Malnutrition

What is MALNUTRITION?

MALNUTRITION IS A STATE IN WHICH A DEFICIENCY OF NUTRIENTS SUCH AS ENERGY, PROTEIN, VITAMINS AND MINERALS CAUSES MEASURABLE ADVERSE EFFECTS ON BODY COMPOSITION, FUNCTION OR CLINICAL OUTCOME.

What does it mean by malnutrition?

A lack of nutrients / inappropriate nutrients LINKED TO An effect on body composition and function

What is the PREVELANCE of obesity normally?

How has childhood obesity increased over the decades?

What is the PREVELANCE of malnutrition globally?

What is the PREVELANCE NATIONALLY of malnutrition?

It affects 3 million people in Britain at any one time

1) Hospital inpatients 30%

2) Hospital outpatients 20%

3) Sheltered housing and elderly at home 14%

4) Children in hospital up to 14%

5) Community / GP 10%

What is the PREVELANCE of malnutrition in relation to UNDERLYING DISEASE?

What is the PREVELANCE of malnutrition in SURGICAL PATIENTS?

•87% patients undergoing general surgery

•82% GI surgery

•75% cancer surgery

•18% undergoing major vascular surgery

What is the MECHANISM of malnutrition?

1) Inadequate intake

2) Impaired nutrient digestion and processing

3) Excess losses

4) Altered requirements

Causes of Malabsorption - IMPAIRED NUTRIENT  DIGESTION AND PROCESSING
= MALABSORPTION

Dysfunction of:

1) Stomach

2) Intestine

3) Pancreas

4) Liver

Causes of Malabsorption - EXCESS LOSS

1) Vomiting

2) NG tube drainage

3) Diarrhoea

4) Surgical drains

5) Fistulae

6) Stomas

Causes of Malabsorption - ALTERED REQUIREMENTS

Increased metabolic demands

1) Inflammation

2) Cancer

3) Wounds

4) Burns     

5) Brain injury

What is SIMPLE STARVATION?

What is STRESS STARVATION?

Simple VS Stress Starvation

What is the IMPACT of malnutrition in healthy people?

The Malnutrition Carousel

What does malnutrition COST?

1) Health costs exceeding GBP 19.6 billion annually

2) Identifying and treating malnutrition presents the fourth biggest potential saving in the NHS today

How does malnutrition get worse during a hospital stay?

1) 200/500 pts malnourished on admission (i.e. 40%)

2) Only 96 had any nutritional information documented

3) On average 200 lost 5.6% of their weight during hospital stay

4) Those referred for nutrition support put on 9.6% during their stay

How does HOSPITALS cause malnutrition?

•Inadequate / unpalatable / unsuitable food

•Can’t reach food / can’t feed themselves

•Altered taste / poor appetite

•Nil by mouth

•Starved for investigations

•And then again if the investigation gets cancelled

•Starved before and after surgery

Inadequate Intake - MEDICAL causes

Medical causes

•Poor diet

•Poor appetite/anorexia/taste disturbances

•'Nil by mouth' for investigation or medical reasons

•Starved before diagnostic procedures – and often cancelled

•Starved before and after surgery

•Pain/Nausea

•Dysphagia

•Depression

•Physical disability and inability to feed self

•Unconsciousness

Inadequate Intake - ENVIRONMENTAL causes

Environmental causes

•Inadequate food quality (meals unpalatable, food poor in nutrients, served of improper temperature)

•Inadequate food availability  outside the reach of elderly or physically incapacitated patients)

•No protected meal times

•Inadequate training and knowledge of medical and nursing staff

How do you PREVENT this?

Measurements - Anthropometry

How to SCREEN for malnutrition?

What ACTIONS can be taken against malnutrition?

What has been done so far to address this problem?

Summary

1) Malnutrition is common (30% in hospital)

2) Malnutrition is important (affects health and recovery from disease)

3) Malnutrition is often neglected in health care

4) Malnutrition is easy to detect using a proven tool (MUST)

5) Treating malnutrition is effective in improving health outcomes