Malnutrition and nutritional assessment

Undernutrition is a significant risk factor for mortality, complications, hospital infections, length of hospital stay, quality of life, and prognosis. Patients with proper nutrition will help prevent undernutrition, prevent the development of the disease, and improve the effectiveness of treatment. Nutrition is an integral part of the comprehensive treatment process.

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Today, the global challenge of malnutrition encompasses both undernutrition and overweight, particularly prevalent in low and middle-income nations. Excessive body fat accumulation poses health risks for overweight and obese individuals. Objectives: To assess nutritional status and identify related factors among Can Tho University of Medicine and Pharmacy (CTUMP) medical students.

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Malnutrition is common in cancer patients. The NUTRISCORE is a newly developed cancer-specific nutritional screening tool and was validated by comparison with the Patient-Generated Subjective Global Assessment (PG-SGA) and Malnutrition Screening Tool (MST) in Spain.

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To investigate of nutritional status in maintenance hemodialysis patients by indicators: anthropometric, dietary energy, and protein intake, dialysis malnutrition score, serum albumin, prealbumin levels. To Understand the relationship between nutritional status and some clinical and laboratory characteristics, initially assessing the results of an oral nutritional supplement on nutritional status in 12 weeks in maintenance hemodialysis patients.

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Assessment of Circulating (Visceral) Proteins The serum proteins most used to assess nutritional status include albumin, total iron-binding capacity (or transferrin), thyroxine-binding prealbumin (or transthyretin), and retinol-binding protein. Because they have differing synthesis rates and half-lives—the half-life of serum albumin is about 21 days whereas those of prealbumin and retinol-binding protein are about 2 days and 12 h, respectively—some of these proteins reflect changes in nutritional status more quickly than others.

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Anthropometrics Anthropometric measurements provide information on body muscle mass and fat reserves. The most practical and commonly used measurements are body weight, height, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC). Body weight is one of the most useful nutritional parameters to follow in patients who are acutely or chronically ill. Unintentional weight loss during illness often reflects loss of lean body mass (muscle and organ tissue), especially if it is rapid and not caused by diuresis.

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Nutritional History A nutritional history is directed toward identifying underlying mechanisms that put patients at risk for nutritional depletion or excess. These mechanisms include inadequate intake, impaired absorption, decreased utilization, increased losses, and increased requirements of nutrients. Individuals with the characteristics listed in Table 72-3 are at particular risk for nutritional deficiencies.

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Protein Catabolism The rate of endogenous protein breakdown (catabolism) to supply energy needs normally falls during uncomplicated energy deprivation. After about 10 days of total starvation, the unstressed individual loses about 12–18 g/d protein (equivalent to approximately 2 oz of muscle tissue or 2–3 g of nitrogen). By contrast, in injury and sepsis, protein breakdown accelerates in proportion to the degree of stress, to 30–60 g/d after elective surgery, 60–90 g/d with infection, 100–130 g/d with severe sepsis or skeletal trauma, and 175 g/d with major burns or head injuries.

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Physiologic Characteristics of Hypometabolic and Hypermetabolic States The metabolic characteristics and nutritional needs of hypermetabolic patients who are stressed from injury, infection, or chronic inflammatory illness differ from those of hypometabolic patients who are unstressed but chronically starved. In both cases, nutritional support is important, but misjudgments in selecting the appropriate approach may have disastrous consequences.

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Marasmus The end stage of cachexia, marasmus is a state in which virtually all available body fat stores have been exhausted due to starvation. Conditions that produce marasmus in developed countries tend to be chronic and indolent, such as cancer, chronic pulmonary disease, and anorexia nervosa. Marasmus is easy to detect because of the patient's starved appearance. The diagnosis is based on severe fat and muscle wastage resulting from prolonged calorie deficiency.

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Harrison's Internal Medicine Chapter 72. Malnutrition and Nutritional Assessment Malnutrition and Nutritional Assessment: Introduction Malnutrition can arise from primary or secondary causes, with the former resulting from inadequate or poor-quality food intake and the latter from diseases that alter food intake or nutrient requirements, metabolism, or absorption. Primary malnutrition occurs mainly in developing countries and under conditions of war or famine.

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Nutritional Status Assessment Full nutritional status assessment is reserved for seriously ill patients and those at very high nutritional risk when the cause of malnutrition is still uncertain after initial clinical evaluation and dietary assessment. It involves multiple dimensions, including documentation of dietary intake, anthropometric measurements, biochemical measurements of blood and urine, clinical examination, health history, and functional status. For further discussion of nutritional assessment, see Chap. 72.

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Acute Care Settings Acute care settings, anorexia, various diseases, test procedures, and medications can compromise dietary intake. Under such circumstances, the goal is to identify and avoid inadequate intake and ensure appropriate alimentation. Dietary assessment focuses on what patients are currently eating, whether they are able and willing to eat, and whether they experience any problems with eating. Dietary intake assessment is based on information from observed intakes; medical record; history; clinical examination; and anthropometric, biochemical, and functional status.

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Estimated Average Requirement When florid manifestations of the classic dietary deficiency diseases such as rickets, scurvy, xerophthalmia, and protein-calorie malnutrition were common, nutrient adequacy was inferred from the absence of their clinical signs. Later, it was determined that biochemical and other changes were evident long before the clinical deficiency became apparent. Consequently, criteria of nutrient adequacy are now based on biologic markers when they are available.

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