Undernutrition

Question 1

Malnutrition is a state in which

Answer 1

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

Question 2

prevalence of malnutrition nationally

Answer 2

3 million people in the UK

Question 3

Malnutrition is highest in patients of which ward in the hospital?

Answer 3

• oncology

Question 4

Impact of undernutrition on health and recovery from illness

Answer 4

• 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

Question 5

Effects of malnutrition

Answer 5

Question 6

Signs and symptoms of undernutrition:

Answer 6

• 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

Question 7

Who is most at risk of malnutrition?

Answer 7

older people over the age of 65

Question 8

Causes of malnutrition:

Answer 8

• long term conditions: renal failure, diabetes
• chronic progressive conditions: dementia, cancer
• cancer and GI conditions
• drug or alcohol abuse

Question 9

Starvation consequences:

Answer 9

• 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

Question 10

Short term vs long term starvation

Answer 10

Question 11

Stress starvation

Answer 11

• 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

Question 12

Starvation vs stress starvation

Answer 12

Question 13

4 causes of malnutrition

Answer 13

• altered nutritional requirements
• inadequate intake
• impaired nutrient digestion and processing
• excess losses

Question 14

Altered requirements: infection, cancer, surgery, burns

Answer 14

causes increased metabolic demands

Question 15

Malabsorption: impaired nutrient digestion and processing (malabsorption):

Answer 15

• dysfunction of:
  
  • stomach
  • intestine
  • pancreas
  • liver
  • coeliac disease

Question 16

Excess loss of nutrients occur:

Answer 16

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

Question 17

fistulae

Answer 17

abnormal connection between two spaces

Question 18

Pressure ulcer:

Answer 18

injury to the skin and underlying tissue primarily caused by prolonged pressure on the skin

Question 19

Nutritional deficiencies causing medical conditions(4):

Answer 19

• 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

Question 20

Screening for malnutrition:

Answer 20

• anyone can be at risk of malnutrition
• MUST: malnutrition universal screening tool
• screening should not replace clinical judgement

Question 21

MUST

Answer 21

Question 22

Alternative measures for malnutrition instead of BMI:

Answer 22

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)