Malnutrition Flashcards
What is malnutrition?
A state of nutrition with a:
- deficiency, excess or imbalance of energy, protein and other nutrients
=> causes adverse effects on tissue, body form and function
What are the possible physiological mechanisms that underlie malnutrition?
- Decreased intake
- Impaired digestion and/or absorption
- Increased nutritional requirements
- Increased nutrient losses
Why may a patient have decreased intake of food?
- poor appetite
- pain on eating
- medication side effects
- dysphagia
- sore mouth
What can cause decreased digestion/ absroption of food?
pathology in:
- stomach (gastritis)
- intestine (Coeliac/ Crohn’s)
- pancreas
- liver
What can cause the body to have an increased nutritional requirement?
- catabolism infection
- trauma
- burns
- surgery
What can cause increased loss of nutrients from the body?
- vomiting
- diarrhoea
- stoma losses
Most patients experiencing malnutrition live in a Nursing Home or Residential Home. TRUE/FALSE?
TRUE
What percentage of hospital patients are considered malnourished?
30-40%
How can malnutrition lengthen a patients stay in hospital?
a chronic condition results in poor food intake
=> patient becomes malnourished and experiences GI dysfunction, poor wound healing and increased risk of infection
=> this makes them not want to eat => worsening food intake and malnutrition
=> their stay in hospital lengthens to break this cycle
What are the potential psychosocial causes of malnutrition?
- Self neglect
- Deprivation
- Bereavement/ Loneliness
- Inability to access food
- Lack of cooking skills or facilities
- Poor eating environment
- Lack of assistance
Describe how starvation affects metabolism, weight and hormones
- metabolic rate decreases
- weight loss is slow (all from fat stores)
- hormones show small increase at start (catecholamines/cortisol etc) then fall. Insulin decreases
Describe how injury affects metabolism, weight loss and hormones in the body.
- Metabolic rate increases
- weight loss is FAST (80% from fat store, remainder protein)
- Increases in hormones (catecholamines, cortisol, GH) Insulin increased but relative insulin deficiency
- Salt and water retention occurs
What common effects can malnutrition cause in a patient?
- poor immune response/ wound healing
- fatigue, weakness and inactivity
- water and electrolyte disturbances
- impaired thermoregulation
- menstrual irregularities
- psychosocial impairment
Weight loss can be a symptom of a variety of GI diseases. Give some examples.
- Coeliac
- Crohn’s
- Cancer (oesopahgeal/gastric/colorectal)
- intra-abdominal infection
- impaired GI motility
- acute liver disease
How is malnutrition screened for/ identified?
- physical appearance very thin
- recent unplanned weight loss in history
- loose fitting clothing/jewellery that used to fit
- risk of under-nutrition from recent illness
- swallowing difficulty present which could impair persons ability to eat and drink
WHat scoring system is used to assess patients nutritional status and when should this be completed during their hospital stay?
- MUST score
- all patients must be screened within 1 day of admission
- Also screened at regular intervals throughout their stay
What physical measurements can be used as part of a nutritional assessment?
Anthropometry
=> Mid-arm muscle circumference around Triceps
Grip strength
=> Refer to validated charts
What biochemical markers may be used in the assessment of malnutrition?
- Albumin
- Transferrin
- Transthyretin (prealbumin) [useful in monitoring response to nutritional support]
- Retinol binding protein (reflects recent dietary intake)
- IGF1
- Micro Nutrients
What vitamins and minerals are ALWAYS low in the high risk group for malnutrition?
- Vitamins A, C, D, E
- Zinc
What nutritional support options exist for those who are malnourished?
- Food fortification
- Oral nutrition support – e.g. snacks and/or sip feeds
- Enteral tube feeding
- Parenteral nutrition – the delivery of nutrition intravenously
Who needs nutritional support?
- BMI <18.5
- Unintentional weight loss >10% within the last 3–6 months
- BMI <20 and unintentional weight loss >5% within the last 3–6 months
- Poor absorptive capacity
- high nutrient losses
- increased nutritional needs from catabolism
What can be used in food fortification to improve the patients diet?
- use of cheese/ full fat milk in everyday diet to increase energy/ protein content without increasing overall amount of food consumed
- adding powdered nutritional supplements to food
- fortifying foods to increase calorie/protein intake
What issues do patients find interfere with their eating habits the most when admitted on a hospital ward?
- Presentation of food/drink
- Difficulty swallowing
- Unpleasant smells on the ward
- Treatment/ scans at mealtimes
- Lack of privacy
- Hospital crockery or cutlery
How can we help patients to want the food they are given on the ward?
- arrange protected mealtimes where they shouldn’t be disturbed
- Ensure food is within reach of patients
- Offer tea/coffee/refreshments
- Provide assistance/encouragement to patients
- Avoid routine administration of drugs/blood pressure/documentation etc during meal time
- Offer condiments
