Nutrition | Flashcards
What is nutrition?
“Nutrition is the intake of food, considered in
relation to the body’s dietary needs”
What is the definition of good nutrition?
An adequate, well balanced diet
combined with regular physical activity – is a
cornerstone of good health
What is the definition of poor nutrition?
Can lead to reduced immunity,
increased susceptibility to disease, impaired
physical and mental development, and reduced
productivity
What is malnutrition?
The insufficient, excessive or imbalanced
consumption of nutrients. It means “poor nutrition” and can refer to:
1. Undernutrition – when you don’t get enough
nutrients.
2. Overnutrition – when you get more nutrients
than you need
What % of patients are malnourished or at risk of malnutrition on admission to hospital?
25-34%
What population of people are at highest risk of malnutrition?
Over 75
What are the risk factors for malnutrition in the elderly?
- Cognitive (7)
- Physical (7)
- Social (4)
Cognitive:
- Executive planning
- May be unable to vocalise what food they want
- May misinterpret sensation of hunger
- Higher thirst and hunger thresholds
- Early satiety
- Depression
- Bereavement
Physical:
1. Reduced dexterity - e.g. can’t open packets
2. Poor Mobility
3. Teeth - don’t have their denture with them
4. Swallowing
5. GI complications – delayed gastric emptying,
malabsorption
6. Polypharmacy/ drug interactions
7. Reduced basal metabolic rate
Social
- Access to food
- Inability to shop or prepare food
- Lack of knowledge about food, cooking & nutrition - Finances
- Relatives to help with shopping/ preparing food
- Isolation and loneliness
- e.g. spouse usually cooks and after they die, they don’t know how to cool
Why are patients in hospital more at risk of malnutrition (9)?
- Food service
- Slow eating speed
- Missing dentures
- Assistance / supervision
- Food left out of reach / unable to open packets
- Unpleasant sights, sounds, smells
- ↑ nutritional requirements
- Limited provision for religious/cultural dietary needs
- Nil by mouth or missed meals while having tests
How do people get screened for malnutrition in hospitals (2)?
- Every adult patient is screened on admission and weekly after
- Use Malnutrition Universal Screening Tool (MUST)
How does the MUST tool work?
Step 1 BMI score
>20 = 0
18.5-20 = 1
<18.5 = 2
+
Step 2 Weight loss score (unplanned weight loss in the past 3-6 months)
<5% = 0
5-10% = 1
>10 = 2
+
Step 3 Acute disease effect score (e.g. illness preventing them eating)
-If patient is acutely ill and there has been or is likely to be no nutritional intake for >5 days = Score 2
Step 4 Max score = 6 Score 0 low risk Score 1 medium risk Score 2 or more high risk
Step 5 Management guidelines
What are step 5 management guidelines?
0 low risk
=Routine clinical care
-Repeat screening
1 medium risk
=observe
-document dietary intake for 3 days
2 or more high risk
=treat
-Refer to dieticial, nutritional support team or implement local policy
What are the possible overall aims of treatment?
- Prevent further weight loss
- Maintain nutritional status
- Increase weight
- Improve nutritional status
What is the management of malnutrition?
- Start with oral feeding - try food
- Little and often
- Choose full fat and sugary options
- Nourishing drinks
- Food enrichment
- Multivitamin - If nutritional requirements cannot be met
- Oral nutritional supplement - If that doesn’t work, enteral and parental
What are indications for enteral feeding (2)?
- Patients who either are unable to take any
nutrition orally - Patients unable to take
sufficient nutrition orally, but in whom the
gastrointestinal tract is functioning
What are indications of parenteral nutrition (PN) by IV?
When it is not possible to supply nutrition
using the GI tract (ie. when intestinal
failure is present)
