Malnutrition and Malabsorption

Question 1

Malnutrition

Answer 1

= an important consequence and contributor to chronic disease

A complex multifactorial problem which can be difficult to manage

NICE Definition:
- BMI < 18.5
OR Unintentional weight loss > 10% in last 3-6m
OR BMI < 20 + intentional weight loss > 5% in last 3-6m

10% patients >65 are malnourished, the vast majority of those living independently (not in hosp/nursing home)

Screening tool for Malnutrition = MUST
Malnutrition Universal Screening Tool
- Should be done on admission to care/nursing H and hospital or if there is concern e.g. elderly, thin, pressure sores
- Takes into account BMI, recent weight change and presence of acute disease
- Categorises patient into low, medium, and high risk

Mx of Malnutrition:

• Dietician support if patient is high risk
• A ‘food-first’ approach with clear instructions (e.g. add full fat cream to mash potato) rather than just prescribing oral nutritional supplements (ONS) such as Ensures. If ONS are used they should be between meals rather than instead of.

Question 2

Malabsorption

Answer 2

Characterised by

• DIARRHOEA
• STEATORRHOEA
• WEIGHT LOSS

Causes can be divided into:
INTESTINAL: Eg villous atrophy
- Coeliac
- Crohn's
- Tropical Sprue
- Whipple's disease
- Giardiasis
- Brush border enzyme deficiencies (e.g. lactase insufficiency)

PANCREATIC: Eg deficiency of pancreatic enzyme production or secretion

• Chronic pancreatitis
• CF
• Pancreatic Cancer

BILIARY eg Deficiency of bile salts needed for emulsification of fats

• Biliary obstruction
• PBC

Other causes:

• Bacterial overgrowth
• Short bowel syndrome
• Lymphoma