Nutrition and Diagnosis
Malnutrition occurs when a person's diet does not provide enough nutrients or the right balance for optimal health. Symptoms vary but often include weight loss, decreased appetite, fatigue, and irritability.
Poor nutrition can be divided into two categories
- Malnutrition (common undernutrition), i.e. insufficient amount of nutrients
- Overnutrition, i.e. taking in more nutrients than your nutritional requirements
In this article, we will focus on malnutrition. Malnutrition is a serious condition that occurs when the diet does not contain adequate amounts of nutrients.
The World Health Organization (WHO) defines malnutrition as follows:
"Imbalance between the demand for nutrients and energy and the supply, the satisfaction of which allows growth, maintenance of life functions and the performance of specific functions."
"Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients, or impaired nutrient utilization.
The double burden of malnutrition consists of both undernutrition and overweight and obesity, as well as diet-related noncommunicable diseases.
Undernutrition manifests in four broad forms: wasting, stunting, underweight, and micronutrient deficiencies."
According to the definition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) malnutrition is a:
"Condition resulting from the lack of absorption or consumption of nutrients, leading to a change in body composition, impairment of physical and mental functions of the body and adversely affecting the outcome of treatment of the underlying disease."
Types of malnutrition
- Marasmus - chronic starvation, leading to cachexia, often occurring in the course of the neoplastic process, neurological diseases, mental disorders, or chronic diseases.
- Kwashiorkor - protein-energy malnutrition, often occurring in patients initially properly nourished, resulting from injuries or operations.
- Mixed - a severely devastated organism, often occurs in chronically ill people with malnutrition of the marasmus type, after injuries or surgery.
Symptoms
Malnutrition occurs when the body is not getting enough food and essential nutrients. Malnutrition is most often caused by poor food choices.
Malnutrition can lead to:
- Delayed growth
- Chronic fatigue and irritability, carbohydrate deficiency
- Problem with concentration, deficiency of magnesium and B vitamins
- High risk of developing infection
- Difficult wound healing
- Hair loss, baldness, silicon and zinc deficiency
- Development of parasitic diseases
- Bleeding gums, deficiency of vitamin C, calcium, and fluoride
- Brittle nails
- Impairment of night vision, vitamin A deficiency
- Dryness and deterioration of the skin
- Feeling cold and low body temperature
- Absorption disorders of nutrients
- Learning difficulties
- Problems with the hormonal economy and the nervous system, fat deficiency
- Bone weakness, calcium, and vitamin D deficiency
- Decreased focus
- Weakening of the immune system, deficiency of vitamin C, EFA (essential fatty acids), iron, and folic acid
- No appetite
- Decrease in the amount of muscle tissue in the body and decrease in muscle strength, protein deficiency in the body
If a person is not getting the right balance of nutrients, they may also suffer from malnutrition. It is important to note that obesity with malnutrition is possible. Obese people can also suffer from malnutrition.
Do you suffer from malnutrition, lack of appetite, lack of energy and concentration, or just want to talk about healthy eating? Get in Touch With Us!
Malnutrition and weight loss often occur in oncological patients with diseases such as tuberculosis, AIDS, anorexia, and bulimia.
People with irritable bowel syndrome, endocrine disorders, e.g. hyperthyroidism, or metabolic diseases, e.g. type 1 diabetes, are also at risk of sudden and significant weight loss (before starting insulin treatment).
Stages of malnutrition
- Insufficient amount of nutrients in the body. Caused by their low supply, excessive loss or metabolism disorders, or increased demand for them.
- Depletion of body stocks.
- Disturbance of physiological and biochemical processes. At this stage, slight symptoms of malnutrition may appear, e.g. lack of concentration, and decrease in energy.
- Advanced stage of malnutrition. Appearing visible symptoms, accompanied by organ changes, e.g. weight loss.
Diagnostics
Anthropometric. Underweight is a condition in which there is a significant decrease in BMI. BMI is calculated by dividing weight in kilograms by height in meters squared.
BMI is calculated using the following formula: BMI (kg/m)2 = body weight (kg) / (height [m])2.
A healthy BMI for adults is usually between 18.5 and 24.9 kg/m2. People with a BMI between 17 and 18.5 kg/m2 may be slightly malnourished, those with a BMI between 16 and 18 kg/m2 may be moderately malnourished, and those with a BMI below 16 kg/m2 may be severely malnourished.
The following definitions of nutritional status are accepted depending on BMI:
| Above 40.0 kg/m2 | obesity class III (in this situation, nutritional treatment is necessary). |
| 35.0 - 39.9 kg/m2 | obesity class II (in this situation, nutritional treatment is necessary) |
| 30.0 - 34.9 kg/m2 | obesity class I (in this situation, nutritional treatment is recommended) |
| 25.0 - 29.9 kg/m2 | overweight (in this situation, nutritional treatment is recommended) |
| 18.5 - 24.9 kg/m2 | normal nutritional status. |
| 17.0 - 18.5 kg/m2 | risk of malnutrition, underweight (in this situation, nutritional treatment is recommended) |
| < 17.0 kg/m2 | malnutrition, moderately underweight (in this situation, nutritional treatment is necessary) |
| < 16.0 kg/m2 | severely malnourished, severely underweight (in this situation nutritional treatment is necessary) |
It should be remembered that parameters such as body weight or BMI may be biased, among others, due to fluid retention related to the state of hydration of the body.
Other useful anthropometric tests include the measurement of skinfold thickness over the non-dominant triceps muscle.
Malnutrition also occurs when there is an unexpected weight loss of > 10% in the last six months or > 5% in the last three months, such weight loss qualifies as severe malnutrition of the body, which requires proper nutritional management.
Biochemical
It is important to additionally perform a visceral protein (albumin, prealbumin, and transferrin) and total lymphocyte count (CLL) test in the case of malnutrition, as it will be helpful in diagnosing malnutrition.
It should be emphasized that no single tool for assessing the health status of patients is the most effective for assessing the nutritional status on its own.
Treatment
Treatment for malnutrition depends on your general health and the degree of malnutrition. Nutritional treatment consists in supplementing the deficiencies of nutrients, including vitamins, minerals, protein, fat, and carbohydrates, as well as providing an appropriate portion of energy.
It is recommended:
- Introduce a proper diet that will meet the nutritional needs of the body.
- Eat foods that are rich in good calories and protein.
- Take care of snacks between meals that are rich in minerals: macro and micronutrients.
Some people also need support with basic issues such as limited mobility. For example, home care or occupational therapy.
Prevention
Prevention of malnutrition. The best way to prevent malnutrition is to eat a healthy, balanced diet. Eating a variety of foods from the main food groups is recommended, including:
- Fruits and vegetables.
According to the guidelines of the World Health Organization (WHO), the minimum consumption of vegetables and fruits per day should be 400 grams, which should be consumed in at least 5 portions.
- Starchy foods such as bread, rice, potatoes, and pasta.
- Some dairy products or dairy-free alternatives.
- Protein sources such as meat, fish, tofu, eggs, and beans.
Consider utilizing the Eatwell Guide as a valuable resource to obtain insights into diverse food categories and gain valuable tips for maintaining a nutritious and well-rounded diet.
Do you find it challenging to strike a harmonious equilibrium among various food groups? Look no further than the AnaskoMed team for assistance! Drop us a message to schedule a consultation, and we'll address your concerns effectively.
If you don't have a local office nearby or if you prefer the convenience of connecting with a qualified and experienced dietitian online, feel free to contact us. We're here to support you in your journey towards better nutrition.
Bibliography
The National Center for Biotechnology Information. Malnutrition. (2023)
Malnutrition. Authored by Dr Hayley Willacy, Reviewed by Dr Toni Hazell. (2022)
WHO, Malnutrition. Quantifying the health impact at national and local levels. (2005)
BAPEN, Malnutrition Universal Screening Tool. (2017)
Castro-Vega, I., et al. (2018)
Eroğlu, A. G. (2019). Malnutrition and the heart
Keller, U. (2019). Nutritional laboratory markers in malnutrition
NCBI, Mathur, P., et al. (2019) Overnutrition: Current scenario & combat strategies
WHO, Obesity and overweight. (2021)
BAPEN, The 'MUST' explanatory booklet. (2011)
Todorovic, V. E. (1989). A Pocket Guide to Clinical Nutrition: A Collection of Data to Provide Basic Guidelines for the Dietician Involved in Nutritional Support. Parenteral & Enteral Nutrition Group of the British Dietetic Association.
Remember that the information in this article is not a diet or education tailored individually, so if you have any health problems or your diet is more demanding, use the option of individual dietary cooperation or contact your doctor before using it.
