What Is Malnutrition?
Malnutrition refers to deficiencies, extremes, or imbalances in a person’s energy and/or nutrient intake. The term malnutrition refers to 3 broad groups of conditions:
- Malnutrition, including wasting (low weight for height), stunting (short height for age), and underweight (low weight for age);
- Micronutrient-related malnutrition, including micronutrient deficiencies (lack of important vitamins and minerals) or excess micronutrients.
- Overweight, obesity, and diet-related non-connectable diseases (such as heart disease, stroke, diabetes, and some cancers).
Who is affected by malnutrition?
Malnutrition is a common health problem. There are an estimated 3 million undernourished people in the UK, and many more are at risk of malnutrition. Around one in three people admitted in hospitals or nursing homes in the UK are undernourished or at risk of undernutrition.
Malnutrition is caused by a poor diet or a problem absorbing nutrients from food. There are many reasons this can happen, including reduced mobility, a long-term health condition, etc,
Types of malnutrition
There are 4 broad sub-forms of undernutrition: Wasting, stunting, underweight, and vitamin and mineral deficiencies. Malnutrition makes children, in particular, much more vulnerable to disease and death.
- Low weight for height is known as wasting. It usually indicates a recent and severe weight loss, because a person has not had enough food to eat and/or has had an infectious disease, such as diarrhoea, that has caused them to lose weight. A young child with moderate or severe wasting is at increased risk of death, but treatment is possible.
- Short stature for age is known as stunting. It is the result of chronic or recurrent malnutrition, generally associated with poor socioeconomic conditions, poor maternal health and nutrition, frequent diseases, and/or inadequate feeding and care of infants and young children in the early stages of life. Growth retardation prevents children from reaching their physical and cognitive potential.
- Children who are underweight for their age are known as underweight. A skinny child may be stunted, wasted, or both.
Vitamin and mineral intake deficiencies often referred to as micronutrients, can also be clustered. Micronutrients allow the body to produce enzymes, hormones, and other substances that are essential for proper growth and development.
Iodine, vitamin A and iron are the most important in terms of global public health; their deficiency poses a major threat to the health and development of populations around the creation, particularly children and pregnant women in low-income countries.
Overweight and obesity
Overweight and obesity occur when a person weighs too much for their height. The accumulation of abnormal or excessive fat can affect health.
Body Mass Index (BMI) is a weight-for-height index that is commonly used to classify overweight and obesity. It is defined as the weight of a person in kilograms divided by the square of her height in meters (kg / m<2FEMININE>). In adults, being overweight is defined as a BMI of 25 or more, while obesity is a BMI of 30 or more.
Overweight and obesity are the results of an imbalance between energy consumed (too much) and energy expended (too little). Globally, people consume foods and beverages that are more energy-dense (high in sugar and fat) and are less physically active.
Diet-related non-communicable diseases
Non-communicable diseases (NCDs) related to diet contain cardiovascular diseases (such as heart attacks and strokes, which are often linked to high blood pressure), certain cancers, and diabetes. Unhealthy diets and poor nutrition are among the top risk factors for these diseases globally.
Scope of the problem
- In 2014, approximately 462 million adults worldwide were underweight, while 1.9 billion were overweight or obese.
- In 2016, it was estimated that 155 million children under the age of 5 were stunted, while 41 million were overweight or obese.
- About 45% of deaths of children under 5 years of age are related to malnutrition. These occur mainly in low- and middle-income countries. At the same time, in these same countries, rates of childhood overweight and obesity are increasing.
Symptoms of malnutrition
Some signs and symptoms of malnutrition include:
- Lack of appetite or interest in food or drink
- Tiredness and irritability
- An inability to concentrate
- Always feeling cold
- Injury of fat, muscle mass, and body tissue
- Longer wound healing time
- An increased risk of complications after surgery
- Eventually, a person can also experience shortness of breath and heart failure.
In children, there may be:
- Poor growth and low body weight
- Tiredness and lack of energy
- Irritability and anxiety
- Measured behavioural and intellectual development, possibly resulting in learning difficulties
- Treatment is possible. In some cases, however, malnutrition can have long-term effects.
Causes of malnutrition
Unfortunately, malnutrition in developed countries is even more common in situations of poverty, social isolation, and substance abuse. However, most malnutrition in adults is associated with disease and can arise due to:
- Reduced dietary intake
- condensed absorption of macro and/or micronutrients
- Increased losses or altered requirements
- Increased energy expenditure (in specific pathological processes).
Malnutrition affects people in all parts of the world, but some populations are at higher risk.
Populations that are prone to malnutrition include:
- People living in developing countries or areas with incomplete access to food: Malnutrition and micronutrient deficiencies are particularly common in sub-Saharan Africa and South Asia.
- People with higher nutrient needs, especially children and pregnant or lactating women: In some developing countries, between 24% and 31% of pregnant and lactating mothers are undernourished.
- People living in poverty or low income: Low socioeconomic status is associated with malnutrition.
- Older adults, especially those who live alone or have disabilities: Research shows that up to 22% of older adults are malnourished and more than 45% are at risk of malnutrition.
- People with problems affecting nutrient absorption: People with Crohn’s disease or ulcerative colitis may be up to four times more likely to be malnourished than those without these conditions.
If a person has any signs of malnutrition, the first step will be to find out why.
If a doctor suspects Crohn’s disease, celiac disease, or another condition, they can perform laboratory tests to confirm the diagnosis. Giving these conditions can improve a person’s nutritional status.
They may also do the following:
- Blood tests for general screening and monitoring
- Tests for specific nutrients, such as iron or vitamins
- Prealbumin testing, as malnutrition commonly affects levels of this protein.
- Albumin tests, which may specify liver or kidney disease
- A tool to identify risks
- Some tools can help classify people who have or are at risk of malnutrition.
One way to screen adults is by using the Universal Malnutrition Screening Tool (MUST). Research has shown this to be a reliable tool.
Experts intended this tool to recognize adults, especially older adults, with malnutrition or at high risk of malnutrition. It is a five-step plan that can help healthcare breadwinners diagnose and treat these conditions.
The five steps are as follows:
Step 1: Measure a person’s height and weight, calculate their body mass index (BMI) and provide a score.
Step 2: Write down the percentage of unplanned weight loss and provide a score. For example, an unplanned loss of 5-10% would give a score of 1, while a loss of 10% would give a score of 2.
Step 3: Identify any physical or mental health conditions and provide a score. For example, if a person has been seriously ill and has not eaten for more than 5 days, the score will be 3.
Step 4: Add the scores from steps 1, 2, and 3 to get an overall risk score.
Step 5: Use local guidelines to develop a score-based care plan.
The score will be one of the following:
- Low risk: 0
- Medium risk: 1
- High risk: 2 or more
Doctors only use MUST identify general malnutrition or malnutrition risk in adults. The test will not identify specific nutritional deficiencies or imbalances.
Nutritional lack anaemia can result if a person’s diet cannot provide the nutrients they need.
Treatment of malnutrition
Treatment of malnutrition depends on the underlying cause and a person’s malnutrition. You may be given tips to follow at home, or a dietitian or other qualified health professional may provide support at home. In severe cases, hospital treatment may be necessary.
Your healthcare professional should request your consent when starting or stopping nutritional support. If you are unable to consent, they must act in your best interest by following medical guidelines.
Dietary changes and supplements
A dietitian will advise you on diet changes that can help. They can create a personalized diet plan that ensures you get enough nutrients.
They may also suggest:
- Have a healthier and more balanced diet
- Eating “fortified” foods that contain additional nutrients
- Snacking between meals
- Drinking high-calorie beverages
- Receive home grocery deliveries
If these measures are not enough, taking additional nutrients in the form of supplements may be recommended. These should only be taken on the advice of a healthcare professional.
You will have regular appointments to check that any changes to your diet are helping to improve your nutrition. You may need to adjust your diet to make it more effective.
If you can’t eat enough to meet your body’s needs, for example, because you have trouble swallowing (dysphagia), you may need an alternative way to get nutrients.
This can include:
- Using a tube that is passed through the nose and into the stomach (nasogastric tube)
- Using a tube that is placed directly into your stomach or intestine through the skin of your abdomen (percutaneous endoscopic gastrostomy – PEG – tube)
- Using a solution containing nutrients that are fed directly into your blood through a tube into a vein (parenteral nutrition)
- These treatments usually start in the hospital but can be continued at home if you are well enough.
Assistance and support services
Some people who are malnourished need extra care to help them deal with underlying problems such as limited mobility.
This can include:
- Home care visitors who can help you buy food or cook if it is difficult for you; read more about getting care at home
- Occupational therapy: An occupational therapist can classify problems with daily activities and help find solutions.
- A ‘meal service on wheels’ or home delivery – this can often be provided by the local authority, although there is usually a charge
- Speech and language therapy: A speech therapist can teach you exercises to help with swallowing problems and give you advice on diet changes (such as foods that are easy to swallow).
- Find out how to feed a loved one.
Treat malnutrition in children
Malnutrition in children is often caused by long-term health problems, for which hospital treatment is needed. But this is not the case for all malnourished children.
Treatment may involve:
- Dietary variations, such as eating foods high in energy and nutrients
- Support to families to help them manage the factors that affect a child’s nutritional intake
- Treatment for any fundamental medical conditions causing malnutrition
- Vitamin and mineral supplements
- High-energy and protein nutritional supplements, if other treatments are not enough on their own
- Severely malnourished children must be fed and rehydrated very carefully. They cannot be given a normal diet right away. Usually, they will need special care in the hospital.
Once they are well enough, they can gradually start eating a normal diet and continue this at home.
It is important that the treatment is monitored regularly to make sure it is working. Height and weight measurements will be taken and the child will be referred to specialized services if he/she does not improve.
The best way to prevent malnutrition is to eat a healthy and balanced diet.
A healthy and balanced diet is vital for maintaining health and fitness. To stay healthy, you should eat a variety of foods from the four main food groups, including:
- Lots of fruits and vegetables
- Full of bread, rice, potatoes, pasta, and other starchy foods
- Some milk and dairy products
- Some meat, fish, eggs, beans, and other non-dairy protein sources
- The Eatwell Guide shows the different types of food you need to eat (and in what proportions) to maintain a balanced and healthy diet.
It is important that treatment is monitored regularly to make sure it is working. Weight and height measurements will be taken and the child will be referred to specialized services if he/she does not improve.