Malnutrition: The Quiet Killer

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Before I started my dietetic degree I thought malnutrition was a third world problem. I thought it happened to kids in Africa who didn’t have enough food. I got a reality check as I learned more about nutrition in Australia and participating in clinical placements in the community, hospitals and residential aged care facilities. Australia is not immune to this life-threatening condition.  Currently in Australia:

  • >40%1 are living/at risk of malnutrition in the community
  • 20-50%2 are malnourished in hospital
  • Up to 70%3 are malnourished in nursing homes

These are shocking statistics but unfortunately it no surprise to me having worked in these setting. After graduating, malnutrition became a large part of my caseload.

Malnutrition is basically inadequate nutrition. It is a condition that develops when the body does not receive the right amount of nutrients for growth or to maintain healthy tissues and organ function. Malnutrition can occur in people who are under-nourished or over-nourished and can be both a cause and consequence of ill health.

Malnutrition begins with changes in nutrient levels in blood and tissues. As the condition deteriorates, enzyme levels are disrupted; changes in tissue and then organ function are seen, followed by illness and death.

People at risk for under-nutrition

Physiological Social

Psychological

Infants, children and teenagers Substance abusers Depression
Pregnant or breastfeeding mothers Need assistance with meals Lengthy hospitalisation
Older adults Financial constraints Excessive dieting
People with cancer Food access issues
Poor appetite
Unintentional weight loss
Swallowing issue
Diarrhea, vomiting, excess sweat, bleeding or body secretions
Degenerative conditions (Parkinson Disease, Multiple Sclerosis, Motor Neuron Disease, Dementia/Alzheimer’s Disease)
Diseases (gastrointestional, wound)
Food allergies

People at risk for over-nutrition

  • Eating too many empty calories – High in energy by low in other nutrients
  • Not having a balanced diet

4 ways to reduce/treat malnutrition

  1. Turn the old style healthy eating pyramid upside down.
  2. Focus on consuming foods and drinks that contain high amounts of energy and protein. These types of foods usually belong to the meat and alternatives, dairy and fats and oil food groups. ‘Sometimes foods are also great for treating malnutrition for the same reason – they are also high in energy and/or protein. When malnutrition is diagnosed there is no need to limit ‘sometimes food’ just for the taste or when you feel like it as per in healthy individuals eating mindfully or intuitively.
  3. Don’t rely on ‘nutrition intuition’, as the first thing that goes is our appetite when we are at risk or have malnutrition. Appetite is a big part of nutrition intuition or eating intuitively, but works against us when we are malnourished. Appetite also naturally decreases in response to such things as pain, infection, illness, depression, loneliness.
  4. Enjoy small frequent meals – nibbling/grazing/drinking energy (kilojoules/calories) and protein every 2 hours throughout the day. When your appetite is poor it is hard to complete meals. Making a point of not limiting food consumption to breakfast, lunch and dinner will provide more opportunities to get the required nutrients to treat malnutrition.

Malnutrition is something we need to take notice of as it is associated with poorer health and quality of life. If you are malnourished, there will be more GP visits, hospital visits and early admission to nursing homes. See an APD to help treat or minimise the occurrence of malnutrition in yourself or someone you know. It’s a devastating condition (for the patient and their family and friends) that can be managed with the right care.

***

Statistic sources

1/ Rist G, Miles G, Karimi L. The presence of malnutrition in community-living older adults receiving home nursing services. Nutrition & Dietetics 2012; 69: 46–50 3.

2/ Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clinical Nutrition 2008; 2008 Feb;27(1):5-15. Epub 2007 Dec 3.

3/ Watterson C, Fraser A, Banks M et al. Evidence based practise guidelines for the nutrition management of malnutrition in adult patients across the continuum of care. Nutr Diet 2009; 66: S1-34.

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