Medical Nutrition Therapy For Malnutrition

Overview

What is malnutrition?

Malnutrition is a severe condition in which an individual’s diet does not contain the right quantity of essential nutrients such as proteins, vitamins, carbohydrates, fluids, fibres, lipids, and minerals that keep them healthy.² Both undernutrition and overnutrition are referred to as malnutrition. Malnutrition is the most prevalent condition and is a major public issue that impacts millions of individuals in the United Kingdom. People at the age of 75 are more prone to malnutrition and their rate might double in the following 25 years.⁴ Multiple signs and symptoms are demonstrated in malnourished people which include;

• Loss of body weight
• Eating and drinking less food
• Feeling exhausted 
• Lack of growth
• Greater infection risk
• Depression and anxiety 
• Night blindness
• Mood swings 
• Skin breakouts and rashes 
• Thick, dusty, and dry skin
• Light sensitivity
• Tongue swelling 

What is medical nutrition therapy?

To overcome malnutrition in individuals, it is important to reach the nutritional requirements by providing medical nutrition therapy. It is a therapy in which a person's nutritional condition is assessed and they are given a personalised nutritional diet plan for their health condition. This type of nutritional therapy varies from person to person, sometimes involving alterations in an individual’s diet plan and lifestyle. For others, it involves following a severe diet plan and tube feeding. To avoid malnutrition, it is important to address medical nutrition therapy.¹

Classification of malnutrition

Malnutrition is classified into four categories such as overnutrition, undernutrition, lack of micronutrients, and lack of macronutrients.⁷

Overnutrition

This is the consumption of excessive nutrients that cause a detrimental impact on health. Recently, the World Health Organization (WHO) added over-nutrition to the category of malnutrition.

Undernutrition

This is when the body lacks essential nutrients. The individual either does not get adequate amounts of nutrients or their body is unable to absorb abundant nutrients from the food they are eating.

Micro-nutrition

Vitamins and minerals are essential micronutrients as they are required in small amounts for the body to function properly. If a person is mildly lacking vitamins and minerals in their diet, the individual is suffering from micronutrient undernutrition. And micronutrient over-nutrition occurs when an individual overdoses on minerals and vitamins.

Macro-nutrition

Macronutrients are significant for the body to function properly. When a person lacks proteins, fats, and carbohydrates, the body starts to fall apart and does not generate enough energy. However, when a body consumes excess amounts of fats, proteins, and carbohydrates, it ultimately leads to chronic disorders such as coronary artery disease, diabetes, and stroke. 

Diagnosis 

The main diagnostic characteristics of malnutrition among children are < -3SD weight-for-age and 115mm upper arm circumference. Malnourished children suffer from reduced appetite and other medical conditions and should be admitted for care.⁸

Evaluation of malnutrition 

Population more prone to malnutrition

Underprivileged and low-income

People living in developing countries have less access to nutritious food. While those who are living in developed countries have easy access to fast food products, which contain higher calories but low nutritional value.³

Children

Offspring require essential nutrients in larger amounts for their growth and development compared to adults. Children belonging to poor families are at a greater risk of malnutrition.³

Illness

Numerous severe diseases have a direct impact on a person’s diet and calorie absorption, making an individual more prone to malnutrition.³ 

Elderly people

As people become older, their health gets worse with time due to innumerable factors such as reduced exercise and movement, loss of appetite, and reduced ability to nutrient absorption.³

Medical conditions 

Medical conditions are major factors of malnutrition. In some cases, the body needs to absorb more nutrients, while in others, the body is unable to utilise nutrients. These medical conditions are:

• In liver and cancer disorders, persistent pain and sickness occur that lead to a lack of appetite. 
• Some disorders such as emphysema and pulmonary fibrosis cause the body to require large amounts of nutrients but lack the appetite.
• Sometimes the body is unable to digest food and absorb essential nutrients due to cystic fibrosis and ulcerative colitis.
• Individuals suffering from dementia are unable to converse their needs and desires and, thus, experience a lack of appetite.
• During fractures and burns, the body demands more nutrients.⁷

Social factors

Several social problems also contribute to malnutrition, such as:⁷

• Lack of food nutrition knowledge
• Alcohol and drug use
• Complete dependence on food banks
•  Lack of movement
•  Low wages

Medical nutrition therapy for malnutrition

Malnutrition can be treated or prevented in people suffering from chronic disorders, those admitted to hospitals for long periods, and those who have experienced major surgical treatment. This therapy is also used for people who have metabolic disease and chronic food intolerance and need strict diet plans.

Aims of Medical Nutrition Therapy

Nutritional Evaluation

Medical nutritional therapy aims to serve as a nutritional assessment in which healthcare or nutritionists gather information about a person’s nutritional status. In nutritional valuation, the individuals’ body measurements are obtained to evaluate the body composition such as body mass index (BMI), height, weight, the thickness of the folded skin, and leg or arm perimeter. Some healthcare professionals or nutritionists recommend blood tests to determine the nutritional status of the people.

Diet Evaluation

Another purpose of the diet assessment involves the approximation of regular dietary consumption and total calorie intake, which helps the nutritionist to know the person’s eating routine, portion sizes, cooking approaches, and overall regime quality. Many other factors can impact a person's diet, such as changes in taste and smell, swallowing difficulty, taste liking, and food intolerance. 

Restoration of nutritional status

Medical nutrition therapy helps in changing individuals’ lifestyles and behaviour like altering eating habits, intake of balanced food, and retaining an energetic regime. In certain conditions, people may take advantage of particular diets. Low carbohydrate food is recommended for diabetic people and a portion of gluten-free food for people with celiac disorder.

It is important to provide artificial nutrition to those people who are struggling to digest and absorb essential nutrients. Artificial nutrition consists of an adequate amount of minerals, vitamins, proteins, fats, and carbohydrates based on the individual's body requirements.¹⁰

Intervention of medical nutrition therapy

This therapy is a remarkably complex medicinal intervention that involves enteral nutrition (nutrition is transported into the stomach to be consumed by the gastrointestinal tract), parenteral nutrition (nutrition is transported into the bloodstream with the help of a tube), and oral feeding (providing nutritional supplements orally). These interventions not only differ in mode of feeding and type but also in nutritional targets. However, researchers mostly suggest enteral nutrition (EN) rather than parenteral nutrition (PN) because it has less side effects and better results. Moreover, it is the responsibility of healthcare professionals to choose the best nutrition interventions, and regularly check and assess the response to treatment.¹⁰

Nutritional counseling

Healthcare professionals and nutritionists must provide proper counselling to malnourished people based on their nutritional assessment and screening, age, and nutritional status. In the assessment stage, healthcare professionals should scrutinise the causes of malnutrition at clinical, dietary, and medical levels in children, adults, and elderly people. It helps nutritionists to understand and recognise other factors that may be involved in causing malnutrition in people such as poor sterility, food insecurity, unsafe drinking water, anxiety and depression, and assist them to overcome these issues. A proper nutrition plan should help in meeting nutritional goals such as recommending supplementary and therapeutic food products which help in managing malnutrition.⁵

Actions to monitor malnutrition

Several actions must be taken to provide nutritional support and care to malnourished people. 

Increasing awareness 

Healthcare professionals and nutritionists must support in preventing malnutrition and raising awareness among people for early treatment which help them to improve their well-being and live a healthy life. 

Early identification of malnutrition

It is necessary for people with signs and symptoms, to go to a physician for screening and assessment of nutrition and diet. 

Examining and assessing 

The individual’s weight, nutritional status, and diet regime should be evaluated before working on improvements and positive outcomes.⁴

Summary

Scarcities, excesses, and imbalance of nutrients in a person’s intake lead to malnutrition, which is the most common issue among people. If it is not identified or treated in perfect time, it can lead to sickness. The World Health Organization (WHO) is trying its best to free the world from malnutrition and promote efficacious nutrition interventions and healthy foods.¹¹ It is essential for people to become habitual of a balanced diet which should contain all the nutrients such as proteins, fats, carbohydrates, fluids, minerals, and vitamins. When someone loses their appetite, nutrient-dense food products and fluids are highly recommended to help improve their nutritional value. It is best to choose meals that are easy to prepare and eat and must be nutrient-dense.