Undernutrition Flashcards
Define undernutrition
‘A state of nutrition in which a deficiency of energy, protein and other nutrients causes measurable adverse effects on tissue/body structure and function and clinical outcome’
How do we classify undernutrition?
Using BMI
What are the types of undernutrition?
Nutrient specific or generalised (lack of food)
Primary (inadequate intake) or secondary (disease)
How does the body adapt to starvation?
Early starvation - liver glycogen used to provide energy
Stores used up within 24 hrs
Glucose synthesised from protein
Fat metabolised to release FAs
Long-term = lipolysis is preferred (sparing protein)
What are the consequences of undernutrition?
Muscle function
- muscle wasting
- increased muscle fatigability
- leads to deterioration
Cardiovascular function
- loss of cardiac muscle with reduced cardiac output, poor tissue perfussion, hypertension
Gastrointestinal tract
- impaired gastric + pancreatic exocrine function = reduced digestion
- Mucosal cell atrophy = reduced absorption
- Increased intestinal permeability to bacteria
(Lose) Immune system function
- impaired immune response, poor healing, increased sickness
- reduced survival
- increased requirements for repair
- longer hospital stays
- post-operative complications w/ pts who lose > 10% body weight
- Increased risk of readmission to hospital
What are the functional consequences of undernutrition?
Increased risk of hypothermia
- loss of subcutaneous fat
- Thermoregulation is impaired
- reduced thermogenic response to cooling
What are the psychological (brain) consequences of undernutrition?
Fatigue/weakness
Deterioration in intellectual function
lack of initiative
Bedridden
Apathy (lack of emotions)
changes in behaviour
Exhaustion
How do we make energy stores last longer
How do we treat undernutrition?
Provide what they are lacking
Increasing nutrient intake to reverse effects:
- vitamins
- minerals
- macronutrients
- fluid
Becareful of reintroducing nutrient due to refeeding syndrome
What is refeeding syndrome?
Sudden administration of high glucose levels in undernourished pts
This can lead to:
- hypokalaemia
- hypophosphataemia
- hyperglycaemia
- respiratory failure
- cardiac failure
Need to initate feeding carefully
How do we treat an anorexia nervosa patient?
Need to stabilise so they do not lose further weight
Use enteral feeding
- nasogastric tube
- for severe anorexia
- initiate slowly to prevent refeeding syndrome
Monitoring
- electrolytes, fluid, glucose
- ECG (cardia arrythmias)
- Oedema = refeeding
What are the methods of nutrition support to treat undernutrition?
Oral
- supplement food w/ household items (cream, cheese, milk powder)
- supplementing food w/ modular products (maxijul/polycal)
- oral liquid supplements (sip feeds)
If unabe to eat, then Tube feeding
- via nasal access, nasogastric + nasojejunal
- or via enterostomy feeding (by the mouth to GIT)
Parenteral nutrition (if GIT is impaired)
- peripheral or central
- made up in sterile conditions
- conyains lipid, CHO, vitamins, minerals, trace elements
Which method of nutritional support is prefereed?
Enteral
- cheaper + safer
- stimulates gut-associated immune function
- maintains intestina mucosa
- stimulates intestinal + biliary motility
What are some reasons to give nutrition parentally?
Severe inflammatory bowel disease
Mucositis (following chemotherapy)
Severe acute pancreatitis
Some pts w/ multi organ failure
Following major bowel surgery
Should avoid long term to prevent gut changes
What are the hazards of parenteral nutrition?
Nutritional + metabolic
- hyperglycaemia
- electrolyte imbalance
Catheter-related
- Infection
- occlusion
- Vein thrombosis
Effect on other organ systems
- liver disease
- biliary disease
