Malnutrition Flashcards
Define malnutrition
A state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue, body form (body shape, size and composition), function and clinical outcome
Name some effects of disease related causes of malnutrition
Decreased intake
impaired digestion / absorption
Increased nutritional requirements
Increased nutrient losses
How many hospital admissions are identified as malnourished?
30-40%
What happens to the majority of patients who are treated for malnutition
They improve their nutritional status
Name some economic consequences of malnutrition in the over 65s
More hospital admissions
Longer length of stay
more GP visits
More OP visits
What is the main difference between short term and long term malnutrition?
Short term is adaptive and they usually return to normal
Long term is a gradual decline and harmful
Describe the malnutrition cycle
Anorexia and weight loss result in complications, contributing to illness which results in a hospital admission
What do chronic conditions often result in
Poor food intake leading to malnutrition
What is an effect of malnutrition in the GI system
Dysfunction - increased infection rate, decreased wound healing and physical weakness. These all result in a poor food intake
Describe some acute events which can lead to poor food intake
Sepsis, pneumonia, fever, surgery, trauma, radiotherapy, chemotherapy
Name some psychosocial causes of malnutrition
Inappropriate food provision self neglect lack of assistance bereavement inability to access food poor eating environment deprivation loneliness lack of cooking skills/ facilities
What happens to the metabolic rate in starvation
Reduced
What happens to the weight in starvation
slow loss, almost all from fat stores
What happens to the water and sodium in starvation
Initial loss but then late retention
What happens to the metabolic rate in injury
Increased
What happens to the weight in injury
Rapid loss 80% from fat stores, remainder from protein
What happens to water and sodium
Retained
Name some adverse effects of malnutrition
Impaired immune responses Impaired wound healing reduced muscle strength and fatigue reduced respiratory muscle strength inacrtivity, especially in bed bound patient water and electrolyte disturbances impaired thermoregulation menstrual irregularities. amenorrhoea impaired psycho-social function
What can weight loss be an indicator for?
Impaired GI motility Acute liver disease Intra- abdominal infection acute liver disease coeliac disease oesophageal cancer gastric cancer colorectal cancer crohn's disease
Name some consequences of malnutrition
Impaired immune function Delayed healing pressure sores Immobility Muscle weakness Cardio-respiratory weakness Psychosocial effects Length of stay Hospital costs Prolonged recovery
When do we screen for risk of under nutrition?
On admission and at regular intervals thereafter
What screening tool do we use in Tayside?
MUST (Malnutrition Universal Screening Tool)
What is the usefulness of albumin in nutritional assessment?
Constitutes around 50% of total protein in plasma
Low levels therefore could indicate malnutrition although this can be affected by various other factors
Generally speaking, what is the trend in biochemical assessment of nutritional status
Most tests are reduced or poor in malnourished individuals
What type of person requires nutritional support?
BMI <10% within the last 3-6 months
No nutritional intake for 5 days
Poor absorptive capacity or high nutrient losses
Name some types of nutrition support
Food fortification and dietery counselling
Oral nutrition support (additional snacks)
Enternal tube feeding (PEG)
Parenteral nutrition (IV)
Name some oral nutritional supplements
Ready made drinks (sip feeds)
Powders to reconstitue with milk (Build up, ensure)
Pudding with forticreme
Name some fat supplements
Calogen
Proc-Cal is used for what?
Fat and protein supplements
What does ETF stand for
Enteral Tube feeding
How does ETF work
Delivers nutritional complete feed via a tube into the stomach (NG, NJ, PEG)
The feed is nutritionally complete
What are the indications for ETF
Inadequate or unsafe oral intake (SALT)
A functional, accessible GI tract
What are some contra-indications for ETF
Lower GI obstruction Prolonged intestinal ileus Severe diarrhoea or vomiting High enterocutaneous fistula Intestinal ischaemia
What are some complications of ETF
Nasal damage Tube falls ut Oesophagitis Aspiration Nausea Hyperglycaemia Fluid overload Electrolyte disturbance
What is parenteral Nutrition
The administration of nutrient solutions via a central or peripheral vein
What are the problems with Parenteral nutrition
Expensive
Complications are life threatening
Needs specialist skills
Psycho-social disturbance
What is the main indicator for parenteral nutrition?
A non-functional, inaccessible or perforated (leaking) GI tract
What are some reasons for a perforated GI tract?
IBD with severe malabsorption
Radiation enteritis
Short bowel syndrome
Motility disorders
How do you estimate energy requirements
calculate basal metabolic rate
May need to add factor to account for increased requirements caused by metabolic stress of disease
Add factors for activity and thermomgenesis
May add/ subtract energy to allow weight gain/ loss
What is refeeding syndrome?
Potentially fatal shifts in fluids and electrolytes and disturbances in organ function and metabolic regulation that may result from rapid initiation of re feeding after a period of under nutrition
How can excessive feeding be administered?
By PN or EN
What are some of the metabolic features of refeeding syndrome?
Hypokalaemia Hypophosphataemia Hypomagnesaemia Altered glucose metabolism Fluid overload
What are some of the physiological features of refeeding syndrome?
Arrhythmias Altered level of consciousness Seizure Respiratory failure Cardiovascular collapse Death
Who is at moderate risk of refeeding syndrome?
Patients who have had little or no nutritional intake for >5days
Who is at extremely high risk of refeeding syndrome?
BMI 15days
What is the prevention and management of refeeding syndrome in moderate risk patients?
Introduce a nutrition support at a maximum of 50% of requirement for the first 48hours
Monitor clinical and biochemical parameters
Increase nutrition support to meet full requirements if monitoring reveals no problems
What 4 things do we need to check in high risk refeeding syndrome patients?
PO4, Mg2+, K+ and Ca2+
What rate of feed do we start high risk patients on?
10kcal/kg/day
What is the rate of feed that we start extremely high risk patients on?
5kcal/kg/day
What can with-holding nutrition be perceived as?
Neglect
