Theme 1: Lecture 1 - Malnutrition Flashcards
Define malnutrition
- Malnutrition is 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
- Malnutrition can mean under or over nutrition
In which diseases is there a higher incidence of malnutrition
- > 40% pts with GI/liver disease
- Up to 80% GI malignancy
What can cause malnutrition
- Inadequate intake
- Impaired nutrient digestion and processing
- Excess losses
- Altered requirements
What can cause impaired nutrient and digestion processing
Dysfunction of:
- Stomach
- Intestine
- Pancreas
- Liver
What can cause excess losses of nutrition
- Vomiting
- NG tube drainage
- Diarrhoea
- Surgical drains
- Fistulae
- Stomas
What is a fistula
A fistula is an abnormal connection or passageway that connects two organs or vessels that do not usually connect
What is a stoma
Any opening into the body
What can cause altered nutrient requirements
Increased metabolic demands:
- Inflammation
- Cancer
- Wounds
- Burns
- Brain injury
The impact of malnutrition in healthy people
Decreased skeletal muscle mass and function day 5
18% loss (and above) of mass leads to physiological disturbance:
- Cardiac 45% reduction in CO
- Respiratory / diaphragmatic muscle mass and contractility
- Gut and immune function
- Impaired renal function
- Impaired liver function and fatty change/necrosis
- Decreased immunity and resistance to infection
- Impaired wound healing
- Reduced strength
- Hypothermia
- Depression/apathy
Approximately 40% weight loss is fatal
How do malnutritional patients differ from the general population
MALNOURISHED PATIENTS:
- Attend their GP surgery more often
- Are admitted to hospital more frequently
- Stay in hospital longer
- Succumb to infections
- Often discharged to long-term care
- Die
How do hospitals cause malnutrition
- Inadequate / unpalatable / unsuitable food
- Can’t reach food / can’t feed themselves
- Altered taste / poor appetite
- NBM
- Starved for Ix (Investigations)
- And then again if the Ix gets cancelled
- Starved before and after surgery
Medical causes of inadequate intake of nutrition
- Poor diet
- Poor appetite/Anorexia/Taste disturbances
- ‘Nil by mouth’ for investigation or medical reasons (Starved before diagnostic procedures – and often cancelled, Starved before and after surgery)
- Pain/Nausea
- Dysphagia
- Depression
- Physical disability and inability to feed self
- Unconsciousness
Dysphagia
Difficulty swallowing
Environmental causes of inadequate intake of nutrition
- Inadequate food quality (meals unpalatable, food poor in nutrients, served of improper temperature)
- Inadequate food availability outside the reach of elderly or physically incapacitated patients)
- No protected meal times
- Inadequate training and knowledge of medical and nursing staff
How can malnutrition be prevented in hospital
- We need to find these patients “at risk”
- All hospital inpatients on admission and all outpatients at their first clinic appointment should be screened. Screening needs to be repeated weekly for inpatients and when there is clinical concern for outpatients
What should you be on the look out for to prevent malnutrition
- Low weight
- Weight loss
- Poor intake or predicted to become poor (ie planned surgery)
- Poor absorptive capacity
- High nutrient losses
- Increased nutritional needs (burns, sepsis etc)
What has been done so far to address the problem of malnutrition in hospitals
- MUST screening rolled-out nationwide
- Yearly MUST-screening (allows hospitals to show they are screening patients for malnutrition)
- Educating staff (improved timing / help at meals, mouth care etc)
- Protected meal times
- Volunteers helping at meal times
- Improving recording food and fluid intake
- Dedicated Nutrition support teams and dietitians
How does the MUST screening tool calculate a an overall risk of malnutrition score
BMI score plus weight loss score plus acute disease effect score are added together to calculate an overall risk of malnutrition
Low risk MUST score
- 0
- Routine clinical care
Median risk MUST score
- 1
- Observe
High risk MUST score
- 2 or more
- Teat/refer to a dietician
