Malnutrition Dietetics

State of energy, protein and nutrient deficiency which causes measurable adverse effects on body composition, tissues and clinical outcome

BMI < 25 kg/m2 OR more than 10% weight loss in 3-6 months, OR BMI < 20kg/m2 and more t han 5% wt loss in 3-6 months

1/they have infants with low birth weight 2/be ill 3/less able to do physical activity

Inability to do physical work, fatigue

Poorer outcome after surgery or chemotherapy disturbances in thermoregulation

NO but it can highlight individuals AT RISK of malnutrition, where a pt has eaten NOTHING or VERY LITTLE for > 5 days and is likely to eat nothing for the next 5 days or longer (NICE 2006)

1/dysphagia, 2/disability, 3/dependency, 4/dentition/dentures, 5/diarrhoea, 6/disease, 7/disability, 8/dementia, 9/depression, 10/disease, 11/diet, 12/drugs

Crohn's, coeliac, GI surgery

C diff diarrhoea, vomiting, wounds oozing, ascites; draining fluid and protein losses

GI tract, muscle mass lost from gut so villi lost to act as protection so infection through gur via that. wound healing slower pre or post op, wt loss, kyphosis, lowered immune system; susceptibility to infection, sepsis (bloodstream overwhelmed by bascteria), decreased CO leading to heart failure, difficult to cough or exporate to increase in chest infections, water and alectrolye disturbances, impaired thermoregulation, pressure sores, decreased Q0L

Causing depression apathy, lading to loss or morale and ability to recover

For bed bound subjects or kyphosis use ulna length (olcranon to styloid process) to estimate height, or knee height or demispan (sternal notch to point between middle and ring finger). if subject cannot be weighed use a weight recently documted in their notes or a self reported weight. BMI can be estimated using MUAC; measure length from acromion to olcranon process then measure the half point

If MUAC is less than 23.5 cm, BMI is likely to be lessthan 20 kg/m2 i.e. subject is likely to be underweight. If MUAC is more than 32.0 cm, BMI is likely to bemore than 30 kg/m2 i.e. subject is likely to be obese.

Albumin- but due to long half life of 21 days secondary to disease state or hydration changes

Switch from fat metaboolism to carohydrate metabolism, increased insulin release and increased uptake of glucose, phosphate, potassium, magnesium and water into cells.