Malnutrition when, where, and how Flashcards

a state of nutrition in which a deficiency or excess (imbalance) of energy, protein or other nutrients causes measurable adverse effects on tissue or body functions and clinical outcomes

A state resulting from lack of intake or uptake of nutrition that leads to altered body composition and body cell mass, leading to diminished physical or mental function and impaired clinical outcomes from disease

• Starvation or deficiency-related Pathway

Initiated by decreased intake or absorption of food and nutrients

• The inflammation/disease related pathway

Resulted from anoroxia and increased tissue breakdown

1. ⬇️ resting energy expenditure
2. ⬇️ heart rate
3. ⬇️ body temperature
4. ⬇️ spontaneous physical activity
5. Glycogen stores are depleted within 1 to 2 days
6. Body fat is the main energy source
7. Protein stores are partially protected, but muscle is still depleted to ensure a supply of amino acids for protein synthesis and oxidation for energy (to survive starvation)

60 days

1. more complex and maladaptive
2. ⬆️ REE increases
3. ⬆️ resting heart rate
4. ⬆️ body temperature
5. Protein breakdown in skeletal muscle increases
6. AA > (gluconeogenesis, synthesis of acute-phase proteins)
7. Protein turnover is not regulated by nutrient requirements but continues even when sufficient energy and protein are supplied, leading to loss of muscle mass
8. Blunted responses to nutritional treatments
9. Inflammation leads to symptoms affecting nutrition which leads to low ink

1. Disease related malnutrition with inflammation (chronic, acute)
2. Disease related malnutrition without inflammation
3. malnutrition without a disease (socioeconmic or psychological)

⬇️ Lower muscle strength

⬇️ Lower Quilty of Life

⬇️ Reduced ability of daily tasks

⬇️ Lower mood

⬇️ Lower recovery

⬆️ Higher risk of infections

⬆️ Higher risk of mortality

1. Increased length of stay
2. Hospital admission
3. Readmissions
4. GP visits
5. Home healthcare services
6. Prescription costs

1. functional and physiological and metabolic effects
2. poor quality of life
3. less ability to preform ADL and dependancy

Malnutrition results in increased use of health and social care resources and are associated with considerable excess costs

Compared with the well-nourished, malnourished individuals:

• 2 x GP visits
• 3 x hospital admissions
• Increase packages of care
• discharged to care homes
• 2 x healthcare costs

93%

5%

27%

1. Dementia
2. Depression
3. Bereavement
4. Mental illness
5. Anxiety
6. Apathy
7. Motivation
8. Loneliness
9. Self-esteem
10. Independence
11. Substance abuse

1. Financial issues
2. Social isolation
3. Access to shops
4. Access to care services
5. Social networks

1. Disease severity
2. Inflammatory response
3. GI function
4. Pain
5. Co-morbidities
6. Dentition
7. Swallowing difficulties
8. Medical interventions
9. Surgery
10. Medication

30%

Up to 70%

1. Nutrition Risk Score 2002 (NRS-2002)
2. Mini Nutritional Assessment-short form (MNA-SF)
3. Malnutrition Universal Screening Tool (MUST)

1. Weight (% weight change)
2. Height
3. Body mass index (BMI)
4. Change in dietary intake
5. Acute disease effect

Inpatients: First time when admitted, re-screened weekly

Outpatients: First clinic visit, when there is a clinical concern

People in care homes: First time when admitted, re-screened monthly, when there is a clinical concern

All people: First contact with their GP, when there is a clinical concern

1. Anthropometry i.e. weight and body composition
2. Biochemical and other laboratory data
3. Clinical condition e.g. disease severity, poly-morbidity, medications
4. Dietary intake i.e. current, past and future
5. Environmental, psychological and social issues
6. Functional status e.g. handgrip strength, activities of daily living

In chronic illness and old age, higher BMI associated with improved survival and decreased morbidity

Interview techniques 24-hour recall, Diet History

Record techniques Food record chart, Dietary diary, Weighed intake

• Patients eat more, have better outcomes and are less likely to die
• Early identification and treatment of malnutrition would save the NHS
• Malnutrition is the sixth largest source for NHS savings
• Tailored nutritional therapy in hospital results in better outcomes and lower mortality than hospital diet.

Intake: A change in behaviour that results in increased nutrient intake and/or improved diet quality

Body composition: improved weight (or minimise weight loss), lean body mass, fat mass?

Patient- centred outcomes: improved functional status e.g. activities of daily living, quality of life, patient satisfaction

Decreased symptoms and complications, costs to the NHS

1. Dietary counselling

2. Food fortification

3. Oral nutrition support

4. Enteral nutrition

5. Parenteral nutrition

1. Protected mealtimes
2. Red trays and feeding assistance
3. Help with shopping, menu planning and meal
4. preparation from paid and informal carers
5. Home meal delivery services
6. Lunch clubs and social eating
7. Befriending services
8. Cookery classes

1. Nasogastric/duodenal/jejunal
2. Orogastric
3. Gastrostomy/
4. gastrojejunostomy
5. Jejunostomy

1. To ensure nutrition support is provided safely, and to detect and treat clinical complications as early and effectively as possible.

2. To assess the extent to which nutritional objectives have been reached.

3. To alter the type of nutrition support, or the components of the regimen, to improve its effectiveness and to minimise or prevent metabolic complications.