Undernutrition

UndernutritionUndernutrition is a metabolic situation in which energy needs are not covered due to lack of intake, increased needs or both.Vitamin deficiencies can be associated.

TYPICAL DIFFERENTS OF NUTRITION:

They are common in the elderly.

Undernutrition by hypercatabolism:

Increased energy requirements by increasing protein catabolism. The prognosis and the treatment depend on the cause (cancer, tuberculosis, prolonged fevers, hyperthyroidism, etc.).

It must not be allowed to settle down while waiting for a diagnosis. Its correction can improve the evolution and comfort of the patient.

Malabsorption malnutrition:

This is the case of IBD (inflammatory bowel diseases).

Dietary malnutrition:

– Voluntary selection of intake, in eating disorders (anorexia nervosa).

– Bad socio-economic conditions, Alzheimer’s disease.

CONSEQUENCES OF NUTRITION:

They are plurifocal:

– Muscle impairment   : reduction of muscle strength and endurance, amyotrophy and gradually, cachexia.

– Decreased defenses   :

 decreased cytokine synthesis of the inflammatory and immune response;

 reduction of immunoglobulin synthesis, and alteration of cellular immunity (altered T cell and macrophage functions).

The result is a lesser response to infections, viral, bacterial and mycotic;

– delayed healing by decreasing collagen synthesis;

– Decrease of digestive secretions: gastric, pancreatic, biliary exocrine insufficiency, which leads to malabsorption and bacterial translocation: this reflects the need sometimes to start renutrition with parenteral nutrition or to start a venous treatment, because nutrients and medications are poorly absorbed;

– repercussions on the respiratory system which may lead to acute respiratory failure by reducing the activity of the respiratory centers;

– effects on the myocardium: reduction of heart weight, myofibrillar atrophy, cellular edema and reduction of cardiac output;

– other effects: neuropathies, abnormalities of taste and smell, amenorrhea.

HOW TO EVALUATE NUTRITION:

Clinical arguments:

– To appreciate the general state, the state of the muscular masses, the subcutaneous adipose panniculus, the state of hydration.

– To identify the lesions of the skin, the state of the integuments, the mucous membranes.

– Appreciate the field: the medical and surgical antecedents, the age ++, the psychological disturbances, the addictions (alcohol, drugs).

– Specify the nutritional intake, the type of diet and its recent changes.

Anthropometric measurements:

– Measurement of body weight loss   : index allowing to appreciate the weight loss since the last 6 months compared to the usual weight. If it is> 10% undernutrition is severe.

– Body mass index   = Weight (Kg) / Size squared (m)

20 <normal man <25

19 <normal woman <24

– Waist size   : is measured between the iliac crest and the ribs and objectifies the abdominal distribution of fats.

Normal man <100 cm

Normal woman <90 cm

Paraclinical criteria:

– Albumin:   its half-life is long (20 days). Hypoalbuminemia <30-35 g / l indicates old and prolonged undernutrition, but does not allow to judge recent disorders.

– Prealbumin:   its half-life is 2 to 3 days, so it is interesting for monitoring. Its concentration can be falsely increased by chronic renal failure. It falls during recent undernutrition, but also in cases of inflammatory syndrome or hyperthyroidism.

Particularities of undernutrition of the elderly

 Serious, she is often under-diagnosed +++

 Risk situations: recent isolation (bereavement), debilitating dementia, admission to an institution but especially acute infection.

 The clinical assessment must include the assessment:

 mental status (MMS) and home autonomy (ADL, IADL);

 resources and social factors (who does the shopping, who prepares the meals?), Ask the relatives to check the contents of the fridge;

 systematic swallowing;

 teeth and dental appliances;

 walking.

 Specific geriatric tool: mini mutritionnal assessment (MNA)

 It must be systematically prevented in case of acute infection

 Protein and high calorie supplements must be adapted to the tastes of the elderly (enriched soups and purées, neutral Fortimel replacing milk in the morning).

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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