Malnutrition

When most people think of malnutrition it is usually an image of undernutrition that comes to mind. However, a person can be obese and also malnourished. Malnutrition is a physical state of unbalanced nutrition, and encompasses both undernutrition and overnutrition.

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​Undernutrition is caused by a lack of calories, protein or other nutrients, and frequently occurs in areas of the world which lacks adequate access to food and clean water. On the contrary, overnutrition is caused by consuming too many calories and not eating enough nutritious foods, including fruits, vegetables, whole grains, lean protein, beans, dairy, and nuts or seeds. This form of malnutrition results in vitamin and mineral deficiencies and is commonly observed in food insecure, impoverished areas of the United States. 

Registered Dietitian Nutritionists (RDNs) are focusing on improving the speed of diagnosing malnutrition in health care settings. Adult malnutrition in clinical healthcare settings ranges from 15-60% of hospitalized patients. Research shows that malnutrition increases the risk of death, length of hospital stay and overall health care costs (1).

There are several reasons why a patient may not be getting enough nutrition. Perhaps the patient requires more nutrition than usual related to their condition, or maybe they are unable to properly absorb nutrients. When a hospital patient becomes malnourished their medical treatment and recovery are affected, therefore the expertise of RDNs is imperative to the health care team. Ensuring patients receive the nutrition they need can make all the difference in healthcare outcomes for critical care patients.

​Hospitals are now required to screen for malnutrition within the first 24 hours of patient admission. The definition of malnutrition for adults according to the electronic Nutrition Care Process Terminology (eNCPT) is "inadequate intake of protein and/or energy over prolonged periods of time resulting in loss of fat and/or muscle stores including starvation-related malnutrition, chronic disease or condition-related malnutrition and acute disease or injury-related malnutrition (2)."

RDNs assess malnutrition using weight history, dietary intake, lab values and a physical exam. A nutrition-focused physical exam involves checking for body fat and muscle loss, fluid accumulation and hand grip strength. A minimum of two clinical charactertistics is recommended for the diagnosis of malnutrition in adults. It is interesting to note that serum proteins, such as albumin and prealbumin, do not respond to changes in nutrient intake and are not included in as clinical characteristics of malnutrition (2).

RDNs are working hard to improve nutrition interventions for malnutrition in health care. Appropriate nutrition plays a crucial role in patients' recovery processes and has the potential to save a significant amount of healthcare dollars.

Resources:
1. What is Malnutrition. www.eatright.org. http://www.eatright.org/resource/food/nutrition/healthy-eating/what-is-malnutrition. Accessed December 18, 2016.
2. Adult Malnutrition in the Acute Care Setting. www.eatrightpro.org. http://www.eatrightpro.org/resource/news-center/nutrition-trends/diseases-and-conditions/adult-malnutrition-in-the-acute-care-setting. Accessed December 18, 2018.