Malnutrition

Question 1

What are the fixed and variable influences on dietary demand?

Answer 1

Fixed (basal metabolic rate):

• Membrane pumps, transport and signalling
• Mechanical work at a cellular and tissue level
• Substrate turnover

Variable:

• Physical Activity
• Maintaining body temp
• Growth
• Processing dietary intake

Question 2

How do we calculate basal metabolic rate?

Answer 2

We can use direct calorimetry

Or more commonly use equations adjusted for illness, age, acqtivity etc.

Question 3

Define malnutrition

Answer 3

A state where an imbalance of energy, protein & other nutrients causes measurable adverse effects on body form, function and clinical outcome.

Question 4

What are the major signs of malnutrition?

Answer 4

Severe under-nutrition causes marasmus and kwashiorkor.

Over nutrition leads to obesity

Question 5

Define marasmus and kwashiorkor

Answer 5

significantly lower than expcted weiht

Salt and fluid retention brought on by under nutrition leading to oedema & Ascites

Question 6

How do we calculate BMI?

Answer 6

Weight in K
Divided by Height squared in metres

So for me roughly 75/1.8squared = 23

Question 7

Define overweight in terms of BMI?

Answer 7

Overweight = BMI>25

Obese = BMI > 30

Question 8

What are some conditions obesity predisposes you to?

Answer 8

Breast and bowel cancer

Hypertension, CVD disease, Diabetes, Fatty liver, NASH, Cirrhosis etc.

Question 9

Define underweight in terms of BMI?

Answer 9

Underweight = BMI <20

Physical impairment tends to occur <18 and conseqeunces get severe <16

Question 10

What are the clinical consequences of undernutrition?

Answer 10

• Impaired immune response
• Reduced muscle strength
• Impaired wound healing
• Impaired recovery from illness/surgery
• Impaired psycho-social function
• Poor clinical outcomes

Question 11

What can cause under nutrition and how do we classify them?

Answer 11

Split into:
Appetite Failure:
- E.g. Anorexia or Flu

Access Failure:

• Teeth problems
• Head injury
• Cancer of head/neck

Intestinal failure

• Loss of functioning gut mass below minimum required for digestion/absorption
• E.g. Short bowel syndrome
• Very Rare

Question 12

How do we screen for patients at risk of undernutrition?

Answer 12

With the Malnutrition Universal Screening Tool! (MUST)

It can be carried out by anyone, no training required

Question 13

What are the questions of MUST?

Answer 13

BMI:

• <20 = 1 point
• <18.5 = 2 points

Weight Loss:
Unplanned in last 3-6 months
- 5-10% of body mass = 1 point
- >10% = 2 points

Eating:
Have you eaten in last 5 days? (also if the patient is acutely ill and is likely to have no nutrional intake for more than 5 days)
- No = 2 points

Total score is from 0-6

Question 14

How do we respond to a MUST Score?

Answer 14

0 - Review in the future, i.e. monitoring. This is done for patients and people in care homes + other risk groups

1 - Supplements, dietary advice and close monitoring

2 or more - Dietary advice, supplements, refer to a dietician

Question 15

What are the high risk groups for malnutrition?

Answer 15

• The ill
• Socially isolated
• Old age
• Socially vulnerable groups

Question 16

How do we treat malnutrition?

Answer 16

Call a state registered dietician

Question 17

What types of feeding are available for the undernourised in hospital?

Answer 17

Fine Bore NG tube

Percutaneous Endoscopic Gastrostomy (PEG) tube
- I.e. a tube passes into stomach through abdominal wall

IV feeding
- For people with intestinal failuer

Sip feeds:
- Oral nutritional supplements