Malnutrition

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

In the case of malnutrition, not all of the necessary nutrients are available to the body in sufficient quantities. The possible causes for this range from chewing and swallowing problems to tumor diseases to depression, poverty and social isolation. Malnutrition occurs particularly often in old age. Read everything you need to know about malnutrition here: definition, causes, symptoms, diagnosis and treatment!

Malnutrition: description

In the case of malnutrition, the body is not supplied with enough energy, protein or other nutrients (such as vitamins and minerals). As a result, there are sometimes serious changes in body functions. In addition, the risk of various diseases and the risk of death increases.

Malnutrition can occur at any age. Malnutrition is particularly common in old age.

Forms of malnutrition

Doctors differentiate between two forms of malnutrition:

Quantitative malnutrition: In the long term, the body is supplied with less food than it needs to meet its energy needs.
Qualitative malnutrition: Here there is a lack of proteins or other nutrients (vitamins, bulk or trace elements, etc.).

The two forms can also occur in combination with one another.

Malnutrition: symptoms

Malnutrition can lead to a wide variety of problems. The various nutrients fulfill countless important functions in the body, so that a deficiency causes different symptoms.

For example, a lack of carbohydrates (the most important source of energy) can trigger headaches, circulatory problems, poor concentration and visual disturbances. A deficiency in proteins weakens the immune system, delays recovery from illness and leads to a reduction in muscle mass. Iron deficiency leads to anemia in the long run, recognizable by pale skin and persistent tiredness and exhaustion.

The extent of the symptoms and the consequences of the nutrient deficiency depends largely on how severe the malnutrition is. A slight malnutrition often only triggers unspecific symptoms such as weakness, tiredness, loss of appetite and lack of drive. A long-standing or severe malnutrition, on the other hand, can have clearer and more serious consequences and disrupt important organ functions.

Overall, malnutrition can have the following consequences:

general weakness
fatigue
Listlessness
Breakdown of the skeletal muscles
Loss of muscle strength
Disorders in the sequence of movements
increased risk of falls and broken bones
Decrease in heart muscle mass and pumping power
Cardiac arrhythmias
Decrease in the respiratory muscles with weaker and shorter breaths
weakened immune system and thus increased susceptibility to infections
delayed and impaired wound healing
increased risk of pressure sores and bedsores (if bedridden)
neurological disorders
dementia

Malnutrition in old age also increases the risk of death - slightly overweight, on the other hand, does not, which is why the latter is more advantageous for older people.

Malnutrition: causes and risk factors

Malnutrition occurs when:

the nutrient intake is lower than the nutrient requirement in the long term,
the supplied nutrients cannot be sufficiently utilized or
there is an uncontrolled breakdown of body substance.

This can have different causes. In individual cases, malnutrition is usually caused by several of them, not just one factor alone. The main causes are:

Loss of appetite (anorexia)

Many people with chronic or serious illnesses have little appetite and therefore eat little, which in the long term leads to malnutrition. Such diseases are, for example, severe infections (such as tuberculosis or HIV), tumor diseases and autoimmune diseases. The mental stress, anxiety and depression associated with such illnesses can also have a negative effect on appetite. A feeling of fullness that occurs prematurely and changes in the sense of taste and smell can also play a role.

Swallowing and passage disorders

Problems moving food through the gastrointestinal tract are another possible cause of malnutrition. Such problems arise, for example, with chronic constrictions (stenoses) in the small intestine of Crohn's disease patients: in order to avoid symptoms as a result of these constrictions, many affected eat little.

Narrowing caused by a malignant tumor, such as the esophagus or stomach, can also make it difficult to eat and thus cause malnutrition. Such tumors can on the one hand become a mechanical obstacle, on the other hand they can also hinder the mobility (motility) of the digestive tract. This can be the case, for example, with pancreatic cancer and after cancer-related removal (of the stomach or esophagus (resection)).

Chewing and swallowing disorders

Bad teeth, fungal infections (oral thrush) and mouth ulcers can make chewing so difficult that those affected avoid eating - malnutrition can result. Dry mouth (due to medication or a salivary gland disease) can also cause problems with chewing and swallowing. In addition, stroke patients, for example, often have swallowing disorders, which can contribute to malnutrition.

Changes in the sense of taste and smell

If the sense of taste and smell is disturbed, this often affects the appetite - those affected eat too little, which in the long term results in malnutrition. Old age, virus or tumor diseases are possible reasons for changes in the sense of taste and smell.

Problems digesting food (maldigestion)

In order to be able to use the food ingested, the body must first break it down into small components. This requires various digestive juices, which are produced by the pancreas, among other things. In the case of chronic inflammation (pancreatitis) or cancer (pancreatic carcinoma), this pancreatic secretion is lacking, which impairs the utilization of food. So although people may eat enough, malnutrition can develop.

The same thing can happen if the body loses excessive bile acid so that it is no longer available for digestion. Such a bile acid loss syndrome occurs, for example, when the last section of the small intestine (terminal ileum) had to be removed in Crohn's disease patients.

Problems absorbing nutrients (malabsorption)

Various diseases of the stomach and small intestine can impair the absorption of nutrients in such a way that malnutrition develops despite sufficient food intake. These diseases include, for example, atrophic gastritis (chronic inflammation of the gastric mucous membrane in which the mucous membrane recedes) and celiac disease / sprue.

Even if the stomach (gastric resection) or a large part of the small intestine (short bowel syndrome) had to be removed due to illness, malnutrition can result as a result of malabsorption.

Problems with the utilization of the nutrients

In the case of insulin resistance, the body cells do not respond sufficiently to the hormone insulin. This hormone normally ensures that the cells can absorb sugar (glucose) from the blood and use it for energy. Insulin resistance can contribute to malnutrition. It can occur, for example, in infections, tumor diseases and liver cirrhosis, but it can also be caused by cortisone therapy.

Dysfunctional nutrient utilization with subsequent malnutrition can also result in other ways, for example through increased protein breakdown (proteolysis) in pancreatic and other tumor diseases.

Medication

The above factors, which often lead to malnutrition, can also be caused by medication. A lack of appetite can be a side effect of antibiotics, sedatives (tranquilizers), tricyclic antidepressants, opiates (strong pain relievers) and digoxin (heart medicines).

A change in taste is often caused by pain relievers (analgesics), diabetes drugs (antidiabetic drugs), high blood pressure drugs (antihypertensive drugs), cytostatics (cancer drugs), certain antibiotics (penicillin, markolides) or psychotropic drugs (drugs against mental illness).

Dry mouth is often the result of treatment with sedatives (tranquilizers, sedatives), Parkinson's medication, antidepressants, beta-blockers (cardiovascular drugs), allergy drugs (antihistamines) or diuretics.

Many cytotoxic drugs, opiates, antibiotics, high blood pressure drugs, antidepressants, and antifungal agents (antifungal drugs) cause nausea, which affects food intake. In the longer term, such drug side effects can contribute to malnutrition.

Other factors

Factors such as poverty, social isolation, loneliness or grief contribute to the development of malnutrition, especially in many older people. The loss of independence, for example as a result of a stroke or other illness, also plays a role: Those who find it difficult to shop and prepare meals often neglect food intake.

Frequent age changes such as declining sensory perception or changes in hunger and satiety regulation can also play a role in the development of malnutrition. The same goes for increasing forgetfulness, confusion, and dementia - some patients simply forget to eat.

Malnutrition: examinations and diagnosis

If malnutrition is suspected, the doctor will, if possible, talk to the patient in detail about their eating habits, existing complaints and illnesses and their social situation (anamnesis). Possible questions are:

How many meals do you eat a day?
Do you have a warm meal every day?
Do you eat fruits and vegetables every day?
Do you eat dairy products every day?
How often do you eat meat / meat products and fish?
Do you suffer from a lack of appetite?
How much do you drink every day?
How much alcohol do you consume per week?
Do you smoke? When Yes, how much?
Are you physically active?
Have you accidentally lost weight recently?
How is your social situation?
Are you suffering from any stress or stress?

It is often helpful if the doctor can also talk to close relatives in order to find out their assessment of the patient's eating habits, etc.

Physical examination

This is followed by the physical examination. The doctor measures the patient's blood pressure and pulse. He examines the teeth / dentures as well as the chewing and swallowing function. He looks at the tongue and skin for signs of dehydration. He also pays attention to possible tissue damage (lesions), ulcers and rhagades (small cracks in the skin).

The doctor looks at how thick the subcutaneous fatty tissue is (e.g. above the triceps on the upper arm) and looks for possible tissue swelling (edema) and ascites (ascites).It also checks the patient's muscle status and muscle strength against resistance (biceps, hamstrings).

Body mass index (BMI)

The physical examination of suspected malnutrition also includes determining the patient's weight. The body mass index (BMI) can be calculated from the ratio of body weight to body height: BMI = body weight divided by the square of the body height.

This measure is used to assess weight and support the diagnosis of malnutrition. According to the World Health Organization (WHO), a BMI of less than 18.5 kg / m2 is malnutrition. Different BMI classifications are often used for seniors. For example, according to some specialist nutrition societies (e.g. in Germany and Austria), there is a risk of malnutrition in older people from a limit value of 20 kg / m2.

By the way: If the patient has accumulations of water in the tissue (edema) or in the abdominal cavity (ascites), the BMI is not meaningful because the weight of the water falsifies the measured value of the body weight.

Blood test

To determine if there is any malnutrition, the doctor will also have the patient's blood tested in the laboratory. A blood count is done and the so-called structural proteins (such as albumin) are determined. Vitamin B12 levels, electrolytes and other blood parameters may also be measured.

Further investigations

If the suspicion arises that the malnutrition has a disease-related cause such as a tumor, further, specific examinations will follow.

Malnutrition: treatment

To successfully treat malnutrition, one must eliminate the underlying causes whenever possible. For example, if a poorly fitting denture interferes with food intake, it should be adjusted. Swallowing therapy can help with swallowing disorders. If, for example, as a result of a stroke, physical impairments make it difficult to eat and drink independently, physiotherapy, occupational therapy and eating training can be useful. In the case of drugs whose side effects (such as nausea and poor appetite) contribute to malnutrition, it may be possible to switch to better tolerated preparations. Existing diseases such as tumors, which are responsible for the insufficient supply of nutrients, must be treated properly.

In addition, malnutrition requires further measures, which should be observed by the patients themselves or their relatives and caregivers:

Nutritional measures

The nutrient deficit in malnutrition itself is remedied by an adequate supply of nutrients. For this purpose, a varied and high-energy diet is recommended, which takes into account the likes and dislikes of the patient. Seasoning dishes with herbs and spices can stimulate the appetite.

In the case of chewing and swallowing difficulties, the correct consistency of the food should be ensured: Food that is too dry or difficult to chew (such as a hard crust of bread) should be avoided. Instead, you should chop fruit, meat, etc. into bite-sized pieces before serving. It is usually not necessary to puree the food completely (except for severe swallowing difficulties) - porridge-like food also usually does not look very appetizing.

In the case of malnutrition, several small meals during the day make more sense than three large ones. In addition, you should stick to fixed meal times and ensure a calm, comfortable atmosphere while eating without disturbance and distraction.

Adequate hydration is also very important for patients with malnutrition. However, people with swallowing problems can easily choke on beverages and thin foods (such as soups). Then you should thicken the liquids with a tasteless powder.

Balanced drinking food

Sometimes malnutrition can only be remedied with the help of balanced drinking food. It contains all essential nutrients in sufficient quantities and can be used both for nutrition alone and as a supplement to normal diet. Products rich in energy and protein are particularly recommended. Balanced drinking food is available in different flavors in the pharmacy.

Tube feeding

If an energy-rich diet and / or balanced drinking food are not sufficient to compensate for the deficits of malnutrition, the patient must be fed artificially through a tube - either for a limited time or for a long time. With the help of nurses, artificial feeding can also be carried out at home.

More tips

Despite possible weakness and fatigue, people with malnutrition should be physically active and move around every day as much as possible, for example take a short walk. The exercise and the fresh air can stimulate the appetite.

In the case of physical impairments (such as hemiplegia after a stroke), the use of special crockery and cutlery can be useful. For example, non-slip plates, special cutlery and cups with reinforced handles can make it easier to eat and drink independently and thus counteract malnutrition.

People with malnutrition who live alone need help - for example from nurses, (voluntary) carers, from the mobile help service, the shopping service or from “meals on wheels”.

Malnutrition: disease course and prognosis

Malnutrition often affects the elderly in particular. How well and quickly it can be treated depends, among other things, on the underlying causes. It is also important to act as early as possible: the earlier it is detected, the easier it is to treat malnutrition. Attention is therefore required on the part of patients themselves as well as relatives, doctors and nurses. With the right treatment, malnutrition in old age can be remedied in most cases.

If, on the other hand, malnutrition is not recognized in the elderly and persists for a long time, it increases the risk of mortality.

Tags: anatomy healthy feet baby toddler