Malnutrition Flashcards
what is malnutrition
A state in which deficiency of nutrient such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome
(A lack of nutrients/inappropriate nutrients linked to effect on body composition and function)
includes overnutrition
what is an example of over nutrition
global obesity pandemic
obesity prevalence tripled between 1975 and 2016
Tenfold increase in childhood and adolescent obesity in four decades
what is the prevalence of malnutrition globally
500 million affected
Eg Somalia – displaced persons camp
Disproportionately effects children
what is the prevalence of malnutrition nationally
Mostly in care settings eg kids in hospital, hospital in and out patients, sheltered and elderly housing
Ageing population – increase chance of getting malnutrition
how can chance of getting malnutrition vary
Risk changes with hospital ward – more likely on oncology, less likely on theatre or orthopaedic/trauma
Higher in certain disease – greater than 40% for GI disease and up to 80% for GI malignancy, high for oesophageal, gastric, pancreatic, colorectal
how prevalent is malnutrition in surgical patients
Malnutrition high in those undergoing general surgery, GI, cancer surgery, far lower for major vascular surgery
what is the mechanism of malnutrition
Impaired nutrient digestion and processing – malabsorption
Dysfunction of stomach, intestine, pancreas, liver
Excess losses by vomiting, NG tube drainage, diarrhoea, surgical drains, fistulae, stomas
Altered requirements
Increased metabolic demands – inflammation, cancer, wounds, burns, brain injury
what is simple starvation (12-24 hours)
uncomplicated fasting
Mostly muscle breakdown for gluconeogenesis in the liver, glycogen stores for periphery and glucose for brain
fat used for liver (glycerol) and periphery
what is simple starvation (7 days)
uncomplicated fasting
less muscle breakdown, ketogenesis over takes gluconeogenesis so ketone bodies for brain, peripheries
more fat broken down
what is stress fasting
ischaemic tissue provides lactate for glycogen
muscle and fat for gluconeogenesis and small amount of ketogenesis
glucose for periphery and brain
how are simple and stress starvation similar
insulin plasma and resistance increase
how are simple and stress starvation different
simple dec metabolic rate, protein synthesis and blood glucose and stress inc them
when does stress starvation increase a parameter more than simple starvation
muscle protein breakdown
gluconeogenesis
salt and water retention
when does simple starvation increase a parameter more than stress starvation
plasma albumin
ketone bodies
nitrogen balance (dec less)
what are the effects of malnutrition in healthy people
ventilation - loss of muscle and hypoxic responses impaired liver function and fatty change impaired gut integrity and immunity decreased immunity and resistance to infection impaired wound healing reduced strength hypothermia depression and apathy reduced CO impaired renal function
what approximate weight loss is fatal
40%
what does malnutrition result in
A major contribution increased morbidity and mortality, decrease function and quality of life, increased frequency and length of hospital stay and higher healthcare costs
what is the cost of malnutrition
Attend GP more often, admitted to hospital more frequently, stay in hospital longer, succumb to infections, often discharged to long term care or die
4th biggest potential saving in the NHS (by identifying and treating it)
Malnutrition gets worse during hospital stay
How does malnutrition get worse in hospital
Inadequate, unpalatable, unsuitable food
Cant reach food or feed themselves
Altered taste and poor appetite
NBM
Starved for investigations, can get cancelled or redone
Starved before and after surgery
medical causes for inadequate intake
Poor diet Poor appetite/anorexia/taste disturbances NBM for investigation/medical reasons Pain/nausea Dysphagia Depression Physical disability and inability to feed self Unconsciousness
environmental causes for inadequate intake
Inadequate quality (unpalatable, poor in nutrients, improper temperature)
Inadequate availability, outside reach of elderly or physically incapacitated patients
No protected meal times
Inadequate training and knowledge of staff
how is inadequate intake prevented
Find at risk patients – screened (repeated weekly for inpatients or when there is clinical concern for outpatients)
Look out for – low weight, weight loss, poor intake or predicted to become poor, poor absorptive capacity, high nutrient losses, increased nutritional needs (eg burns, sepsis)
what is the MUST screening tool
BMI, weight loss score, acute disease affect score
overall risk of malnutrition
management guidelines (in line with risk)
how is malnutrition dealt with currently
Yearly screening
Educating staff
Protected meal times
Volunteers helping at meal times
Improving recording food and fluid intake
Dedicated nutrition support teams and dieticians
All Doctors should know about it and how to detect and treat it
