Nutrition Disorders: Malnutrition

Question 1

What is the definition of malabsorption according to the NICE guidelines?

Answer 1

• a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome

Question 2

According to the WHO does malnutrition include undernutrition that causes wasting, stunting, underweight?

Answer 2

• yes

Question 3

According to the WHO does malnutrition include inadequate vitamins or minerals?

Answer 3

• yes

Question 4

According to the WHO does malnutrition include being overweight or obese?

Answer 4

• yes

Question 5

According to the WHO does malnutrition include diet-related noncommunicable diseases (non transmissable diseases) such as diabetes and CVD?

Answer 5

• yes

Question 6

In the UK aprox how many people are malnourished?

Answer 6

• 3 million are underweight and not consuming enough vitamins and minerals

Question 7

According to the British Association of Parentral and Entral Nutrition in 2015 what does malnutrition increase?

Answer 7

• all costs associate with healthcare
• prescriptions, appointments, admissions, disease associated malnutrition

Question 8

In 2011-2012 what was the estimated cost of malnutrition in England?

Answer 8

• £19.6 billion/year

Question 9

In terms of malnutrition was does the Malnutrition Carousel tell us?

Answer 9

• malnourished patients attend hospital are likley to have further complication when in hospital
• upon discharge they are even more malnourished which increases GP appointment, prescriptions and hospital appointments

Question 10

Which bodily systems does malnutrition affect?

Answer 10

• all systems
• reduced muscle mass and inactivity causing falls
• pressure ulcers and blood clots
• reduced ability to cough may predispose to chest infections and pneumonia
• heart failure

Question 11

Are those aged above or under 65 years of age at a greater risk of malnutrition?

Answer 11

• >65 year olds

Question 12

Are those who are healthy or with long term health conditions at a greater risk of malnutrition?

Answer 12

• long-term conditions e.g. diabetes, renal failure, chronic lung disease

Question 13

Are those who with a chronic progressive disease or healthy at a greater risk of malnutrition?

Answer 13

• chronic progressive conditions – for example, dementia or cancer

Question 14

Are those who have alcohol or drug abuse at risk of malnutrition?

Answer 14

• yes

Question 15

In starvation of over 3 month when patients have loss >40% of their body weight or has a BMI <11 and 10 in men and women, respectively, is survival common?

Answer 15

• no
• survival is rare

Question 16

Simple starvation can be divided into 2 categories, what are they?

Answer 16

• short term starvation (<72 hours)
• prolonged starvation (>72 hours)

Question 17

What is stress starvation?

Answer 17

• patients are starved combined with metabolic response to trauma, sepsis and critical illness

Question 18

In stress starvation, what contributed to the overidiing of the normal adaptive responses of simple starvation that involves conserving body protein?

Answer 18

• over-ridden by the neuroendocrine and cytokines

Question 19

In stress starvation, what happens to metabolic rate, ketosis and blood glucose?

Answer 19

• metabolic rate rises
• ketosis is minimal, protein catabolism accelerates to meet the demands for tissue repair
• gluconeogenesis and there is hyperglycaemia and glucose intolerance

Question 20

In stress starvation, what happens to salt and water levels?

Answer 20

• salt and water retention is exacerbated
• may result in oedema and hypoalbuminaemia

Question 21

Altered nutritional requirements is one of the causes of malnutrition. What causes an alteration in a patients nutritional requirements?

Answer 21

• generally due to illness or infection

Question 22

Inadequate intake is one of the causes of malnutrition. What causes Inadequate intake?

Answer 22

• extreme diets
• poverty/drugs/alcohol

Question 23

Impaired nutrient digestion and processing is one of the causes of malnutrition. What causes this?

Answer 23

• GIT dysfunction and/or disease

Question 24

Excess losses is one of the causes of malnutrition. What causes this?

Answer 24

• vomiting/diarrhoea
• surgical drains
• fistulae/stomas
• pressure ulcers

Question 25

There are a number of medical conditions resulting from external nutritional deficiencies, what are the 4 most common of these?

Answer 25

1 - iron deficiency anaemia

2 - vitamin B12 deficiency (pernicious anaemia and nerve problems)

3 - vitamin D deficiency causes rickets in children and osteomalacia in adults

4 - thiamine deficiency causes wet or dry Beriberi, Wernicke Korsakoff syndrome

Question 26

Before a patient can be treated for malnutrition is screening. Why is this important and what tool is used in Kent?

Answer 26

• 1st step for recognising and treating malnutrition
• Malnutrition Universal Screening Tool (MUST)

Question 27

What is Malnutrition Universal Screening Tool (MUST)?

Answer 27

• screening tool for malnutrition
• 0 = low risk
• 1 = medium risk
• 2 = high risk

Question 28

If you cannot measure a patients BMI or waist circumference, what is an alternative measure?

Answer 28

• mid upper arm circumference