Malnutrition is a broad term which refers to both under-nutrition and over-nutrition. Malnutrition can be defined as the insufficient, excessive or imbalanced consumption of nutrients. Several different nutrition disorders may develop, depending on which nutrients are lacking or consumed in excess.
Causes
- Alcoholism
- Cannot go out to buy foods
- Depression
- Diseases like; anorexia nervosa or bulimia, celiac disease, Crohn’s disease or ulcerative colitis, dysphagia, gastritis, pancreatitis, serious bouts of diarrhoea and/or vomiting
- High food prices
- Improper diet (when recovering from an illness)
- Lack of breastfeeding
- Shortage of food
- Unable to prepare food
- Undue food distribution
Symptoms and signs
- Breathing difficulties
- Chest infection
- Decreased mobility and stamina as a result of muscle wasting
- Feelings of apathy
- Fertility problems
- Hypothermia
- Poor libido
- Recurrent infections and slow recovery(weakened immunity)
- Reduced muscle and tissue mass
- Respiratory failure
- Tiredness
- Wounds that take longer to heal
Investigations
BAPEN’s (British Association for Parenteral and Enteral Nutrition’s) MUST (Malnutrition Universal Screening Tool) is a quick-to-use screening tool to identify those at risk of malnutrition.
MUST 5-step plan:
- Step 1 – Measure height and weight to get a BMI (body mass index) score.
- Step 2 – Note the percentage of unplanned weight loss and score.
- Step 3 – Establish acute disease (any underlying illness, such as a psychological condition) effect and score.
- Step 4 – Add scores from steps 1, 2 and 3 together to obtain the overall risk of malnutrition.
- Step 5 – Use management guidelines and/or local policy to develop a care plan.
Treatment
- The underlying illness/condition needs to be treated
- Specially planned healthy, nutritious diet i.e. enough carbohydrates, proteins, fats and dairy, as well as vitamins and minerals.
- Additional nutritional supplements
- Artificial nutritional support
Malnutrition diseases
Marasmus
It is one of the most common malnutrition diseases in children. This condition results in overall energy deficiency.
Cause
Deficiency of both proteins and calories
Symptoms and signs of marasmus
- Body weight may be lower than 80% of the normal required weight of the person.
- Dry and scaly skin
- Oedema
- Extensive muscle wasting
- Fretful
- Highly susceptible to contracting infectious diseases
- Irritable
- Loose skin
- Person looks emaciated
- The adipose tissue reserves get severely depleted, especially from the buttocks and thighs.
- Voraciously hungry.
Treatment
- Providing all the required nutritional supplements
- Treating dehydration
- Treating any other infections
Kwashiorkor
Kwashiorkor is one of the more severe forms of protein malnutrition and is caused by inadequate protein intake. It is, therefore, a macronutrient deficiency.
Causes
- Areas where there are:
- Famine
- Limited food supply
- Low levels of education (do not know what is a balanced diet)
- Protein-depleted diets (starches and vegetables, with little meat and animal products)
- Infections
- Chronic illnesses
Symptoms and signs of Kwashiorkor
- Changes in skin pigment
- Decreased muscle mass
- Dermatitis
- Diarrhoea
- Oedema
- Failure to gain weight and grow
- Fatigue
- Hair changes (colour or texture)
- Irritability
- Enlarged liver
- Lethargy or apathy
- Severe infections
- Shock
Investigations
Blood test—
- Arterial blood gas
- BUN
- Full blood count
- Creatinine clearance
- Serum creatinine
- Serum potassium
- Total protein levels
Urine test
Treatment
- Oral rehydration
- Nutritional support
- Calories(carbohydrates, simple sugars, and fats)
- Protein
- Vitamins
- Mineral supplements.
- lactase enzyme(for lactose intolerance)
- Food must be reintroduced slowly
- Restore blood volume and maintain blood pressure(if in shock )
- Ayurvedic Medicines
Complications
- Coma
- Permanent mental and physical disability
- Shock
Prevention
Take a balanced diet which has enough carbohydrates, fat (at least 10 per cent of total calories), and protein (12 per cent of total calories).
Anaemia
Hyponatremia
This is a serious type of electrolyte disturbance that is normally seen in people who have high levels of anti-diuretic hormone(ADH).
Causes
- Deficiency of sodium in the blood and diet.
- Medical illnesses like; diarrhoea, excessive vomiting, and polydipsia.
Symptoms and signs of Hyponatremia
- Nausea
- Vomiting
- Headache
- Mental Clouding
- Confusion
- Convulsions
- Stupor
- Coma
Treatment
- It depends on the underlying cause
- Intravenous administration of saline in severe volume depletion
- Hypertonic saline in seizures
Hypokalemia
Causes
- Deficiency of potassium in the diet
- Dehydration
- Diarrhoea
- Excessive loss of potassium from the body
Signs and symptoms of Hypokalemia
- Cardiac Arrhythmias.
- Constipation
- Muscle Cramps
- Myalgia
- Respiratory Depression
- A slight change in blood pressure
- Tetany
Treatment
- Food high in potassium in the diet.
- Fluid replenishment (diarrhoea, dehydration)
- Antibiotics