In many parts of the world, undernutrition results from a lack of food. In some cases, however, undernourishment may stem from a health condition, such as an eating disorder or a chronic illness that prevents the person from absorbing nutrients.
This article will focus mainly on undernutrition.
What is malnutrition?
Older people can be at risk of nutrition if they are isolated and have mobility problems.
Malnutrition involves a dietary deficiency. People may eat too much of the wrong type of food and have malnutrition, but this article will focus on undernutrition, when a person lacks nutrients because they do not consume enough food.
Poor diet may lead to a lack of vitamins, minerals, and other essential substances. Too little protein can lead to kwashiorkor, symptoms of which include a distended abdomen. A lack of vitamin C can result in scurvy.
Scurvy is rare in industrialized nations, but it can affect older people, those who consume excessive quantities of alcohol, and people who do not eat fresh fruits and vegetables. Some infants and children who follow a limited diet for any reason may be prone to scurvy.
According to the World Health Organization (WHO), 462 million people worldwide are malnourished, and stunted development due to poor diet affects 159 million children globally.
Malnutrition during childhood can lead not only to long-term health problems but also to educational challenges and limited work opportunities in the future. Malnourished children often have smaller babies when they grow up.
Signs and symptoms of undernutrition include:
- lack of appetite or interest in food or drink
- tiredness and irritability
- inability to concentrate
- always feeling cold
- loss of fat, muscle mass, and body tissue
- higher risk of getting sick and taking longer to heal
- longer healing time for wounds
- higher risk of complications after surgery
- reduced sex drive and problems with fertility
In more severe cases:
- breathing becomes difficult
- skin may become thin, dry, inelastic, pale, and cold
- the cheeks appear hollow and the eyes sunken, as fat disappears from the face
- hair becomes dry and sparse, falling out easily
Eventually, there may be respiratory failure and heart failure, and the person may become unresponsive. Total starvation can be fatal within 8 to 12 weeks
Children may show a lack of growth, and they may be tired and irritable. Behavioral and intellectual development may be slow, possibly resulting in learning difficulties.
Even with treatment, there can be long-term effects on mental function, and digestive problems may persist. In some cases, these may be lifelong.
Adults with severe undernourishment that started during adulthood usually make a full recovery with treatment.
Malnutrition can result from various environmental and medical conditions.
1) Low intake of food
This may be caused by symptoms of an illness, for example, dysphagia, when it is difficult to swallow. Badly fitting dentures may contribute.
2) Mental health problems
3) Social and mobility problems
Some people cannot leave the house to buy food or find it physically difficult to prepare meals. Those who live alone and are isolated are more at risk. Some people do not have enough money to spend on food, and others have limited cooking skills.
4) Digestive disorders and stomach conditions
If the body does not absorb nutrients efficiently, even a healthful diet may not prevent malnutrition. People with Crohn's disease or ulcerative colitis may need to have part of the small intestine removed to enable them to absorb nutrients.
Persistent diarrhea, vomiting, or both can lead to a loss of vital nutrients.
Addiction to alcohol can lead to gastritis or damage to the pancreas. These can make it hard to digest food, absorb certain vitamins, and produce hormones that regulate metabolism.
Alcohol contains calories, so the person may not feel hungry. They may not eat enough proper food to supply the body with essential nutrients.
6) Lack of breastfeeding
Not breastfeeding, especially in the developing world, can lead to malnutrition in infants and children.
In some parts of the world, widespread and long-term malnutrition can result from a lack of food.
In the wealthier nations, those most at risk of malnutrition are:
- older people, especially those who are hospitalized or in long-term institutional care
- individuals who are socially isolated
- people on low incomes
- those who have difficulty absorping nutrients
- people with chronic eating disorders, such as bulimia or anorexia nervosa
- people who are recovering from a serious illness or condition
Prompt diagnosis and treatment can prevent the development and complications of malnutrition.
There are several ways to identify adults who are malnourished or at risk of malnutrition, for example, the Malnutrition Universal Screening Tool (MUST) tool.
MUST has been designed to identify adults, and especially older people, with malnourishment or a high risk of malnutrition.
It is a 5-step plan that can help health care providers diagnose and treat these conditions.
Here are the steps:
- Step 1: Measure height and weight, calculate body mass index (BMI), and provide a score.
- Step 2: Note the percentage of unplanned weight loss and provide a score. For example, an unplanned loss of 5 to 10 percent of weight would give a score of 1, but a 10-percent loss would score 2.
- Step 3: Identify any mental or physical health condition and score. For example, if a person has been acutely ill and taken no food for over 5 days, the score will be 3.
- Step 4: Add scores from steps 1, 2 and 3 to obtain an overall risk score.
- Step 5: Use local guidelines to develop a care plan.
If the person is at low risk of malnutrition, their overall score will be 0. A score of 1 denotes a medium risk and 2 or more indicates a high risk.
MUST is only used to identify malnutrition or the risk of malnutrition in adults. It will not identify specific nutritional imbalances or deficiences.
Following the MUST screening, the following may happen:
Low risk: Recommendations include ongoing screening at the hospital and at home.
Medium risk: The person may undergo observation, their dietary intake will be documented for 3 days, and they will receive ongoing screening.
High risk: The person will need treatment from a nutritionist and possibly other specialists, and they will undergo ongoing care.
For all risk categories, help and advice on food choices and dietary habits should be offered.
The type of treatment will depend on the severity of the malnutrition, and the presence of any underlying conditions or complications.
The healthcare provider will prepare a targeted care plan, with specific aims for treatment. There will normally be a feeding program with a specially planned diet, and possibly some additional nutritional supplements.
People with severe malnourishment or absorption problems may need artificial nutritional support, either through a tube or intravenously.
The patient will be closely monitored for progress, and their treatment will be regularly reviewed to ensure their nutritional needs are being met.
A dietitian will discuss healthful food choices and dietary patterns with the patient, to encourage them to consume a healthy, nutritious diet with the right number of calories. Those who are undernourished may need additional calories to start with.
Regular monitoring can help ensure an appropriate intake of calories and nutrients. This may be adjusted as the patient's requirements change. Patients receiving artificial nutritional support will start eating normally as soon as they can.
To prevent malnutrition, people need to consume a range of nutrients from a variety of food types. There should be a balanced intake of carbohydrates, fats, protein, vitamins, and minerals, as well as plenty of fluids, and especially water.
People with ulcerative colitis, Crohn's disease, celiac disease, alcoholism, and other health issues will receive appropriate treatment for their condition.