malnutrition (CONSEQUENCES (Structure and Function
Structure and Function
- More complications
- Longer hospital stay
- More healthcare required after discharge
- Survival decreases with increase of weightloss
- Vicious cycle of malnutrition
- 19.6 bil in health care - Elia 2015
- More money in secondary care than primary care
definition and detection
BAPEN 2000: A state of nutrition in which there is a deficiency or excess of energy, protein, and other nutrients which causes measurable adverse effects on tissue/body form, function, and clinical outcome.
- Immune Function
- Chronic disease
- Acute disease
- Starvation-related malnutrition
- Elderly - many people struggle to afford food.
- Poverty - increased reliance on foodbanks
- Skin-fold thickness
- Serum albumin
- Body fat %
- BMI <18.5%
- more than10% weight loss
- BMI 18.5-20 kg/m2 and weight loss 5-10%
- Reduced food intake for more than 5 days.
- BMI < 18.5
- Weight loss > 10% or 5% in 3 months
- FFMI <15 and <17 in women and men.
- BMI <20 kg/m2 <70 yrs or 22 BMI if >70.
- Based off BMI
- Malnutrition Universal Screening Tool
- Nutrition risk Screening
- if the definition includes excess - why do malnutrition screening tools not include 5/10% weight gain?
5-23% patients attending GP12-29% people in institutions12% elderly living at home
- 10-60% adults
- 8-79% children
- Different criteria in different populations and different cut-offs.
- Difference in reference standards / BMI / weight loss / tricep skinfold
- Reference populations may not be appropriate
MUST found 25% malnourish in hospitals, 41% malnourished in care homes
NRS found 33% hospital admissions
McWhirter & Pennington 1994 - 40% hospital admission malnourished - 52% of those had no nutritional information recorded - only 10 received nutritional support
Bavelaar 2008 - 1/3 patients malnourished, no nutrition assessment in GP referral - nutrition assessment taken by 50% med students, 30% nurses. - 40% received no training
Inadequate nutrition intake
- Reduced intake when food is available (sickness/physical difficulties in eating)
- Reduced intake when appropriate food is not available (poverty/distaste/cooking issues)
- Increased requirement
- Lack of support/care/resources
- Change in food environment