hospital more frequently, stay in hospital longer, succumb to infections, patients are often discharged to long-term care, patients more likely to die.

Question 11

What is the economical cost of malnutrition to the NHS?

Answer 11

Approx. £13 billion annually

Question 12

How do hospitals cause malnutrition?

Answer 12

• Inadequate / unpalatable / unsuitable food
• Can’t reach food / can’t feed themselves
• Altered taste / poor appetite
• NBM/ Starved for investigations (may get cancelled)
• Starved before and after surgery
• No protected meal times

Question 13

How do we assess and detect malnutrition?

Answer 13

BMI calculations/ anthropometry

MUST Screening Tool

Question 14

What factors are considered in the MUST malnutrition screening tool?

Answer 14

BMI, unplanned weight loss in the past 3-6 months, and presence of acute disease.

Question 15

What actions can be taken following the MUST screening tool?

Answer 15

• Low Risk: Routine clinical care
• Medium Risk: Observe and document dietary intake
• High Risk: Treat, refer to dietician, monitor dietary intake and review