Refers to the depletion of essential micronutrients and erosion of lean body mass.
Malnutrition refers to an imbalance between the growth and breakdown of body tissues and nutrients stores that results in loss of muscle and organ mass, decrease in physical or mental functioning, and impaired clinical outcomes.
Malnutrition is found in 5 to 10% of community dwelling persons older than 65 years, in 20 to 40% of hospitalized patients, and up to 50% of nursing home residents.
Many chronic illnesses are associated with low-grade inflammation: COPD, inflammatory bowel disease, kidney failure, chronic pancreatitis, multiple cancers in which C reactive protein concentrations are above the upper limit of normal manifesting with reduced nutritional intake.
In most end-stage chronic diseases of major organ systems inflammation driven malnutrition occurs: malnutrition develops in 20 to 50% of patients with COPD, CHF, cirrhosis of the liver, or chronic renal disease.
Slow but continuous tissue erosion and blunted responses to turn to nutrition of treatments as a result of long-term exposure to inflammation.
A UN report reveals almost 821 million people worldwide did not have enough to eat in 2017, up from 804 million in 2016.
Malnutrition incorporates, weight loss, low BMI, low, skeletal muscle mass, low food intake, and disease burden or inflammation.
Approximately 7.5 million children under the age of 5 die from malnutrition, usually brought on by not having the money to find or make food.
Mandatory assessment for the evaluation of malnutrition should occur with weight loss, low body mass index, low muscle mass, decreased food intake, or food assimilation, and a high disease burden, as indicated by the presence of persistent or recurrent inflammation.
A state in which there is a deficiency of energy, protein, and other nutrients that can cause measurable adverse effects on body and negatively impacts clinical outcomes.
Malnutrition is classified as moderate or severe.
Defined as subacute for chronic state of nutrition in which combination of varying degrees of overnutrition and undernutrition and inflammatory activity lead to deleterious changes in body composition and function.
In contrast to energy expenditure with pure food deprivation, resting energy expenditure increases with food, deprivation, and inflammation.
Inflammation driven malnutrition is associated with an increased heart rate and body temperature, protein breakdown in skeletal of muscle increases.
Amino acids from the muscle are used as fuel for the production of glucose through gluconeogenesis and for the synthesis of proteins, such as acute phase reactants.
During inflammation protein turnover continues with the loss of muscle mass.
Nutritional intake in acutely older patients is substantially reduced when the concentration of C reactive protein exceeds 30 mg/L
Three sub types are recognized: disease related to malnutrition in the absence of underlying inflammation, disease related malnutrition with underlying inflammation, and starvation due to inadequate access to food/nutrients.
The two major pathophysiologic pathways of malnutrition: inflammation related pathway, resulting from anorexia and increased tissue breakdown, and the deficiency related pathway initiated by decreased intake or absorption of food and nutrients.
Characteristics include: insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation that may mask weight loss, and diminished functional status as measured by hand grip strength.
Sarcopenia with decreased muscle strength and mass is the major disabling complication of disease related malnutrition.
Malnourishment defined as unintentional loss of more than 10% of body weight or greater than 7-10 days of inadequate nutritional intake.
Severe acute malnutrition is associated with childhood morbidity and mortality sand affects more than 20 million children with severe wasting worldwide.
A well nourished person has body stores generally sufficient to provide essential nutrients, resist infection, promote wound healing and support physiologic functions for 7-10 days.
When inadequate intake or absorption of energy and nutrients occurs, adaptation of metabolism occurs with decreased resting energy expenditure, heart rate, body temperature, and spontaneous physical activity.
Glycogen store in the liver and muscles are depleted within one to two days and replaced by body fat as the main energy source.
Protein stores are partially protected, but are depleted from muscle to ensure supply of amino acids for protein synthesis and oxidation for energy.
Survival for up to 60 days in a state of complete starvation is possible if fluids are available.
Nutritional complications of systemic illness can compromise muscle, and nerve function.
Malnutrition diminishes quality of life, autonomy, and may pose life-threatening risk because of infectious and visceral complications,
Common in critically ill individuals with 20-40% of such patients have protein energy malnutrition.
Worsens over time in patients who require prolonged hospitalization.
Protein malnutrition surrounding hospitalization associated with increased morbidity and mortality in hospitalized patients.
Malnutrition including chronic undernutrition and acute malnutrition is known to have caused stunted growth in various populations.
Protein energy malnutrition associated with hospital acquired infection, impaired wound healing, prolonged recovery in patients admitted to the ICU.
Obese individuals may be significantly malnourished due to the effects of illness related inflammation on skeletal muscle.
Malnutrition driven by inflammation, is mediated by inflammatory cytokines and prostaglandins as occurs with cancers, infections, end-stage organ disease, critical illness, with progressive complex, metabolic, and maladaptive features.
Malnutrition prevalence varies according to the type and stage of cancer.
Immunodeficiencies and resulting infections occur early in the course of malnutrition.
Malnutrition is associated with T cell dysfunction, and B-cell dysfunction which attenuates humoral antibody production.
Chances of the upper G.I. tract lead to malnutrition early, whereas breast, lung, and renal cancer malnutrition occurs with more advanced disease.
Deficiencies in micronutrients, including vitamin B1, B6, B12, and vitamin D, folic acid, and essential N-3 and N-6 fatty acids have specific deleterious health effects.
Critical illness malnurition associated with catabolic hormonal and cytokine responses.
In critically ill patients cortisol, catecholamines, glucagon levels are increased and interleukin-1, interleukin-6 and interleukin-8 and tumor necrosis factor alpha are increased in tissues.
In the critically ill there is peripheral tissue resistance to insulin and insulin like growth factor (Burnham).
Major trauma, burns, acute infections with significant inflammation rapidly degrade fat, muscle, and organ tissues.
With critical illness glycogenolysis and gluconeogenesis occur casing a net breakdown of skeletal muscle, enhanced lipolysis, which provide needed glucose, amino acids and fatty acids required for cellular and organ function and wound healing.
During critical illness availability of plasma substrates are diminished by the presence of insulin resistance, lipoprotein lipase inhibition and insufficient levels of certan substrates, such as glutamine to meed metabolic needs.
In patients with Crohn’s disease or celiac disease malabsorption with weight loss and malnutrition are their main manifestations of disease.
Common in hospitalized patients and is associated with detrimental metabolic consequences such as muscle wasting.
Common in hospitalized patients and is associated with detrimental metabolic consequences such as muscle wasting.
Associated with a higher mortality and morbidity, increased infections and increased length of hospital stay.
Randomized clinical trial’s challenge the approach of using nutritional therapies in the acute phase of illness in unselected patients.
Associated with a higher mortality and morbidity, increased infections and increased length of hospital stay.
Randomized clinical trial’s challenge the approach of using nutritional therapies in the acute phase of illness in unselected patients.
A person with a BMI of less than 18.5 kg/m2 is considered malnourished.
The mortality rate for hospitalized children with severe acute malnutrition is as high as 50%.
Severe acute malnutrition contributes to approximately 1,000,000 deaths annually, among children worldwide.
It is now recommended for treatment of uncomplicated acute severe malnutrition in children is the use of a ready to use therapeutic food fortified with peanut paste, milk powder, oil, sugar and a micronutrients supplement.
With the use of the above ready to use therapeutic food the mortality rate for acute severe malnutrition is still 10-15%.
There is a high prevalence of clinically significant infections among children hospitalized with severe malnutrition, and it is recommended that the routine use of antibiotics in such patients.
In a randomized, double-blind, placebo controlled trial the addition of antibiotics to therapeutic regimens for uncomplicated severe acute malnutrition was associated with significant improvement in recovery and mortality rates for outpatient treatment (Trehan I et al).
Scurvy is one of the accompanying diseases of malnutrition as are beriberi and pellagra.
Malnutrition affects about 30% of oncological and hematological malignancy patients and is associated with higher mortality, impaired functional status and longer hospital stays.
Neurologic disorders have a risk of malnutrition mainly related to reduced food intake for non-inflammatory reasons.
Alzheimer’s diseases associated with malnutrition in 20 to 30% of patients.
Treating malnutrition involves addressing both the underlying causes and the specific nutritional deficiencies.
Providing a balanced diet that includes adequate calories, proteins, vitamins, and minerals.
This may involve increasing the intake of nutrient-dense foods such as fruits, vegetables, whole grains, lean proteins, and healthy fats.
In cases where dietary intake alone cannot meet nutritional needs, vitamin and mineral supplements may be provided:for deficiencies such as iron, vitamin A, iodine, or zinc.
Ready-to-use therapeutic foods (RUTF), such as fortified pastes and bars, may be used to treat severe acute malnutrition, especially in children.
Tube feeding for those unable to eat orally-Can be nasogastric, nasojejunal, or via gastrostomy
Parenteral Nutrition- Intravenous feeding for severe cases or when the digestive system can’t be used to provide nutrients directly into the bloodstream.
Refeeding syndrome may develop, especially in severely malnourished patients and occurs at the beginning of nutritional therapy.
When supplied glucose increases insulin levels, and phosphate, potassium, and magnesium shift intracellularly in the blood and serum concentration are decrease leading to hypophosphatemia, edema, cardiac and respiratory failure.