Malnutrition

When you think of malnutrition you may assume it only affects people in third world countries but malnutrition in Australia is more common than people realize.

It can affect many different people; young or old but it is estimated that as many as 50% of older people aged 65 years or older are at risk of poor nutrition particularly those in hospital or aged care homes. This is because many elderly people naturally experience a reduction in their appetite as they age with many missing meals or surviving on a diet of “tea and toast” as they become unmotivated to cook for one. Some medications and illnesses can also reduce a person’s appetite or they may have poor mobility and shopping is difficult. They may also have difficulty swallowing or chewing food due to an illness or something as simple as new or ill fitting dentures making it uncomfortable to eat.

NUTRITION

With an ageing population in Australia, could you know someone who is at risk of malnutrition and would you know what risks to look for in that friend or relative?

So what is Malnutrition?

Malnutrition is a serious condition that occurs when a person’s diet does not contain enough of the right balance of nutrients to meet the demands of their body. This can affect growth, physical health, mood, behaviour and functions of the body impacting your overall health. It is possible to eat a diet high in calories but containing few vitamins or minerals. This means you can become malnourished even though you might be overweight or obese. It is also possible to become malnourished gradually if poor health begins to affect a persons’ ability to feed themselve's properly which is why it can occur more commonly in the elderly. The main treatment option for someone who can eat normally is to provide extra food that has extra nutrient content either with an increase in high energy foods or supplementation.

In addition to the elderly a wide selection of other people are considered high risk of becoming malnourished such as:
• People living alone and being socially isolated
• People with dementia who may forget to eat
• People with long term conditions such as diabetes or kidney disease
• People with health conditions that disrupts your body’s ability to digest food or absorb nutrients such as Crohn’s disease or ulcerative colitis.
• People who are recovering from physical injuries, surgery or illness
• A carer of a relative who may be neglecting their own health either not having the time or energy to feed themselves properly
• People who have swallowing or chewing difficulties (including anyone who has had oral/dental surgery or new/ill fitting dentures)
• People with health conditions that cause lack of appetite such as cancer, liver disease, persistent pain or nausea
• Fussy eaters whose diet falls short of the necessary nutrients the body needs for optimal function.
• People who have reduced mobility and lack of transport
• A physical disability or impairment making it difficult to cook for yourself
• People with a limited knowledge about nutrition or cooking - older men who become widowed may have trouble cooking healthy meals, as might students leaving home for the first time.
• People who have eaten little or nothing for the last five days or are likely to eat little or nothing for five days or longer
• People who have drug or alcohol problems
• People on low incomes

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Signs and Symptoms 

Do you recognize any of these signs and symptoms of malnutrition in someone you know?
In Adults
• Unplanned weight loss this could be gradual
• Poor appetite (eating less than half of meals or snacks served)
• Clothes that fit more loosely than usual
• Lack of strength or energy to undertake routine activities
• Lack of energy and breathlessness
• Changes to skin (dry and flaky) and nails (brittle) cracked lips
• Weakening of the muscles
• Wounds taking longer to heal
• Bruising
• Eyes appear sunken
• Dizziness
• Increased vulnerability to infections
• A body mass index (BMI) of less than 18.5 (a method used as a guide for assessing whether someone may be malnourished).
In Children
• Inability to concentrate or become irritable.
• Failure to grow to expected adult height
• Hair loss

If a friend or relative experiences any of these symptoms it is recommended they see their doctor or healthcare practitioner.

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Body Mass Index

Body Mass Index (BMI) is used to estimate your total amount of body fat. It is calculated by dividing your weight in kilograms by your height in metres squared (m2).
For most adults a healthy BMI is between 18.5 and 24.9. This means that:
• A BMI between 17 and 18.5 could suggest you are mildly malnourished
• A BMI between 16 and 18 could suggest you are moderately malnourished
• A BMI under 16 could suggest you are severely malnourished

For a BMI calculator go to: http://www.betterhealth.vic.gov.au/bhcv2/bhcsite.nsf/pages/bmi
 

Treatment for Malnutrition 

Treatment for Malnutrition varies depending on a number of different factors such as:
• whether the person is mildly, moderate or severely malnourished
• the underlying cause of malnutrition
• whether the person is able to cook healthy meals for themselves
• whether the person is able to eat and digest food normally

Depending on these factors the person will either be treated at home under the supervision of a dietitian, qualified healthcare professional or admitted to hospital.

The person may be treated with a high energy diet, with the aim to gradually increase their intake of proteins and carbohydrates. This may mean eating five or six smaller meals a day instead of just breakfast, lunch and dinner. In addition to this nutritional drink and food supplements may be recommended which can also help meet energy and nutritional needs. These supplements have options suitable for diabetics, children and those with additional fibre needs and can be alternated with food or taken alone instead of a meal or mixed in with food to boost nutrition. They are a good option for those people recovering from illness, injury or surgery, those unable to cook or themselves or even those people who have trouble chewing food as they are easy to prepare and can be sipped throughout the day.

If the person has difficulty swallowing food or drinking a feeding tube may be used to provide nutrients directly into the digestive system or a drip can be used to provide nutrients and fluids directly into the bloods vessels.

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Preventing Malnutrition

As a lack of essential nutrients is one of the main causes of malnutrition, the best way to prevent the condition is to eat a healthy, balanced diet. For otherwise healthy people, a recommended diet would contain foods from all the four major food groups. Food and drinks high in fat or sugar are not essential and should only be consumed in small amounts. Macro nutrients are the main nutrients that provide the body with energy and help growth. They include carbohydrates, proteins and fats. Micro nutrients are vitamins and minerals that are required for many functions inside the body. For example you require regular intake of iron to help in the production of new red blood cells.

Four main food groups

• Fruit and vegetables
• Bread, rice, potatoes, pasta and other starchy foods
• Milk and dairy foods
• Meat, fish, eggs, beans and other non dairy sources of protein

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What you can do to help someone

If you have a friend or relative who you believe is at risk from malnutrition you can do a number of things to help them:
• Visiting them frequently whether at home, age care home or hospital
• Where possible eat together during some mealtimes
• Encourage frequent high protein/high carbohydrate small meals throughout the day rather than three larger ones
• Consider nutritional drink supplements for those suffering from loss of appetite, living alone or recovering from illness.
• Bring food and high energy snacks particularly any their favourite foods to increase their appetite and encourage eating
• Monitor them closely for any physical changes and for those in an aged care home or hospital raise your concerns with the staff or medical practitioner.
• Prepare meal portions for them in advance such as soups and stews that can be frozen and reheated when required
• Stock up the fridge with nutritious snacks for ease and convenience so there is always something to hand
• Encourage light exercise such as a short walk which can boost appetite and help with digestion.
• Consult a nutritionist for ways to increase appetite and meet nutritional needs
• Suggest adding spices, herbs, lemon juice, mustards or garlic to meals for extra flavour and appeal as certain medications and ageing can dull a persons’ sense of smell and taste.
• Set a timer or alarm as a reminder for them to eat something every 2-3 hours
• Encourage drinking fluids before and after meals but not during to avoid filling up on low energy liquids rather than foods.

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High energy meal and snack solutions for sufferers of malnutrition:

• Porridge made with milk with fruit added on top
• Sardines on toast
• Peanut butter on toast
• Avocado on toast or crackers
• Milky drinks as a bedtime snack
• Adding milk, butter or cheese into mashed potato
• Sprinkle cheese on a variety of savory dishes
• Unsalted nuts
• Shepherd’s pie
• Soups with pulses, pasta or meats added
• Yoghurts or rice pudding
• Jacket potato with baked beans or tuna
• Cheese and crackers
• Boiled eggs
• Ripe bananas eaten alone or mashed into yoghurts, rice pudding or smoothies
 

Malnutrition information sourced from:
www.nhs.uk/malnutrition
www.aprs.com.au/index.php?option=com_k2&view=item&id=388:australian-hosptials
www.webmd.com/healthy-aging/nutrition-world-3/maintaining-appetite
www.sustagen.com.au
http://summaries.cochrane.org/CD002008/advice-on-diet-for-malnutrition-as-a-result-of-disease-in-adults
www.peninsulaliving.com.au
www.pediasure.com
www.ensure.com
http://www.profromonline.com/
 

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