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Undernutrition Tory Davis, PA-C Malnutrition Undernutrition and overnutrition Undernutrition can result from inadequate ingestion of nutrients, malabsorption, impaired metabolism, loss of nutrients due to diarrhea, or increased nutritional requirements (as in cancer or infection). Stages of Undernutrition Each takes time to develop First, nutrient levels in blood and tissues change Second, intracellular changes in biochemical functions and structure Finally, signs and symptoms Risk Factors Ages and stages Social circumstances: poverty Medical conditions Infancy and Childhood High demands for: – Vit E – Energy – Essential nutrients Nutrients req’d for nl body fxn that we can’t produce – must be obtained by diet Vegan mother breastfeeding B12 deficiency Adolescence Anorexia Rapid growth Pregnancy Fe deficiency anemia Folate deficiency anemia Pica – seen more in pregnancy – want to eat things that aren’t normally considered food – sometimes to replace nutrional deficit Old Age Sarcopenia (progressive loss of lean body mass) begins at 40! physical activity food intake – Anorexia cytokine levels androgen levels Basic metabolic rate Disorders/Procedures DM – can’t absorb GI Tract disorders – Malabsorptions, IBD,Bowel resection – Impaired absorption of fats. Fat-sol vitamins, B12, Ca, Fe Liver d/o – Impair metabolism of vit A, B12, protein Disorders/Procedures Renal disorders – Deficiencies of protein, vit D, Fe Increased metabolic demands – Infection, trauma, fevers, burns Diets Vegetarian – B12 in vegans – Fe defic in ovo-lacto – Protein Fad diets – Protein, vit, minerals – Ask Liberace Diet Meds/drugs/supplements – Alter appetite – Alter absorption and metabolism Etoh/Drugs – Neglect of nutritional needs – Etoh deficiencies of Mg, Zinc, thiamine Thus the “banana bag (mg, zinc thiamine + others).” Why? – see note below Diagnosis of Undernutrition Hx: dietary intake, weight change, above risk factors SHx: money for food? Able to prepare meals? Think elders! PE: BMI, look for signs of deficiencies OR conditions that could predispose to undernutition. – Like what? Jaundice, spoon nails, wasted, pale (sign of anemia), hair loss or thinning, etc MNA- Mini Nutritional Assessment Testing- Labs Serum albumin as indirect measure – May indicate protein deficiency Other testing– Vitamin/mineral levels as specific tests PEM Protein Energy Malnutrition Energy deficit secondary to chronic deficiency of all macronutrients Graded mild to severe, based on percentage of expected wt Primary- inadequate intake Secondary from drug or d/o that interferes with nutrient use PEM Developing countries: – Children who can’t consume enough protein and calories Lack of access Developed countries: – Institutionalized elderly – Abuse (child or elder) – Pts with decreased appetite or impaired digestion/absorption/metabolism Vitamins Organic compound required as nutrient in tiny amounts but can’t be synthesized by the organism and must be obtained via diet. See posted vitamin chart for sources, functions, effects of deficiencies Vitamin Deficiencies in developed countries Poverty Food faddism Drugs (ie drug/vit interactions) Alcoholism Parenteral nutrition (prolonged or with inadequate supplementation) S/S Nutritional Deficiency: General Wasting Cachexia Energy deficiency Skin Rash – many vits (usually def), zinc, fatty acids Rash in sun-exposed areas – Niacin (pellagra) Easy bruising – Vit C or K Hair/nails Thinning or loss of hair – Protein Premature whitening of hair – Selenium Spooning of nails – Iron Eyes Impaired night vision and Corneal keratomalacia – Vit A Mouth Cheilosis (angular cheilitis) and glossitis – Riboflavin, niacin, pyridoxine, iron Bleeding gums – Vitamin C, riboflavin Extremities Edema – Protein def Why? Neuro Stocking/glove paresthesias and numbness – Thiamin Tetany – Ca, Mg Cognitive and sensory deficits – Thiamin, niacin, B12 MSSK Wasting – Protein Bony deformities – Vit D, Ca Bone tenderness – Vit D Joint pain/swelling – Vit C GI Diarrhea – Protein, niacin, folic acid, B12 Diarrhea with dysgeusia – Zinc Dysphagia/odynophagia (PlummerVinson syndrome) – Iron Endo Thyromegaly – Iodine
