Malnutrition occurs when the body does not get enough vitamins, minerals, andother nutrients it needs to maintain healthy tissues and organ function. Both undernourished or over-nourished people can suffer from malnutrition.
Undernutrition is a consequence of consuming too few essential nutrients or using or excreting them more rapidly than they can be replaced.
Infants, young children, and teenagers need additional nutrients. So do womenwho are pregnant or breastfeeding. Nutrient loss can be accelerated by diarrhea, excessive sweating, heavy bleeding (hemorrhage), or kidney failure. Nutrient intake can be restricted by age-related illnesses and conditions,excessive dieting, severe injury, serious illness, a lengthy hospitalization, or substance abuse.
The leading cause of death in children in developing countries is protein-energy malnutrition. This type of malnutrition results from inadequate intake ofcalories from proteins, vitamins, and minerals. Children who are already undernourished can suffer from protein-energy malnutrition when rapid growth, infection, or disease increases the need for protein and essential minerals.
In the United States, nutritional deficiencies generally have been replaced by dietary imbalances or excesses associated with many of the leading causes of death and disability. Overnutrition results from eating too much, eating too many of the wrong things, not exercising enough, or taking too many vitamins or other dietary replacements.
Risk of overnutrition is also increased by being more than 20% overweight, consuming a diet high in fat and salt, and taking high doses of:
- Nicotinic acid (niacin) to lower elevated cholesterol levels
- Vitamin B6 to relieve premenstrual syndrome
- Vitamin A to clear up skinproblems
- Iron or other trace minerals not prescribed by a doctor.
Nutritional disorders can affect any system in the body and the senses of sight, taste, and smell. Malnutrition begins with changes in nutrient levels inblood and tissues. Alterations in enzyme levels, tissue abnormalities, and organ malfunction may be followed by illness and death.
Poverty and lack of food are the primary reasons why malnutrition occurs in the United States. Ten percent of all low income households members do not always have enough healthful food to eat, and malnutrition affects one in four elderly Americans. Protein-energy malnutrition occurs in 50% of surgical patients and in 48% of all other hospital patients.
There is an increased risk of malnutrition associated with chronic diseases,especially disease of the intestinal tract, kidneys, and liver. Patients withchronic diseases like cancer, AIDS, and intestinal disorders may lose weightrapidly and become susceptible to undernourishment because they cannot absorb valuable vitamins, calories, and iron.
People with drug or alcohol dependencies are also at increased risk of malnurtrition. These people tend to maintain inadequate diets for long periods of time, and their ability to absorb nutrients is impaired by the alcohol or drug's affect on body tissues, particularly the liver, pancreas, and brain.
Unintentionally losing 10 pounds or more may be a sign of malnutrition. People who are malnourished may be skinny or bloated. Their skin is pale, thick, dry, and bruises easily. Rashes and changes in pigmentation are common.
Hair is thin, tightly curled, and pulls out easily. Joints ache and bones aresoft and tender. The gums bleed. The tongue may be swollen or shriveled andcracked. Visual disturbances include night blindness and increased sensitivity to light and glare.
Other symptoms of malnutrition include:
- Goiter (enlarged thyroid gland)
- Loss ofreflexes and lack of coordination
- Muscle twitches
- Scaling and cracking of the lips and mouth.
Malnourished children may be short for their age, thin, listless, and have weakened immune systems.
Overall appearance, behavior, body-fat distribution, and organ function can alert a family physician, internist, or nutrition specialist to the presence of malnutrition. Patients may be asked to record what they eat during a specific period. X rays can determine bone density and reveal gastrointestinal disturbances, and heart and lung damage.
Blood and urine tests are used to measure levels of vitamins, minerals, and waste products. Nutritional status can also be determined by:
- Comparinga patient's weight to standardized charts
- Calculating body mass index (BMI) according to a formula that divides height into weight
- Measuring skin-fold thickness or the circumference of the upper arm.
Normalizing nutritional status starts with a nutritional assessment. This process enables a clinical nutritionist or registered dietician to confirm the presence of malnutrition, assess the effects of the disorder, and formulate diets that will restore adequate nutrition.
Patients who cannot or will not eat, or who are unable to absorb nutrients taken by mouth, may be fed intravenously (parenteral nutrition) or through a tube inserted into the gastrointestinal (GI) tract (enteral nutrition).
Tube feeding is often used to provide nutrients to patients who have sufferedburns or who have inflammatory bowel disease. In this procedure,a thin tubeis inserted through the nose and carefully guiding along the throat until itreaches the stomach or small intestine. If long-term tube feeding is necessary, the tube may be placed directly into the stomach or small intestine through an incision in the abdomen.
Tube feeding cannot always deliver adequate nutrients to patients who:
- Are severely malnourished
- Require surgery
- Are undergoing chemotherapy or radiation treatments
- Have been seriously burned
- Have persistent diarrhea or vomiting
- Whose gastrointestinal tract is paralyzed.
Intravenous feeding can supply some or all of the nutrients these patients need.
Up to 10% of a person's body weight can be lost without side effects, but ifmore than 40% is lost, the situation is almost always fatal. Death usually results from heart failure, electrolyte imbalance, or low body temperature. Patients with semiconsciousness, persistent diarrhea, jaundice, or low blood sodium levels have a poorer prognosis.
Some children with protein-energy malnutrition recover completely. Others have many health problems throughout life, including mental retardation and theinability to absorb nutrients through the intestinal tract. Prognosis for patients with malnutrition seems to be dependent on the the patient's age and the length and severity of the malnutrition, with young children and the elderly having the highest rate of long-term complications and death.
Breastfeeding a baby for at least six months is considered the best way to prevent early-childhood malnutrition. The United States Department of Agriculture and Health and Human Service recommend that all Americans over the age oftwo:
- Consume plenty of fruits, grains, and vegetables
- Eat a variety of foods that are low in fats and cholesterols and contain only moderate amounts of salt, sugars, and sodium
- Engage in moderate physical activity for at least 30 minutes, at least several times a week
- Achieve or maintain their ideal weight
- Use alcohol sparingly or avoid italtogether.
Every patient admitted to a hospital should be screened for the presence of illnesses and conditions that could lead to protein-energy malnutrition. Patients with higher-than-average risk for malnutrition should be more closely assessed and reevaluated often during long-term hospitalization or nursing-homecare.