Malnutrition and Nutritional Supplements

Definition of malnutrition

The British Association for Parenteral and Enteral Nutrition (BAPEN) defines malnutrition as follows:   

Malnutrition is a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients caused measurable adverse effect on tissue/body form (body shape, size and composition) and function and clinical outcome.  The term malnutrition does include obesity; however BAPEN is focused on the problem of ‘undernutrition’.  The term ‘malnutrition’ is used commonly to mean ‘undernutiriton’.   

Causes of Malnutrition

There are multiple factors that may contribute to weight loss and malnutrition. These include:

• financial problems
• social difficulties
• multiple comorbidities
• respiratory difficulties (for example dyspnoea)
• dysphagia
• poor dentition
• adverse effects of drugs
• polypharmacy
• depression, bereavement
• dementia
• reduced taste and smell
• poor appetite.

Correcting Malnutrition

The first step in reducing malnutrition is to identify those who are at risk. There is a variety of malnutrition screening and assessment tools that are validated in various settings.2 These tools include questions about current weight, body mass index, weight change, appetite and comorbidities, and assign a score indicating level of risk. They can help to identify those who are losing weight and who are at risk, but they must be used together with a 'pathway of action'. The factors contributing to poor intake must be treated where possible. Everyone involved in the care of the person can play a part in encouraging food intake and improving nutrition. The causes of poor intake should be closely examined and corrected. In addition the role of the dining environment and other social factors should not be underestimated.6,7 An Accredited Practising Dietitian can provide a comprehensive assessment and advise on strategies.

Most elderly people eat far less than they did when they were younger. Their energy needs are lower, but the requirements for some nutrients such as protein, calcium and riboflavin are actually higher.8 This means that their food must be more nutritious to meet their needs.

A variety of dietary measures can be used to improve energy and nutrient intake. While the temptation might be to reach for a commercial oral nutrition supplement as a first step, there are many approaches that can improve oral intake with regular foods. Supplements have an important role, but the first step should be to find ways to increase the intake from familiar and preferred foods. There is a large element of taste fatigue with supplements and they are potentially an expensive option.

There are three main approaches to increase the intake of protein, energy and nutrient intake from food:

• small frequent meals – encouraging snacks between meals
• increasing the nutrient density of meals by additions of milk powder, grated cheese, margarine and
• cream
• nourishing fluids such as milk drinks, smoothies, juice.

These strategies can increase protein and energy intake, but if the core food groups9 are not taken in recommended amounts, micronutrient deficiencies may develop. In this instance a multivitamin and mineral supplement may be recommended. Improvements in weight and nutrition status can be very difficult to achieve, and individual dietary advice from a dietitian may be needed. The dietitian can assess whether the use of commercial oral nutrition supplements is appropriate and which supplements may suit the individual person.

Supplements

Studies have shown that judicious use of oral nutrition supplements can improve weight, protein and energy intake, nutritional status, physical function, quality of life and length of stay in acute care. 2,10 When a supplement is required there are a number to choose from. The most common and readily available are milk based. They vary in their taste, nutrient profile and indications for use.

Standard Oral Supplements

Standard supplements are suitable for people who have some oral intake, but who are struggling to achieve adequate nutrition. These supplements are best taken as snacks between meals to complement normal meals. Most standard supplements are powder based. Some are 'complete', meaning that they will provide 100% of macro- and micronutrient needs if they are taken as the only form of nutrition. Some are supplemented with fibre, some are low in lactose. The standard dilution is one calorie per mL of fluid.

Examples include:

• Enprocal
• Ensure Powder
• Fortisip Powder
• Proform
• Sustagen Hospital Formula.

Learn more about the benefits of Proform and Sustagen in the education modules below.

Click here to read the full article.

Source: www.australianprescriber.com/magazine/37/4/120/3, Monday 25 August 2014