Malnutrition Flashcards
What is malnutrition
-what are the types
Deficiency/excess energy, protein, nutrients => adverse outcomes on the patient
Starvation related malnutrition
-from social/psychological
Disease related malnutrition
-chronic or acute
Describe the epidemiology of malnutrition
5% of the population are malnourished, 1/3 are in older adults
-the majority of cases are in the community
At risk
50% of admissions to care homes
30% of admissions to hospital
20% of admission to mental health settings
How does malnutrition affect
- the individual
- family and carers
- society
Sarcopenia
Low mood
Decreased productivity and QOL
Increased risk of infections with slower recovery and mortality
Increased dependency on family, carers
-increased meal prep and worry
Increased GP visits, hospital admissions, POC, care home discharges and costs
Why do patients get malnourished
-biopsychosocial
Disease severity, inflammatory response Pain Comorbidities Dentition, swallow, GI function Medical interventions, surgery (NBM)
Social deprivation Isolation Loneliness MH Substance abuse
How would you do nutrition screening
- what is the point
- when would you do it
Identifies patients at risk/are malnourished
-can be done by non specialists
On inpatient admission, repeated weekly
At 1st outpatient appoinntment, repeated when worried
At 1st GP appointment, repeated when worried
On carehome admission, repeated monthly or when worried
How would you use the MUST
Step 1, BMI
- 0 20+
- 1 18.5-20
- 2 U18.5
Step 2, unplanned weight loss in past 3-6months
- 0 U5%
- 1 5-10%
- 2 10%+
Step 3, acutely ill and likely to be no nutritional intake for 5+ days
-2
0 = low risk => routine clinical care 1 = medium risk => observe and follow guidance 2 = high risk => refer to dietician, reweigh weekly and follow guidance
How would you measure someone if you can’t
When is it harder to measure accurately
Height
-kyphosis, osteoporosis
- recent documented/self reported
- ulna, knee height
Weight
- ascities, edema
- bedbound
- self reported
- estimate for ascities and edema
Can use self judgement, mid upper arm dircumference
Hoist scales
How would you assess for malnutrition
A-E assessment
Anthropometry - weight, body composition, weight changes
Biochemical - electrolytes and lab results
Clinical condition - disease severity, medications, comorbidity
Dietary intake - past, present and future
Environmental - psychological, social issues
What degree of weight loss is clinically significant over 3, 6, 12 months
U5% => not significant unless ongoing
5-9% => not significant unless rapid/already malnourished
10%+ => CLINICALLY SIGNIFICANT
THIS IS REGARDLESS OF BMI
How would you interpret someone’s BMI
U18.5 => chronically undernourished 18.5 - 19.9 => likely to be undernourished 20 - 24.9 => desirable 25 - 29.9 => overweight 30+ => obese
How would you establish someone’s dietary intake
Interview - rely on patient memory
- 24hour recall
- diet history of habitual intake
Record technique
- food record chart in wards
- dietary diary by patient
- weighed intake if assessing for allergies
What are we aiming to achieve from treatment
Behaviour change resulting in increased nutrient intake, improved diet
Body composition
-increased weight, fat and body mass
Patient centered outcomes
- symptom relief
- increased functional status and satisfaction
- decreased complications and mortality
How would you support patients with oral nutrition
Vast majority managed by oral support
- tube feeding (enteral nutrition) to replace or supplement oral intake
- parenteral nutrition when GI tract is non functional/inaccessible
Fortisip, fortijuice
=> significant reductions in mortality, complications and hospital admissions
How would you support patients with food fortification
For patients with poor appetite or early satiety
Also for altered texture diets
Fortify with milk powders, full fat products, cream, cheese, custard
=> significant reduction in complications
How would you counsel patients
Personal preferences, normal habits
Involving carers
