malnutrition


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Malnutrition

 

Definition

Malnutrition is the condition that develops when the body does not get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function.

Description

Undernutrition

Malnutrition occurs in people who are either undernourished or overnourished. 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 women who 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, food allergies, 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 is the result of inadequate intake of calories from proteins, vitamins, and minerals. Children who are already undernourished can suffer from protein-energy malnutrition (PEM) when rapid growth, infection, or disease increases the need for protein and essential minerals. These essential minerals are known as micronutrients or trace elements.
Two types of protein-energy malnutrition have been described—kwashiorkor and marasmus. Kwashiorkor occurs with fair or adequate calorie intake but inadequate protein intake, while marasmus occurs when the diet is inadequate in both calories and protein.
About 1% of children in the United States suffer from chronic malnutrition, in comparison to 50% of children in southeast Asia. About two-thirds of all the malnourished children in the world are in Asia, with another one-fourth in Africa.

Overnutrition

In the United States, nutritional deficiencies have generally been replaced by dietary imbalances or excesses associated with many of the leading causes of death and disability.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 skin problems
  • 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. They may also produce anxiety, changes in mood, and other psychiatric symptoms. Malnutrition begins with changes in nutrient levels in blood and tissues. Alterations in enzyme levels, tissue abnormalities, and organ malfunction may be followed by illness and death.

Causes and symptoms

Causes

Poverty and lack of food are the primary reasons why malnutrition occurs in the United States. Ten percent of all members of low income households do not always have enough healthful food to eat. Protein-energy malnutrition occurs in 50% of surgical patients and in 48% of all other hospital patients.
Loss of appetite associated with the aging process. Malnutrition affects one in four elderly Americans, in part because they may lose interest in eating. In addition, such dementing illnesses as Alzheimer's disease may cause elderly persons to forget to eat.
There is an increased risk of malnutrition associated with chronic diseases, especially disease of the intestinal tract, kidneys, and liver. Patients with chronic diseases like cancer, AIDS, intestinal parasites, and other gastric disorders may lose weight rapidly 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 malnutrition. 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.
Eating disorders. People with anorexia or bulimia may restrict their food intake to such extremes that they become malnourished.
Food allergies. Some people with food allergies may find it difficult to obtain food that they can digest. In addition, people with food allergies often need additional calorie intake to maintain their weight.
Failure to absorb nutrients in food following bariatric (weight loss) surgery. Bariatric surgery includes such techniques as stomach stapling (gastroplasty) and various intestinal bypass procedures to help people eat less and lose weight. Malnutrition is, however, a possible side effect of bariatric surgery.

Symptoms

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 are soft and tender. The gums bleed easily. The tongue may be swollen or shriveled and cracked. Visual disturbances include night blindness and increased sensitivity to light and glare.
Other symptoms of malnutrition include:
  • anemia
  • diarrhea
  • disorientation
  • night blindness
  • irritability, anxiety, and attention deficits
  • goiter (enlarged thyroid gland)
  • loss of reflexes and lack of muscular coordination
  • muscle twitches
  • amenorrhea (cessation of menstrual periods)
  • scaling and cracking of the lips and mouth.
Malnourished children may be short for their age, thin, listless, and have weakened immune systems.

Diagnosis

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 the patient's levels of vitamins, minerals, and waste products. Nutritional status can also be determined by:
  • Comparing a patient's weight to standardized charts
  • Calculating body mass index (BMI) according to a formula that divides height into weight
  • Measuring skinfold thickness or the circumference of the upper arm.

Treatment

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 suffered burns or who have inflammatory bowel disease. This procedure involves inserting a thin tube through the nose and carefully guiding it along the throat until it reaches 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.

Prognosis

Up to 10% of a person's body weight can be lost without side effects, but if more 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 the inability to absorb nutrients through the intestinal tract. Prognosis for all patients with malnutrition seems to be dependent on the age of the patient, and the length and severity of the malnutrition, with young children and the elderly having the highest rate of long-term complications and death.

Prevention

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 of two:
  • 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 it altogether.
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-home care.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Malnutrition." Section 1, Chapter 2. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Flancbaum, Louis, MD, with Erica Manfred and Deborah Biskin. The Doctor's Guide to Weight Loss Surgery. West Hurley, NY: Fredonia Communications, 2001.

Periodicals

Alvarez-Leite, J. I. "Nutrient Deficiencies Secondary to Bariatric Surgery." Current Opinion in Clinical Nutrition and Metabolic Care 7 (September 2004): 569-575.
Amella, E. J. "Feeding and Hydration Issues for Older Adults with Dementia." Nursing Clinics of North America 39 (September 2004): 607-623.
Bryan, J., S. Osendorp, D. Hughes, et al. "Nutrients for Cognitive Development in School-Aged Children." Nutrition Reviews 62 (August 2004): 295-306.
Grigsby, Donna G., MD. "Malnutrition." eMedicine December 18, 2003. http://www.emedicine.com/ped/topic1360.htm.
Gums, J. G. "Magnesium in Cardiovascular and Other Disorders." American Journal of Health-System Pharmacy 61 (August 1, 2004): 1569-1576.
Halsted, G. H. "Nutrition and Alcoholic Liver Disease." Seminars in Liver Disease 24 (August 2004): 289-304.
Reid, C. L. "Nutritional Requirements of Surgical and Critically-Ill Patients: Do We Really Know What They Need?" Proceedings of the Nutrition Society 63 (August 2004): 467-472.

Organizations

American College of Nutrition. 722 Robert E. Lee Drive, Wilmington, NC 20412-0927. (919) 452-1222.
American Institute of Nutrition. 9650 Rockville Pike, Bethesda, MD 20814-3990. (301) 530-7050.
Food and Nutrition Information Center. 10301 Baltimore Boulevard, Room 304, Beltsville, MD 20705-2351. http://www.nalusda.gov/fnic.

Other

World Health Organization (WHO) Nutrition web site. 〈http://www.who.int/nut/index.htm〉.

Key terms

Anemia — Not enough red blood cells in the blood.
Anorexia nervosa — Eating disorder marked by malnutrition and weight loss commonly occurring in young women.
Bariatric — Pertaining to the study, prevention, or treatment of overweight.
Calorie — A unit of heat measurement used in nutrition to measure the energy value of foods. A calorie is the amount of heat energy needed to raise the temperature of 1 kilogram of water 1°C.
Kwashiorkor — Severe malnutritution in children primarily caused by a protein-poor diet, characterized by growth retardation.
Marasmus — Severe malnutritution in children caused by a diet lacking in calories as well as protein. Marasmus may also be caused by disease and parasitic infection.
Micronutrients — Essential dietary elements that are needed only in very small quantities. Micronutrients are also known as trace elements. They include copper, zinc, selenium, iodine, magnesium, iron, cobalt, and chromium.

malnutrition

 [mal″noo-trish´un]
poor nourishment resulting from improper diet or from some defect in metabolism that prevents the body from using its food properly. Extreme malnutrition may lead to starvation. Although poverty is still the major cause of malnutrition, the condition is by no means confined to the underdeveloped parts of the world. Anyone can become undernourished by seriously neglecting the diet. A well balanced diet, which varies slightly with a person's age, should include adequate amounts of protein, vitamins, minerals, and carbohydrates. For an explanation of the value of properly balanced diets and guidelines for a healthy diet, see nutrition.

Ignorance of the basic principles of nutrition is probably almost as great a cause of undernourishment as poverty. Misplaced faith in vitamin pills as a substitute for food, for example, can cause undernourishment if carried to extremes. So can over-reliance on excessively processed foods. Modern methods of processing and refining foods can sometimes cause a loss of valuable nutrients, as happens in the refining of certain grains, such as rice. However, this danger is recognized by both the government and the manufacturers who try to retain or restore the nutritional value of many foods. alcoholism, which frequently leads a person to rely on alcohol at the expense of food, is another cause of malnutrition.

People who want to gain or lose weight, or who avoid certain foods, may endanger their health by following an unbalanced diet that lacks essential nutrients. Anyone who plans to follow a special diet should consult with a Registered Dietitian. Malnutrition can also stem from disease. If the organs of the digestive system that transform food into bone, tissue, blood, and energy fail to function properly, the body will not receive adequate nourishment. Such deficiencies can cause certain liver diseases, and some anemias. The endocrine glands and enzymes are also vital to the proper use of food by the body, and defects in their functioning may cause forms of malnutrition.
Symptoms. In general, the symptoms of malnutrition are physical weakness, lassitude, and an increasing sense of detachment from the world. There are also specific symptoms that vary according to the essential substance lacking in the diet. For example, lack of vitamin A can result in night blindness, or poor vision in dim light. In the absence of adequate exposure to sunlight, a lack of vitamin D can cause rickets, which results in malformed limbs in infants and children because the bones fail to harden properly. A lack of vitamin C causes scurvy, with symptoms of bleeding gums and easily bruised skin. Other vitamin deficiency diseases are beriberi and pellagra. If there is not enough iron in the diet, iron deficiency anemia develops. Malnutrition can also result from allergic reactions to foods, as in celiac disease.

In starvation there are signs of multiple vitamin deficiency. There may be edema, abdominal distention, and excessive loss of weight. As starvation progresses, fat cells become small and accumulations of fat are depleted. The liver is reduced in size, the muscles shrivel, and the lymphoid tissue, gonads, and blood deteriorate.

mal·nu·tri·tion

(mal'nū-trish'ŭn),
Faulty nutrition resulting from malabsorption, poor diet, or overeating.

malnutrition

/mal·nu·tri·tion/ (mal″noo-trish´un) any disorder of nutrition.

malnutrition

(măl′no͞o-trĭsh′ən, -nyo͞o-)
n.
Poor nutrition because of an insufficient or poorly balanced diet or faulty digestion or utilization of foods.

malnutrition

[mal′no̅o̅trish′ən]
Etymology: L, malus, bad, nutrire, to nourish
any disorder of nutrition. It may result from an unbalanced, insufficient, or excessive diet or from impaired absorption, assimilation, or use of foods. Compare deficiency disease.

malnutrition

A state caused by prolonged nutritional defects—e.g., decreased proteins, minerals, vitamins or calories.
 
Aetiology
• Exogenous—poverty, alcohol, mental disorders (e.g., severe depression), infection (e.g., TB, malignancy, or nosocomial due to total parenteral nutrition).
• Endogenous—metabolic defects (congenital or acquired), malabsorption.

Clinical findings
Weakness, apathy, anorexia, diarrhoea, skin pigmentation and/or ulceration.
 
Lab
Reduced folic acid, iron, magnesium, bile synthesis, disaccharidase activity, protein, vitamin B12.

Management
See Kwashiorkor, Marasmus.

malnutrition

The result of prolonged nutritional defects–eg, ↓ proteins, minerals, vitamins, or calories Etiology–exogenous Poverty, alcohol, mental disorders–eg, severe depression, infection–eg, TB, malignancy, or nosocomial due to TPN Endogenous Metabolic defects–congenital or acquired, malabsorption Clinical Weakness, apathy, anorexia, diarrhea, skin pigmentation and/or ulceration Lab ↓ Folic acid, iron, magnesium, bile synthesis, disaccharidase activity, protein, vitamin B12. See Kwashiorkor, Marasmus.

mal·nu·tri·tion

(mal'nū-trish'ŭn)
Faulty nutrition resulting from malabsorption, poor diet, or overeating.

malnutrition

Any disorder resulting from an inadequate diet or from failure to absorb or assimilate dietary elements. The term is now often used to describe the effects of an ill-chosen, even if calorifically adequate, diet or of excessive food intake. See also SPRUE, MALABSORPTION, COELIAC DISEASE, CROHN'S DISEASE, ANOREXIA NERVOSA, VITAMIN DEFICIENCY, BERI-BERI, PELLAGRA, SCURVY, XEROPHTHALMIA, RICKETS and KWASHIORKOR.

malnutrition

the state of being poorly nourished due to the diet containing inadequate micro- and macronutrients. Can result in deficiency diseases, such as scurvy (due to lack of vitamin C). Prolonged or repeated weight-loss attempts are likely to cause nutritional deficiencies.

mal·nu·tri·tion

(mal'nū-trish'ŭn)
Faulty nutrition resulting from malabsorption, poor diet, or overeating.

malnutrition,

n a disorder concerning nutrition. It may result from a poor diet or from impaired utilization of foods ingested.

malnutrition

the term used to describe the condition caused by a diet that contains all of the essential nutrients but in suboptimal amounts—an intermediate stage to starvation. It is compatible with life and the same metabolic changes occur as in starvation but to a lesser degree. Ketosis, loss of body weight and muscular power accompany a lower metabolic rate. There is also a fall in body temperature, reduced heart and respiratory rates and sexual activity. Could also be used to describe gross over-nutrition. See also cachexia, starvation.

milk replacer malnutrition
see milk replacer.

Patient discussion about malnutrition

Q. How do I now if my nutrition is correct? I guess it's not... and Id like to fix it but dont really know what should I change...

A. Read more about the recommended nutrition, and learn how to analyze yours here (www.nlm.nih.gov/medlineplus/nutrition.html), and if you have further concerns, you may want to consult a professional (e.g. dietitian). In general, nutrition should include about 30-35 calories per kg per day.

Eat a healthy diet with a lot of vegetables, fruits, and whole grains and a limited amount of red meat. Get at least five servings of fruits and vegetables every day. More is even better. Tips for achieving this goal include: Make fruits and vegetables part of every meal. Frozen or canned can be used when fresh isn't convenient. Put fruit on your cereal. Eat vegetables as snacks. Have a bowl of fruit out all the time for kids to take snacks from.

Cut down on bad fats (trans fatty acids and saturated fats) and consume good fats (polyunsaturated and monounsaturated fat like olive oil and canola oil). Tips for achieving this goal include: Choose chicken, fish, or beans instead of red meat and ch

Q. Will it be good and what is its nutritional value? I wish to take oats as my breakfast with milk or juice. Will it be good and what is its nutritional value?

A. It is undoubtedly a good idea to have oats as your breakfast with milk or juice. It is well known for its high fiber content which is the best remedy for constipation and also plays a vital role in the cholesterol management and smoothens the digestive process. It also helps you in loosing body weight. It is even good for nervous system and in turn treats depression as well. Around 150gm of oat gives 600kcal energy. Apart from protein, lipid, carbohydrate and fiber content, it is a very good source of minerals such as calcium, iron sodium, zinc, and vitamins like vitamin C, B, A.

Q. What is the nutritional value of oats? I am having oats for my morning breakfast from last week, as I know it is good to have them. But what is the nutritional value of oats?

A. oats are rich with vitamins, energy and protein. makes a wonderful breakfast! (at least when my wife makes it!!).
here's a link to a nutritional value list of oats:
http://www.healthrecipes.com/oats.htm

and here's a link to some recipes!:
bread - http://momsrecipesandmore.blogspot.com/2008/12/toasted-oatmeal-bread.html

Biscuits - http://www.vegan-food.net/recipe/927/Oatmeal-Raisin-Cookies/

oatmeal- http://www.fatfree.com/recipes/breakfast/oatmeal

bon apetite!

More discussions about malnutrition
References in periodicals archive ?
The expected intermediate outcomes for this project include : (1) significantly reduced malnutrition in children aged 6 to 59 month in the regions of Kayes, Koulikoro, Segou, Sikasso and the district of Bamako; and (2) reduced malnutrition in pregnant and nursing women in the regions of Kayes, Koulikoro, Segou, Sikasso and the district of Bamako.
To address increasing malnutrition levels, aid agencies have scaled up assistance and treated 97,000 children for severe acute malnutrition in the past six months, while 65,000 children have been treated for moderate acute malnutrition, Farhan Haq, Deputy Spokesman for the Secretary-General, told the regular noon briefing at UN Headquarters in New York.
It is imperative that all clinicians, as well as family and patient advocates, are familiar with the signs of malnutrition in order to identify it as early as possible.
UNICEF is working with national and international partners and the government of Nepal to deliver a comprehensive nutrition response that includes supporting community screening to identify children with severe acute malnutrition in affected districts.
Keywords: acquired brain injury, malnutrition, nursing care, nutritional risk factors, rehabilitation, weight loss
There are three other things needed to make a convincing case for an issue to be targeted by the SDG--and malnutrition has them all.
The "Global Nutrition Report," which was released in November, includes nutrition profiles for each of the United Nations' 193 member states and offers information on nutrition status outcomes, program coverage and underlying malnutrition determinants, such as food security, sanitation and hygiene, resource allocations and policy.
The present descriptive study is based on the objective to assess the malnutrition among the preschooler children in rural community at Taloja village.
In 2014, WFP aims to assist a total of 275,000 people suffering moderate acute malnutrition across Sudan.
C LOTHING - weight loss can be a sign of malnutrition, so look at clothing.
ISLAMABAD -- The Government is endeavouring to address the issues of poverty, malnutrition and food insecurity through joint and collaborative approach between provinces and federation.
AT LEAST three different surveys have debunked the Gujarat Government's claim of having effectively combated malnutrition and revealed that as many as 94 per cent children in the tribal regions of the state stretching right from Ambaji in the north to the Dangs in the south are stunted or undernourished.