Malnutrition: Causes and Consequences

Malnutrition 

There is no commonly recognized definition of malnutrition. It has been used to define a nutritional deficit, excess, or imbalance that has a quantifiable negative influence on body composition, function, and clinical outcome.

Causes

Malnutrition is still more widespread in industrialized nations, owing to poverty, social isolation, and drug abuse.

Most adult malnutrition is associated with disease and may arise due to

• Lowered dietary intake
• Decreased macro- and/or micronutrient absorption higher losses or changed needs
• Higher energy consumption (in specific disease processes)

Dietary Intake 

Reduced food intake is most likely the single most important aetiological component in disease-related malnutrition. This is assumed to be related to changes in cytokines, glucocorticoids, insulin, and insulin-like growth factors, which cause a decrease in appetite feeling. 6 Failure to give frequent nutritional meals in an atmosphere where they are shielded from normal clinical procedures and where they are offered aid and support with feeding when necessary may exacerbate the problem in hospital patients.

Energy Expenditure

For many years, it was assumed that increased energy expenditure was primarily responsible for disease-related malnutrition. There is now significant evidence that overall energy expenditure in many illness states is actually lower than in normal health. The disease's baseline hypermetabolism is mitigated by a decrease in physical activity, with studies in critical care patients indicating that energy expenditure is often less than 2,000 kcal/day.

Increased Losses or Altered Requirements

In some circumstances, such as enterocutaneous fistulae or burns, patients may have excessive and/or specific nutrient losses; their nutritional requirements are usually very different from normal metabolism.

Malabsorption

Malabsorption is an independent risk factor for weight loss and malnutrition in individuals with intestinal failure and those having abdominal surgical operations.

Consequences

Muscle Function

Weight loss owing to fat and muscle mass depletion, including organ mass, is sometimes the most visible indicator of malnutrition. Muscle function degrades before changes in muscle mass, implying that changed food intake has a significant influence irrespective of muscle mass effects. Similarly, increases in muscular function with dietary supplementation occur faster than can be explained by muscle mass restoration alone.

One explanation for these observations is the downregulation of energy-dependent cellular membrane pumping, often known as reductive adaptation. This can happen after only a brief time of fasting. If nutritional intake is insufficient to fulfill needs over a longer period of time, the body draws on functional reserves in tissues such as muscle, adipose tissue, and bone, resulting in changes in body composition.

Gastrointestinal Function

Adequate nutrition is critical for GI function preservation: chronic malnutrition alters pancreatic exocrine function, intestinal blood flow, villous architecture, and intestinal permeability. The colon's capacity to reabsorb water and electrolytes declines, and ion and fluid release occur in the small and large intestines.

Immunity and Wound Healing

Immune function is also compromised, increasing the risk of infection as a result of reduced cell-mediated immunity, cytokine, complement, and phagocyte function. In malnourished surgical patients, delayed wound healing is also widely documented.

Physiological Effects

Malnutrition has both physical and mental implications, including lethargy, sadness, anxiety, and self-neglect.

Clinical Outcomes

Malnutrition's effects on physiological function have a significant impact on clinical outcomes. Surgeons discovered that patients who were hungry or underweight had a greater incidence of postoperative complications and death in the 1930s. This original observation was later validated by a significant number of research. Malnourished surgical patients had three to four times the complication and fatality rates of regularly nourished patients, as well as longer hospital hospitalizations and up to 50% higher expenses. Similar findings have been seen in medical patients, especially the elderly.

It is sometimes difficult to distinguish the negative symptoms of malnutrition from the underlying illness process, especially when each might be a cause and/or a result of the other. However, there is considerable evidence that nutritional supplementation improves outcomes in these individuals; consequently, malnutrition must be diagnosed by screening.

Assessment of Nutritional Status

Early identification of patients at risk of malnutrition during hospitalization (or outpatient clinic attendance) allows for early intervention with nutritional treatment.

Malnutrition Universal Screening Tool

MUST has been demonstrated to be a reliable and valid way of screening patients since it is simple, quick, and straightforward. It intends to identify people at risk by including:

• Current weight (BMI)
• History of recent unintentional weight loss
• Likelihood of future weight loss

The screening procedure identifies individuals who require a more thorough evaluation and the development of a customized step-by-step management plan by a nutrition professional. In vulnerable patient populations, providing frequent meals or food with higher nutritional content may be sufficient to alleviate nutritional risk. Additional steps might include expanding menu options or offering feeding help.

If these social' treatments are insufficient to meet nutritional needs, patients may require oral nutritional supplements or enteral tube feeding under dietetic supervision. Parenteral feeding is rarely required for patients (PN). PN is often required in the setting of an inaccessible or non-functioning GI tract. Rescreening inpatients every seven days throughout their hospital stay informs physicians to individuals who have lost weight and require further assistance.

Current Research: Integrative Medicine 

Journal of Integrative Medicine is a bimonthly, open-access, peer-reviewed journal that offers a global platform for the publication of important research from across the world by recognized research academics, helping to improve the journal's quality.

The journal publishes original research papers, clinical studies, case studies, and review articles on a variety of medical subjects, such as Biomedicine, Malnutrition, Osteopathic, Regenerative, Holistic, Naturopathic, Functional, and Herbal medicine, as well as Psychology and Counseling, Physical Therapy, Homeopathy, Acupuncture, and East Asian Medicine, Nutrition, and Dietary Therapy.

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