Malnutrition

Question 1

Definition

Answer 1

A lack of nutrients/inappropriate nutrients linked to an effect on body composition and function

Question 2

Prevalence of obesity globally

Answer 2

More than 1.9 billion adults overweight
Of these >650 million adults obese
39% of adults overweight
13% of adults population obese

Question 3

Prevalence of Malnutrition nationally

Answer 3

Affects 3 million people in Britain
Community/GP - 10%
Sheltered housing and elderly at home - 14%
Hospital outpatients 20%
Hospital inpatients 30%
Children in hospital up to 14%

Question 4

Prevanlence of malnutrition in relation to underlying disease

Answer 4

>40% pts with GI/liver disease; up to 80% GI malignancy
Oesophageal 57%
Gastric 65%
Pancreatic 85%
Colorectal 33%

Question 5

Mechanism of Malnutrition

Answer 5

Inadequate intake
Impaired nutrient digestion and processing (=malabsorption) (due to dysfunction of stomach, intestine, pancreas, liver)
Excess losses (through vomiting, HG tube drainage, diarrhoea, surgical drains, fistulae, stomas)
Altered requirements (increased metabolic demands)(inflammation, cancer, wounds, burns, brain injury)

Question 6

Types of Starvation

Answer 6

Simple starvation - uncomplicated fasting (12-24 hours) and uncomplicated fasting (7 days)
Stress Starvation

Question 7

Impact of Malnutrition

Answer 7

Decreased skeletal muscle mass and function
18% loss of mass leads to physiological disturbance (reduction in CO, respiratory/diaphragmatic muscle mass, gut and immune function)
40% weight loss is fatal

Question 8

Malnutrition gets worse during a hospital stay

Answer 8

200/500 pts malnourished on admission
On average 200 lost 5.6% of weight during hospital stay
Those referred for nutrition support put on 9.6% during their stay
Causes: inadequate/unpalatable/unsuitable food; can’t reach food; altered taste/can’t feed themselves; NBM; starved for surgery; starved again if Ix is cancelled

Question 9

Inadequate Intake

Answer 9

Medical causes: poor diet/anorexia/taste disturbances; nil by mouth for investigation or medical reasons
Environmental causes: inadequate food quality/availability; no protected meal times; inadequate training and knowledge of medical staff
Preventing this: look out for low weight; weight loss; poor intake; poor absorptive capacity; high nutrient losses; increased nutritional needs (burns/sepsis)

Question 10

Screening

Answer 10

Step 1: BMI score
Step 2: weight loss score
Step 3: acute disease effect score
Step 4: overall risk of malnutrition
Step 5: management guidelines
0 = low risk - routine clinical care
1 = medium risk - observe
2 or more = high risk - treat

Question 11

What has been done to improve intake

Answer 11

MUST screening rolled out nationwide
Yearly MUST screening
Educating staff
Protected meal times (and volunteers helping at meal times)
Improving recording food and fluid intake
Dedicated nutrition support teams and dietitians