Malnutrition

Question 1

Definition

Answer 1

State in which deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome needed for tissue maintenance and repair

Question 2

Total deficiency

Answer 2

Due to inadequate total food intake or severe disease resulting in high losses or increase utilisation or malabsorption. This leads to protein-energy malnutrition.

Deficiencies of specific nutrients (ie vitamins/minerals) which tend to be due to specific malabsorption or restricted diets

Question 3

Causes

Answer 3

• Inadequate intake
• Absorption - impaired nutrient digestion and processing
• Utilisation
◦ May be using it all for inflammatory response
◦ Cannot put weight on /put on muscle / improve nutritional status whilst this is going on
◦ But you can prevent further losses
• Excess losses
◦ May be excessive e.g. protein losing enteropathy / nephrotic syndrome

Question 4

Excess loss [6]

Answer 4

• Vomiting
  
  • NG tube drainage
  • Diarrhoea
  • Surgical drains
  • Fistulae
  • Stomas

Question 5

Altered requirements [5]

Answer 5

• Inflammation
  
  • Cancer
  • Wounds
  • Burns
  • Brain injury

Question 6

Major contributor to [7]

Answer 6

increased morbidity and mortality, decreased function and quality of life, increased frequency and length of hospital stay, and higher healthcare costs

Question 7

Hospital causes [6]

Answer 7

• Inadequate / unpalatable / unsuitable food
  
  • Can’t reach the food / Can’t feed themselves
  • Altered taste / appetite
  • Nil by mouth
  • Starved for investigations
  • Starved pre/post surgery

Question 8

Inadequate intake - medical causes [7]

Answer 8

• 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

Question 9

Inadequate intake - environmental causes [4]

Answer 9

• 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

Question 10

Look out for [6]

Answer 10

•	Low weight
	•	Weight loss
	•	Poor intake (or predicted to be poor e.g. peri-surgical)
	•	Poor absorbative capacity 
	•	High nutrient losses
	•	Increased nutritional needs
	◦	Burns, sepsis, etc.

Question 11

Enhanced recovery [5]

Answer 11

•	Nutrition (pre & post-op)
	◦	avoid pre-op fasting / bowel prep
	◦	introduce oral feeding ASAP post-op
	◦	identify and support malnutrition early
	•	Analgesia
	•	Mobilisation
	•	Anaesthetic
	•	Fluid balance

Question 12

ESPEN guidelines [5]

Answer 12

Pre-op nutrition assessment 
High risk = 7-14 days pre-optimisation 
No prep starving until 6 hr before and drink = 2hr
High carb drink 2hr pre-op 
Oral intake resume within hours

Question 13

Malnutrition spiral [5]

Answer 13

◦	Mucosal atrophy
	◦	Achlorhydria (no stomach acid)
	◦	Reduced pancreatic enzyme output
	◦	Decreased intestinal motility
	◦	Increased mucosal permeability (to bacteria)