Malnutrition Health Article

Treatment

Normalizing nutritional status starts with a nutritional assessment. This process enables a clinical nutritionist or registered dietician to confirm the presence of malnutrition, assess the effects of the disorder, and formulate diets that will restore adequate nutrition.

Patients who cannot or will not eat, or who are unable to absorb nutrients taken by mouth, may be fed intravenously (parenteral nutrition) or through a tube inserted into the gastrointestinal (GI) tract (enteral nutrition).

Tube feeding is often used to provide nutrients to patients who have suffered burns or who have inflammatory bowel disease. This procedure involves inserting a thin tube through the nose and carefully guiding it along the throat until it reaches the stomach or small intestine. If long-term tube feeding is necessary, the tube may be placed directly into the stomach or small intestine through an incision in the abdomen.

Tube feeding cannot always deliver adequate nutrients to patients who:

• are severely malnourished
• require surgery
• are undergoing chemotherapy or radiation treatments
• have been seriously burned
• have persistent diarrhea or vomiting
• whose gastrointestinal tract is paralyzed

Intravenous feeding can supply some or all of the nutrients these patients need.

Prognosis

Up to 10% of a person's body weight can be lost without side effects, but if more than 40% is lost, the situation is almost always fatal. Death usually results from heart failure, electrolyte imbalance, or low body temperature. Patients with semiconsciousness, persistent diarrhea, jaundice, or low blood sodium levels have a poorer prognosis.

Some children with protein-energy malnutrition recover completely. Others have many health problems throughout life, including mental retardation and the inability to absorb nutrients through the intestinal tract. Prognosis for all patients with malnutrition seems to be dependent on the age of the patient, and the length and severity of the malnutrition, with young children and the elderly having the highest rate of long-term complications and death.

Prevention

Breastfeeding a baby for at least six months is considered the best way to prevent early-childhood malnutrition. The United States Department of Agriculture and Health and Human Service recommend that all Americans over the age of two:

• consume plenty of fruits, grains, and vegetables
• eat a variety of foods that are low in fats and cholesterols and contain only moderate amounts of salt, sugars, and sodium
• engage in moderate physical activity for at least 30 minutes, at least several times a week
• achieve or maintain their ideal weight
• use alcohol sparingly or avoid it altogether

Every patient admitted to a hospital should be screened for the presence of illnesses and conditions that could lead to protein-energy malnutrition. Patients with higher-than-average risk for malnutrition should be more closely assessed and reevaluated often during long-term hospitalization or nursing-home care.

BOOKS

Andersen, Jean, and Barbara Deskins. The Nutrition Bible. New York: William Morrow and Co., 1995.

Bennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996.

Berkow, Robert, ed. The Merck Manual of Medical Information: Home Edition. Whitehouse Station, NJ: Merck Research Laboratories, Inc., 1997.

The Surgeon General's Report on Nutrition and Health. Rocklin, CA: Prima Publishing and Communications, 1988.

ORGANIZATIONS

American College of Nutrition. 722 Robert E. Lee Drive, Wilmington, NC 20412-0927. (919) 452-1222.

American Institute of Nutrition. 9650 Rockville Pike, Bethesda, MD 20814-3990. (301) 530-7050.

Food and Nutrition Information Center. 10301 Baltimore Boulevard, Room 304, Beltsville, MD 20705-2351. <http://www.nalusda.gov/fnic>.

OTHER

"Malnutrition." Nutrition Page. Uppsala University. 3 May 1998 <http://www.nutrition.uu.se>.

Mayo Clinic Online. 5 Mar. 1998 <http://www.mayohealth.org>.

Mary K. Fyke