Malnutrition

Malnutrition or risk of malnutrition will usually present with a number of signs and symptoms. Early detection of malnutrition or risk of malnutrition using a screening tool such as MUST (Malnutrition Universal Screening Tool) is essential to ensure early intervention.

Signs and symptoms of malnutrition include:

Loss of appetite
Unintentional weight loss
Lack of energy
Reduced ability to perform daily tasks
Poor concentration
Reduced strength

It is estimated that malnutrition affects over 3 million people in the UK. Of these 1.3 million are over the age of 65¹.

Whilst most people with malnutrition are living in the community, studies have also shown that the following are at risk of malnutrition¹:

25-34% of patients admitted to hospital
30-42% of patients admitted to care homes
18-20% of patients admitted to mental health units

Causes of malnutrition

There are certain people who are at increased risk of malnutrition, these include:

People over the age of 65 years, particularly if they have been admitted to hospital or are living in a care home or nursing home
People with long term conditions such as diabetes or chronic lung disease
People with chronic progressive conditions, for example, dementia and cancer
People who abuse drugs or alcohol

All of these conditions tend to result in physical factors which impact on our eating and drinking habits, increasing the risk of malnutrition.

Dysphagia - swallowing may become more difficult or painful. This can result in limited food choices. You can read here to learn more about dysphagia
Loss of smell or taste – some conditions, medications or treatments may alter your smell or taste, which can then affect your appetite
Difficulties preparing your own meals due to reduced strength and mobility. You can read here about how the Made For You range of meals can help.
Limited mobility may make it difficult to get food or you may rely on others to get food for you

Alongside clinical reasons for increased risk of malnutrition, social factors may play a role. For example:

Social isolation
- Living alone and preparing meals for one can impact on the type and amount of food eaten which may lead to nutritional deficiencies
Poverty
- Not having sufficient money to buy enough food or having to limit the amount of food you buy can be detrimental to our nutritional intake

Complications of malnutrition

If left untreated malnutrition can have significant effects on our bodies, including:

Reduced immune system therefore unable to fight infections
Reduced muscle strength which can lead to:
- Increased risk of falls
- Reduced ability to perform activities of daily living
- Increased risk of pressure sores due to inactivity
Impaired wound healing
Impaired temperature regulation
Specific vitamin and mineral deficiencies e.g.
- Anaemia due to lack of iron
- Osteomalacia due to Vitamin D deficiency

Loss of muscle function and strength is a major consequence of malnutrition and subsequently leads to weight loss. If dietary intake is insufficient to meet nutritional requirements over a prolonged period of time the body draws on our reserves in tissues such as muscle, adipose tissue and bone leading to changes in body composition.

Managing malnutrition at home

Once malnutrition has been identified your GP or dietitian will provide you with advice on how to manage the condition at home.

Dietary changes are the main treatment for malnutrition and will depend on the underlying cause of malnutrition and the degree of malnutrition.

Your diet

Malnutrition occurs due to an imbalance of nutrients in the body. This is usually energy and protein deficiency. You will be advised to ensure your diet contains increased amounts of these nutrients to help promote weight gain and improve muscle strength.

If you have a poor appetite, the following may be advised to help increase your energy and protein intake.

Small, frequent meals and snacks – you may find it easier to have smaller meals with extra snacks in between
Food fortification – this involves adding butter, cream, milk or cheese to existing foods such as porridge, soup or mashed potato to increase the nutrient content without increasing the amount of food you need to eat
Energy dense food choices such as cakes, biscuits or puddings which contain more calories
High calorie drinks such as milkshakes, hot chocolate or tea/coffee made with whole milk.

If you are unable to get all the nutrition you need from food, you may also be recommended to take oral nutritional supplements. These drinks are available in a variety of formats and your GP or dietitian will advise you on the most suitable version for your needs. They contain a mix of energy, protein, vitamins and minerals, which are all important to help manage your nutritional needs.

If malnutrition exists due to dysphagia, any IDDSI food or drink recommendations from a speech and language therapist will need to be taken into account. This may include guidance on how to increase the nutritional content of IDDSI Level 4 puréed diet using food fortification or the use of pre-thickened oral nutritional supplements to meet your nutritional needs.

If you are unable to take sufficient amounts of food and drinks to meet your nutritional needs, you may also need to have a feeding tube to provide extra nutrition such as a PEG. These feeding tubes are fitted in hospitals but can be used at home.

To support your nutritional needs whilst you have dysphagia you may want to consider pre-prepared meals that meet the IDDSI framework standards. The use of such pre-prepared meals can be a practical solution to help manage and treat your malnutrition, particularly if you are unable to prepare your own meals or would like the reassurance that the food you are eating meets the correct lDDSI level and provides you with the nutrition your body needs.

Made For You is a range of specialist nutrition meals designed for people with dysphagia. There are 80 different meals (breakfast, main meal, mini meal and dessert options available) suitable for IDDSI Levels 4-6. The mini meal options are available for IDDSI diet Level 4 and are a great option if you have a small appetite or are unable to finish a full sized main meal portion.

References