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Section 1 - Malnutrition

Nutrition—the provision of nutrients—and malnutrition—the result of extended inadequate intake or severe illness on body composition and function—affect all systems of the body.

Types of malnutrition

Malnutrition has two forms: protein malnutrition (kwashiorkor or hypoalbuminemic malnutrition) and protein-calorie (marasmus or protein-energy) malnutrition.

Protein malnutrition is usually caused by inadequate nutrient intake in conjunction with the stress response. Common causes include chronic diarrhea, renal dysfunction, infection, hemorrhage, trauma, burns, and critical illness. Protein malnutrition can result in:

  • Marked hypoalbuminemia.
  • Anemia.
  • Edema.
  • Muscle atrophy.
  • Delayed wound healing.
  • Impaired immunocompetence.

Protein malnutrition is not as easily recognized as protein-calorie malnutrition, but is associated with significant increases in the rates of morbidity and mortality.

The patient with protein-calorie malnutrition is typically emaciated, elderly, and chronically ill. Long-term nutritional repletion is usually required. Protein-calorie malnutrition usually results in:

  • Weight loss.
  • Reduced basal metabolism.
  • Depletion of subcutaneous fat and tissue turgor.
  • Bradycardia.
  • Hypothermia.

Although the distinction between protein malnutrition and protein-calorie malnutrition is not always clear, these conditions can usually be differentiated on the basis of time course, etiology, and clinical signs.

Risk factors for malnutrition

Any prolonged decrease in nutrient intake should alert the clinician to the possibility of malnutrition. Common risk factors for malnutrition:

Medical problems

  • Recent surgery or trauma
  • Sepsis
  • Chronic illness
  • Gastrointestinal disorders
  • Anorexia, other eating disorders
  • Dysphagia
  • Recurrent nausea, vomiting, or diarrhea
  • Pancreatitis
  • Inflammatory bowel disease
  • Gastrointestinal fistulas

Psychosocial problems

  • Alcoholism, drug addiction
  • Poverty, isolation
  • Disability

Abnormal diet

  • Fad or limited diet
  • Recent decrease in food intake

Consequences of malnutrition

Malnutrition places stressed patients at a greatly increased risk for morbidity and mortality. Numerous reports have documented the association between malnutrition and clinical outcome in a variety of clinical settings.

Some complications are considerably more common in malnourished patients and those with inadequate nutrient intake than in well-nourished individuals. These complications include:

  • A longer recovery period.
  • Impaired host defenses and sepsis.
  • Impaired wound healing.
  • Anemia.
  • Impaired GI tract function.
  • Muscle atrophy.
  • Impaired cardiac function.
  • Impaired respiratory function.
  • Reduced renal function.
  • Brain dysfunction.
  • Delayed bone callus formation.
  • Atrophic skin.

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Section 1 - Malnutrition

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