malnutrition

Malnutrition: description

In malnutrition, the body is supplied with too little energy, protein or other nutrients (such as vitamins and minerals). As a consequence of this, some serious changes in bodily functions can be seen. In addition, the risk of various diseases and the risk of death increases.

Malnutrition can occur at any age. Malnutrition is especially common in old age.

Forms of malnutrition

Physicians distinguish two forms of malnutrition:

• quantitative malnutrition: The body is fed less food in the long term than it needs to meet its energy needs.
• Qualitative malnutrition: There is a shortage of proteins or other nutrients (vitamins, trace or trace elements, etc.).

The two forms can also occur in combination with each other.

Malnutrition: Symptoms

Malnutrition can lead to a variety of problems. The various nutrients fulfill innumerable important functions in the body, so that a deficiency causes different symptoms.

For example, a lack of carbohydrates (the most important source of energy) can trigger headaches, circulatory problems, a lack of concentration, and blurred vision. A lack of protein weakens the immune system, delays the recovery from illness and leads to a decrease in muscle mass. Iron deficiency leads in the long term to anemia, recognizable as a pale skin and persistent tiredness and fatigue.

The extent of the symptoms and consequences of nutrient deficiencies largely depends on how pronounced malnutrition is. A mild malnutrition often only triggers unspecific symptoms such as weakness, tiredness, loss of appetite and lack of drive. On the other hand, a long-term or severe malnutrition can have clearer and more serious consequences and disrupt important organ functions.

Overall, malnutrition can have the following consequences:

• general weakness
• fatigue
• listlessness
• Degradation of skeletal muscle
• Loss of muscle power
• Disorders in the movement process
• increased risk of falls and broken bones
• Decrease in cardiac muscle mass and pumping power
• Arrhythmia
• Decrease of the respiratory muscles with weaker and shorter breaths
• weakened immune system and thus increased susceptibility to infections
• delayed and disturbed wound healing
• increased risk of pressure sores and bedsores (in case of bed rest)
• neurological disorders
• dementia

In addition, malnutrition in old age increases the risk of dying – slight overweight, however, which is why the latter is more beneficial in the elderly.

Malnutrition: causes and risk factors

Malnutrition occurs when:

• the nutrient intake is lower in the long term than the nutrient requirement,
• the nutrients supplied can not be sufficiently utilized or
• there is an uncontrolled breakdown of body substance.

This can have different causes. In individual cases, several of these are usually based on malnutrition, not just one factor alone. The most important causes are:

Loss of appetite (anorexia)

Many people with chronic or severe illnesses have little appetite and therefore eat little, which eventually leads to malnutrition. Such diseases include, for example, severe infections (such as tuberculosis or HIV), tumors and autoimmune diseases. The mental stress, anxiety and depression associated with such disorders can also be detrimental to appetite. An early onset of satiety and changes in taste and smell may also play a role.

Swallowing and passage disorders

Problems with transporting food through the gastrointestinal tract are another potential cause of malnutrition. Such problems arise, for example, in chronic narrowing (stenosis) in the small intestine of Crohn’s disease patients: To avoid symptoms as a result of these constrictions, many sufferers eat little.

Narrowing through a malignant tumor, such as the esophagus or the stomach, can make it difficult to feed, causing malnutrition. On the one hand, such tumors can become a mechanical obstacle, but on the other hand they can hinder the mobility (motility) of the digestive tract. This can be the case, for example, with pancreatic cancer (pancreatic carcinoma) as well as after cancer-related removal (of the stomach or the esophagus (resection).

Chewing and swallowing disorders

Bad teeth, fungal infections (oral thrush) and mouth ulcers can make chewing so difficult that sufferers avoid eating – malnutrition can be the result. Dry mouth (due to medication or salivary gland disease, for example) can cause problems with chewing and swallowing. In addition, for example, stroke patients often have difficulty swallowing, which can contribute to the development of malnutrition.

Changes in the taste and smell

If the taste and smell sensation is disturbed, this often impairs the appetite – those affected eat too little, which in the long run results in malnutrition. Older age, viral or tumor diseases are possible reasons for changes in the sense of taste and smell.

Problems with digestion of food (Maldigestion)

To be able to utilize the ingested food, the body must first break it down into small components. This requires various digestive juices, which are produced by, among others, the pancreas. In chronic inflammation (pancreatitis) or cancer (pancreatic carcinoma) lacks this pancreatic secretion, which affects the food utilization. Although the people concerned may eat enough, malnutrition can develop.

The same thing can happen if the body loses excess bile acid, so there is not enough left for digestion. Such a bile acid loss syndrome arises when in Crohn’s disease the last small intestine section (terminal ileum) had to be removed.

Problems with absorption of nutrients (malabsorption)

Various gastrointestinal and intestinal diseases may affect nutrient uptake to develop malnutrition despite adequate food intake. These diseases include, for example, atrophic gastritis (chronic gastritis in which the mucosa recedes) and celiac sprue.

Even if the stomach (gastric resection) or a large part of the small intestine (short bowel syndrome) had to be removed due to illness, malnutrition may subsequently develop as a result of malabsorption.

Problems with the utilization of nutrients

In case of insulin resistance, the body cells do not respond sufficiently to the hormone insulin. This hormone normally causes the cells to take up sugar (glucose) from the blood and use it for energy. Insulin resistance can contribute to malnutrition. It can occur, for example, in infections, tumors and liver cirrhosis, but can also be caused by cortisone therapy.

A disturbed nutrient utilization with subsequent malnutrition can also result in other ways, such as increased protein degradation (proteolysis) in pancreatic and other tumor diseases.

drugs

The above factors, which often lead to malnutrition, can also be caused by medication. Appetite deficiency may be a side effect of antibiotics, sedatives (tranquilizers), tricyclic antidepressants, opiates (strong pain killers), and digoxin (cardiac).

An altered taste often results from painkillers (analgesics), diabetes medications (hypoglycemic agents), hypertensives (antihypertensives), cytostatics (anticancer drugs), certain antibiotics (penicillin, markolides) or psychotropic drugs (remedies for mental illness).

Dry mouth is often the result of tranquilizers (tranquillizers, sedatives), Parkinson’s drugs, antidepressants, beta-blockers (cardiovascular), allergy (antihistamines) or diuretics.

Many cytotoxic drugs, opiates, antibiotics, high blood pressure, antidepressants and anti-fungal agents (antifungals) cause nausea, which affects food intake. In the longer term, such drug side effects may contribute to malnutrition.

Other factors

Factors such as poverty, social isolation, loneliness or grief contribute to the development of malnutrition, especially among many older people. The loss of self-employment, for example as a result of a stroke or other illness, also plays a role: those who are difficult when shopping and preparing meals, often neglected food intake.

Frequent age changes such as diminished sensory perceptions or altered regulation of hunger and satiety may also play a role in the development of malnutrition. The same applies to increasing forgetfulness, confusion and dementia – some patients simply forget the food.

Malnutrition: examinations and diagnosis

If malnutrition is suspected, the doctor will discuss the patient’s diet, existing medical conditions and illness as well as his or her social situation as far as possible (anamnesis). Possible questions are:

• How many meals do you eat a day?
• Do you eat a hot meal daily?
• Do you eat fruits and vegetables every day?
• Do you eat dairy products daily?
• How often do you eat meat / meat products and fish?
• Do you suffer from lack of appetite?
• How much do you drink daily?
• How much alcohol do you consume per week?
• Do you smoke? When Yes, how much?
• Are you physically active?
• Have you lost weight inadvertently lately?
• What is your social situation?
• Do you suffer from any stress or stress?

Often it is helpful if the doctor can also talk to close relatives to get their opinion about the nutritional habits, etc. of the patient.

Physical examination

Following is the physical examination. The doctor measures the blood pressure and pulse of the patient. He examines the teeth / denture as well as the chewing and swallowing function. He looks at his tongue and skin for signs of dehydration. He also takes care of possible tissue damage (lesions), ulcers and rhagades (small skin tears).

The doctor looks at how thick the subcutaneous fat tissue is (eg above the triceps on the upper arm) and looks for possible tissue swelling (edema) and an ascites (ascites). He also checks the muscle status of the patient and the muscle strength against resistance (biceps, thigh muscle).

Body Mass Index (BMI)

Of course, the physical examination in case of suspected malnutrition also includes determining the weight of the patient. The body mass index (BMI) can be calculated from the ratio of body weight to body height: BMI = body weight divided by the square of the body height.

This measure is used to assess weight and support the diagnosis of malnutrition. According to the World Health Organization (WHO), malnutrition is present at a BMI of less than 18.5 kg / m2. The German Society for Nutritional Medicine proposes for the elderly but a limit of 20 kg / square meter) before.

Incidentally, if the patient has water retention in the tissues (edema) or in the abdominal cavity (ascites), the BMI is not meaningful because the weight of the water distorts the reading of body weight.

blood test

To diagnose possible malnutrition, the doctor will also have the patient’s blood examined in the laboratory. A blood picture is taken and the so-called structural proteins (such as albumin) are determined. You may also measure vitamin B12 levels, electrolytes and other blood parameters.

Further investigations

If there is a suspicion that the malnutrition has a disease-related cause such as a tumor, further, specific investigations follow.

Malnutrition: treatment

To successfully treat malnutrition, you must eliminate the underlying causes as much as possible. For example, if a poorly fitting denture interferes with food intake, it should be adjusted. With swallowing disorders, swallowing therapy can help. If, for example, as a result of a stroke physical impairments complicate the independent eating and drinking, physiotherapy, occupational therapy and Esstraining can be useful. In the case of medicines whose side effects (such as nausea and lack of appetite) contribute to malnutrition, it may be possible to switch to better tolerated preparations. Existing diseases such as tumors, which are responsible for the insufficient nutrient supply, must be treated professionally.

In addition, malnutrition requires further action that should be taken by the patients themselves or their relatives and caregivers:

nutritional intervention

The deficit of nutrients in malnutrition itself is remedied by a sufficient supply of nutrients. For this purpose, a varied and energetic diet is recommended, which takes into account the likes and dislikes of the patient. Seasoning the food with herbs and spices can stimulate the appetite.

When chewing and swallowing disorders should be taken to ensure the correct consistency of the food: too dry or difficult to chew food (such as a hard bread crust) should be avoided. Instead, you should chop fruit, meat & Co before serving in bite-sized pieces. To completely puree the food is usually not necessary (except for heavy dysphagia) – porridge-like food also looks usually less appetizing.

In malnutrition, several small meals during the day are more useful than three large ones. In addition, you should keep fixed meal times and provide a quiet, comfortable atmosphere while eating without disturbance and distraction.

In patients with malnutrition, adequate hydration is also very important. People with dysphagia, however, may easily swallow with drinks or low-viscosity foods (such as soups). Then you should thicken the liquids with a tasteless powder.

Balanced drinking food

Sometimes malnutrition can only be remedied by using balanced nutrition. It contains all vital nutrients in sufficient quantities and can be used both for the sole diet and in addition to the normal diet. Particularly recommended are energy and protein-rich products. Balanced drinking food is available in different flavors in the pharmacy.

tube Feeding

If a high-energy diet and / or balanced nutrition are insufficient to compensate for the deficiencies of malnutrition, the patient must be artificially fed via a probe – either for a limited time or for a long time. With the help of nurses, the artificial diet can also be carried out at home.

More tips

Despite possible weakness and tiredness, people with malnutrition should, as far as possible, be physically active and move about every day, for example taking a little walk. The movement and the fresh air can stimulate the appetite.

In the case of physical impairment (such as hemiplegia after a stroke), the use of special crockery and cutlery may be useful. Non-slip plates, special cutlery and cups with handle reinforcement, for example, can facilitate independent eating and drinking and thus counteract malnutrition.

People with malnutrition who live alone need help – such as carers, (volunteer) caregivers, mobile assistance, shopping or “eating on wheels”.

Malnutrition: disease course and prognosis

Malnutrition affects mainly older people in this country. How well and quickly it can be treated depends, among other things, on the underlying causes. It is also important to act as early as possible: malnutrition can be treated the easier the sooner it is recognized. Therefore, attention is needed both from the patients themselves as well as the relatives, doctors and nurses. With the right treatment, malnutrition in old age can be corrected in most cases.

Will one malnutrition on the other hand, if it is not recognized by older people and persists for a long time, it increases the mortality risk.