Malnutrition

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Top Contributors - Lucinda hampton, Kim Jackson and Rucha Gadgil  

Introduction

Malnutrition means ‘poor nutrition’ when there is a deficiency of energy and nutrients in the diet that causes a measurable clinical outcome or impact on body composition or function. As such, malnutrition can refer to people who are overweight but the term is more often used to apply to people who are underweightie:

1. Undernutrition’—which includes stunting (low height for age), wasting (low weight for height), underweight (low weight for age) and micronutrient deficiencies or insufficiencies (a lack of important vitamins and minerals).
2. Overweight, obesity and diet-related noncommunicable diseases (eg heart disease, stroke, diabetes, and cancer).

Epidemiology

Malnutrition affects people in every country.

• Around 1.9 billion adults worldwide are overweight, while 462 million are underweight.
• An estimated 41 million children under the age of 5 years are overweight or obese, while some 159 million are stunted and 50 million are wasted.
• Adding to this burden are the 528 million or 29% of women of reproductive age around the world affected by anaemia, for which approximately half would be amenable to iron supplementation.
• Malnutrition is common in Australia. Those most at risk are the elderly, half of older Australians living in aged care or at home are either at risk of malnutrition or are malnourished.
• People who have eating disorders, people with a poor appetite, and people with medical conditions such as cancer, HIV or kidney failure need more nutrients and hence are at risk of malnutrition.

Causes

1. The most-common form of malnutrition is protein-energy malnutrition. This occurs when a person gets too little protein, too few calories, or both. Kwashiorkor is a severe protein deficiency. It is common among young children in developing countries. Marasmus is another kind of malnutrition that results from not enough protein or calories. Children with marasmus do not grow properly, and their fat and muscles waste away. Other symptoms include dehydration and dry, loose skin. Marasmus occurs mostly among very young children, usually under famine conditions.
2. People who do not receive vitamins and minerals for a long period of time can develop certain disorders. eg an iron deficiency causes anemia, lack of iodine causes goiter (enlargement of the thyroid gland), vitamin A deficiency can cause blindness or loss of vision, children who do not have enough vitamin D can lead to rickets. Vitamin C deficiency leads to scurvy. Vitamin B12 deficiency can cause blood disorders, affect the nervous system and also cause the intestine to function improperly. Too little thiamin in a diet can result in beriberi. Beriberi damages the nerves and heart.
3. Obesity is a form of malnutrition. It is when a body consumes more calories than it can use. This causes the body to have too much extra fat. Obesity can contribute to many health problems, including high blood pressure, heart disease, stroke, diabetes, and arthritis. Malnutrition can also be caused by eating disorders eg Anorexia nervosa.

The Hospital Setting

Malnutrition has been identified as a significant clinical problem in hospital settings both nationally and internationally. Malnutrition has been strongly associated with adverse clinical outcomes such as an increased length of stay and higher rates of medical complications. An Australian study found the prevalence of malnutrition to be 53%.

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