Undernutrition Flashcards
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.
prevalence of malnutrition nationally
3 million people in the UK
Malnutrition is highest in patients of which ward in the hospital?
- oncology
Impact of undernutrition on health and recovery from illness
- 25-34% hospital admissions are at risk of malnutrition
- longer stay, more complications
- more support needed after discharge from hospital
- more likely to need care
- more GP visits
- more prescriptions
- more hospital admissions
Effects of malnutrition
Signs and symptoms of undernutrition:
- loss of appetite
- weight loss
- cheeks and temples
- tiredness and low energy
- unable to do what they are used to doing including
walking - poor concentration
- poor growth in children
Who is most at risk of malnutrition?
older people over the age of 65
Causes of malnutrition:
- long term conditions: renal failure, diabetes
- chronic progressive conditions: dementia, cancer
- cancer and GI conditions
- drug or alcohol abuse
Starvation consequences:
- during starvation reserves of carb, fat and protein and
are used plus mechanisms to reduce energy
expenditure and conserve protein - reaction to fasting is dependent on energy reserves,
duration of starvation and any additional stresses - survival is rare after 3 months starvation, 40% of loss
of body weight or BMI<10 in women and 11 in men
Short term vs long term starvation
Stress starvation
- occurs with starvation in association with metabolic
stress: burns, trauma, sepsis, critical illness - normal adaptive responses of simple starvation
conserving body protein are over-ridden by the
neuroendocrine and cytokine effects of injury - metabolic rate rises rather than falls, ketosis is
minimal, protein catabolism accelerates to meet the
demands for tissue repair and of gluconeogenesis;
hyperglycaemia and glucose intolerance - salt and water retention is exacerbated which may
results in oedema and hypoalbuminaemia
Starvation vs stress starvation
4 causes of malnutrition
- altered nutritional requirements
- inadequate intake
- impaired nutrient digestion and processing
- excess losses
Altered requirements: infection, cancer, surgery, burns
causes increased metabolic demands
Malabsorption: impaired nutrient digestion and processing (malabsorption):
- dysfunction of:
- stomach
- intestine
- pancreas
- liver
- coeliac disease
Excess loss of nutrients occur:
- vomiting
- diarrhoea
- surgical drains
- fistulae
- stomas
- pressure ulcers
fistulae
abnormal connection between two spaces
Pressure ulcer:
injury to the skin and underlying tissue primarily caused by prolonged pressure on the skin
Nutritional deficiencies causing medical conditions(4):
- iron deficiency anaemia
- vitamin B12 deficiency can cause pernicous anaemia
and nerve problems - vitamin D deficiency causes rickets in children and
osteomalacia in adults - thiamine deficiency causes wet or dry beriberi,
wernicke korsakoff syndrome
Screening for malnutrition:
- anyone can be at risk of malnutrition
- MUST: malnutrition universal screening tool
- screening should not replace clinical judgement
MUST
Alternative measures for malnutrition instead of BMI:
measure between the point of the elbow (olecranon process) and the midpoint of the prominent bone of the wrist (styloid process) (left side if possible)
can estimate height
estimate BMI category from mid upper arm circumference
left arm should be bent at the elbow at 90 degrees
bony protrusion on shoulder (acromion) to the point of the elbow (olecranon process)
