Malnutrition Flashcards
Define malnutrition
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.
What does malnutrition mean?
A lack of nutrients / inappropriate nutrients
LINKED TO
An effect on body composition and function
The worldwide prevalence of obesity nearly _______ between 1975 and 2016.
Tripled
______fold increase in childhood and adolescent obesity in four decades
Tenfold
______ people affected globally by malnutrition
500 million
Name an example of a place in the world where malnutrition is deadly
Somalia – displaced persons camps
- Crude mortality rate 5 per 10.000/day = 18% in a year
- 74% of children <5yrs died during study (240d)
- 81% deaths due to measles and diarrhoeal illness
Malnutrition affects ______ people in Britain at any one time
3 million
Which hospital wards have the highest levels of malnutrition?
- Oncology
- Care of elderly/stroke
- Medical
- Other
- Surgical
- Orthopaedic/trauma
Which diseases have the highest Prevalece of malnutrition in relation to underlying disease?
>40% pts with GI/liver disease
Up to 80% GI malignancy
- Oesophageal 57%
- Gastric 65%
- Pancreatic 85%
Colorectal 33%
What are the 4 mechanisms of malnutrition?
- Inadequate intake
- Impaired nutrient digestion and processing
- Excess losses
- Altered requirements
How does impaired nutrient digestion and processing cause malnutrition?
Impaired nutrient digestion and processing
= malabsorbtion
Dysfunction of
- stomach
- intestine
- pancreas
- liver
How can excess losses cause malnutrition?
- Vomiting
- NG tube drainage
- Diarrhoea
- Surgical drains
- Fistulae
- Stomas
What are the possible reasons for increased metabolic demands?
- inflammation
- cancer
- wounds
- burns
- brain injury
What type of starvation is this?
Uncomplicated fasting
12-24 hours
What type of starvation is this?
Uncomplicated fasting
7 days
Complete the diagram
What is the impact of malnutrition in healthy people?
- Decreased skeletal muscle mass and function day 5
- 18% loss (and above) of mass leads to physiological disturbance
–Cardiac 45% reduction in CO
–Respiratory / diaphragmatic muscle mass and contractility
–Gut and immune function
What percentage of weight loss is fatal in a healthy person?
•Approximately 40% weight loss is fatal
What are the negative effects of malnourishement on patients?
- Attend their GP surgery more often
- Are admitted to hospital more frequently
- Stay in hospital longer
- Succumb to infections
- Often discharged to long-term care
- Die
What is the cost of malnutrition to the NHS?
- Health costs exceeding GBP 13 billion annually
- Identifying and treating malnutrition presents the fourth biggest potential saving in the NHS today
___% of patients are malnourished at admission to hospital
40%
- On average 200 lost ______% of their weight during hospital stay
- Those referred for nutrition support put on _____% during their stay
6%
10%
How do hospitals cause malnutrition?
- Inadequate / unpalatable / unsuitable food
- Can’t reach food / can’t feed themselves
- Altered taste / poor appetite
- NBM
- Starved for Ix
- And then again if the Ix gets cancelled
- Starved before and after surgery
What are the possible medical causes of indaequate intake?
- Poor diet
- Poor appetite/Anorexia/Taste disturbances
- ‘Nil by mouth’ for investigation or medical reasons
- Starved before diagnostic procedures – and often cancelled
- Starved before and after surgery
- Pain/Nausea
- Dysphagia
- Depression
- Physical disability and inability to feed self
- Unconsciousness
What are the possible environmental reasons for inadequate intake?
- Inadequate food quality (meals unpalatable, food poor in nutrients, served of improper temperature)
- Inadequate food availability outside the reach of elderly or physically incapacitated patients)
- No protected meal times
- Inadequate training and knowledge of medical and nursing staff
How can you find patients at risk of malnutrition?
All hospital inpatients on admission and all outpatients at their first clinic appointment should be screened. Screening needs to be repeated weekly for inpatients and when there is clinical concern for outpatients
What possible indicators of malnutrition should you be looking for?
- Low weight
- Weight loss
- Poor intake or predicted to become poor (ie planned surgery)
- Poor absorptive capacity
- High nutrient losses
Increased nutritional needs (burns, sepsis etc)
How can BMI be estimated?
How can height be estimated?
How do you calculate a MUST score?
What is an approriate clinical response to the different MUST scores?
What has been done so far to address the problem of malnutrition?
- MUST screening rolled-out nationwide
- Yearly MUST-screening (allows hospitals to show they are screening patients for malnutrition)
- Educating staff (improved timing / help at meals, mouth care etc)
- Protected meal times
- Volunteers helping at meal times
- Improving recording food and fluid intake
- Dedicated Nutrition support teams and dietitians
