Nutrition and Illness: Malnutrition

Webinar on Nutrition and Illness: Malnutrition

Introduction

  • Speaker: Sharon Kerry, Manager of Nutrition and Dietetics at Royal Prince Alfred Hospital.

  • Focus on malnutrition, covering:

    • Definition of malnutrition.

    • Causes and impact of malnutrition.

    • Addressing malnutrition in acute hospital settings.

    • Case studies related to malnutrition.

Definition of Malnutrition

  • Broad Definition: Malnutrition is a state of nutrition in which a deficiency, excess, or imbalance of energy, protein, and other nutrients results in measurable adverse effects on:

    • Tissue.

    • Body form, body shape, size, and composition.

    • Function and clinical outcomes.

  • Specific Definitions: Includes terms like protein energy malnutrition (e.g., Kwashiorkor, Marasmus).

  • Global Leadership Initiative on Malnutrition's Definition:

    • Malnutrition characterized by:

    • Weight loss.

    • Low Body Mass Index (BMI).

    • Reduced muscle mass.

    • Reduced intake or assimilation due to inflammation or maldigestion.

    • Focus: More emphasis on undernutrition.

Causes of Malnutrition

Community Setting

  • Causes differ from those in hospital settings:

    • Isolation or limited access to food:

    • Physical, economic, social, or psychological barriers.

    • Underlying illnesses:

    • Physical or emotional conditions contributing to malnutrition.

    • Mobility issues:

    • Difficulty accessing or preparing food.

    • Knowledge and education gaps:

    • Lack of awareness about nutrition.

    • Fad diets:

    • Following diets that may not meet nutritional needs.

Hospital Setting

  • Causes include:

    • Acute or chronic illness:

    • Increased energy and protein requirements (up to double).

    • Symptoms from illness or treatment:

    • Nausea, vomiting, loss of appetite, altered taste.

    • Treatment side effects: chemotherapy, radiotherapy.

    • Medications contributing to:

    • Symptoms.

    • Vitamin and mineral deficiencies.

    • Malabsorption issues due to:

    • Diarrhea, steatorrhea, stomas, fistulas causing significant losses of energy and protein.

    • Psychological stress:

    • Anxiety and depression impacting nutritional intake.

Impact of Malnutrition

  • Weight loss leads to:

    • Reduced mobility.

    • Muscle wasting and loss of strength.

    • Increased fall and fracture risk.

    • Decreased independence and hypothermia.

  • Malnutrition increases:

    • Infection rates due to impaired immune function and gut integrity.

    • Impaired wound healing.

  • Clinical complications include:

    • Decreased cardiac output.

    • Impaired renal function.

    • Changes in liver metabolism (e.g., fatty liver).

    • Increased loss of muscle, leading to hypoxia and confusion.

  • Psychological impacts:

    • Low mood, energy, depression, anorexia (loss of appetite).

  • Overall consequences:

    • Reduced response to illness.

    • Increased complications and hospital stay lengths.

    • Increased risk of hospital readmission.

Hospital Acquired Malnutrition

  • Defined as malnutrition acquired during hospital stays.

  • Penalties: Hospital Acquired Malnutrition recognized as preventable, leading to penalties imposed by the Independent Hospital Pricing Authority. Costs estimate:

    • $8,000 for each patient who becomes malnourished in the hospital setting.

  • Main causes:

    • Excessive fasting without nutritional support.

    • Restrictive diets.

    • Slow progression from clear to full fluids.

    • Poor appetite and dislike of hospital food.

    • Increased nutritional requirements.

Addressing Malnutrition in the Hospital Setting

  • Role of the entire healthcare team:

    • Clear documentation of weights; weekly monitoring throughout admission (NSW Health Policy requirement).

    • Screening for malnutrition risks upon admission (required by NSW Health).

    • Early dietary assessments when patients show weight loss or risk of malnutrition.

    • Multidisciplinary referral to dietitians and other support staff (e.g., physiotherapy, occupational therapy) as needed.

  • Advocacy: Ensuring adequate nutrition, especially for those at high risk and those fasted for various medical reasons.

  • Intervention Options:

    • oral, enteral, or parenteral nutrition support:

    • Modifying diet to include oral supplements.

    • Using a MedPass system for oral nutrition supplements.

    • Implementing enteral nutrition in severe cases.

    • Considering parenteral nutrition for extreme malabsorption cases.

Case Studies

Acute Trauma Case

  • Patient: 29-year-old male with severe head injury from motorbike accident.

  • Nutritional Needs:

    • Requires aggressive nutrition support immediately.

    • Anticipated weight loss from 85 kg to 65 kg in less than four weeks.

    • Likely need for ventilation and enteral feeding (orogastric/nasogastric).

    • Upon recovery, may have dysphagia requiring specific texture diets and oral nutrition support.

Pancreatic Cancer Patient

  • Patient: Diagnosed with pancreatic cancer due to ongoing weight loss.

  • Statistics: 85% of patients with gastrointestinal cancers are malnourished.

  • Nutritional Needs:

    • Critical to address preoperative nutritional support.

    • Post-surgery need for jejunal feeding and pancreatic enzyme supplementation.

    • Potential for diabetic management due to surgical resection effects.

    • Continuous focus on high energy and high protein intake due to ongoing nutritional risk.

Crohn's Disease Case

  • Patient: 24-year-old female with flare-up of Crohn's disease.

  • Nutritional Needs:

    • Address malabsorption due to inflammation.

    • Modify diet for hydration and increased energy/protein intake.

    • Likely require vitamin and mineral supplementation.

    • In severe cases, consider enteral or parenteral nutrition.

    • Recognize Crohn's disease is a primary reason for intestinal failure.

Conclusion

  • Approximately 30% of hospital patients are malnourished, with many more at risk.

  • Malnourished patients face:

    • Increased infection risk.

    • Impaired wound healing and higher clinical complications.

    • Increased anxiety and depression risk.

    • Prolonged hospital stays and higher associated costs.

  • Importance of early referral and intervention to improve nutritional and clinical outcomes for at-risk patients.

References

  • Provided at the end of the webinar.