Malnutrition in adults -- causes, symptoms and treatment

Many people do not realise that adults, even those who are obese can be malnourished! Here's all that you need to know about malnourishment in adults.

Written By: Mita Majumdar | Published : March 7, 2016 6:54 PM IST

Malnutrition is a serious, but common, health problem that occurs when your diet does not contain the right amount of nutrients in the right proportion. And don t think that if you are eating five times a day, you are not at risk.

Both, undernutrition, when you don t get enough nutrients, and over-nutrition, when you get more nutrients than you need, are referred to as malnutrition. Here's the difference between malnutrition and undernutrition.

You may be surprised to know that even if you are obese you can be malnourished. Actually the availability of high-calorie, nutrient-poor foods is the key component to the rise of obesity worldwide. On top of it, modern agriculture and food processing techniques lower the micro-nutrient content of foods. So, despite consuming excess calories, you may be micronutrient deficient!

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Again, you are said to be malnourished if you have problem absorbing nutrients from food. This may be because of sedentary lifestyle, long term health condition, or low income.

Malnutrition can be defined as a condition when your body mass index (BMI) is below 18.5 kg/m2. It is categorised as mild to moderate if between 16.0 and 18.5 kg/m2 or severe if below 16.0 kg/m2.

Three types of malnutrition are found in adults

Starvation related
Acute disease or injury related
Chronic disease related

Recent studies have shown that though the starvation and acute disease related malnutrition can be detected easily, chronic disease related malnutrition is difficult to notice, especially in obese patients. [1]

Older adults, too, are at very high risk for malnutrition.

Symptoms of malnutrition in adults

The most common symptom of undernutrition in adults is unintentional weight loss of 5 to 10 percent of your body weight over 3 6 months.

On the other hand, the most common sign of over-nutrition is being overweight because of overeating. Sometimes, excessive intake of specific nutrients and nutritional imbalance caused by fad diets can lead to over-nutrition. So, instead of losing weight, you start gaining weight.

Other symptoms include

Muscle weakness
Feeling tired all the time
Increased susceptibility to infections
Irritability and dizziness
Depression and mood changes

Yes, depression too! Researchers from University of Tromso, Norway, found a strong association between impaired mental health (including sudden fear without apparent reason, faintness or dizziness, easily blaming yourself, depressed or sad, feeling worthless, feeling that everything is a struggle, and feeling hopelessness with regard to the future), low BMI, and malnutrition. [2]

Causes of malnutrition

Poverty is, of course, one of the main causes of malnutrition. But according to the Food and Agriculture Organization of the United Nations, malnutrition is part of a whole web of interacting forces such poor hygiene and sanitation, sickness, ignorance, social practices, gender, low food production, and few kinds of crops.

Other social factors that contribute to malnutrition include

Living alone and being socially isolated (it s a psychological factor actually)
Alcohol and /or drug addiction
Sedentary lifestyle with no exercise
Not knowing much about nutrition or cooking, especially if living alone
Physical factors include
Eating may be difficult if your teeth are in poor condition or your dentures don t fit properly.
Physical disability or mobility problems wherein it is difficult for you to go out to buy foods or to cook food.
Loss of appetite maybe because of chronic illness, or as a result of losing your sense of smell and taste.
Protein-energy undernutrition, which is a severe deficiency of protein and calories when you don t enough proteins and calories for a long time. Although it occurs more in children especially in developing countries, adults too can be affected if food supplies are inadequate.

Medical conditions can also lead to malnutrition

Certain genetic disorders such as cystic fibrosis. According to a study that was done to determine the prevalence of malnutrition in adults with cystic fibrosis (an inherited secretory gland disorder that severely damages the lungs and the digestive system), the researchers from France found that nearly 50 percent adults with cystic fibrosis had malnutrition, and its severity was associated with diagnosis of cystic fibrosis before the age of 18 years. [3]

Conditions that cause loss of appetite, for example, cancer, liver disease, or persistent pain.
Any health condition that require frequent hospital admission.
Conditions such as Crohn s disease and ulcerative colitis that cause inflammation of the digestive tract and disrupt body s ability to absorb nutrients.
Eating disorders
Dysphagia (difficulty in swallowing)
Respiratory disorders, for example, emphysema
Gastrointestinal disorders, for example, malabsorption
Endocrine disorders, for example, diabetes, thyrotoxicosis
Neurological disorders, for example, cerebrovascular accident, Parkinson's disease
Persistent vomiting or diarrhoea
Drug interactions, for example, digoxin, metformin, antibiotics, etc. [4]

Health risks

According to the World Health Organization, hunger and inadequate nutrition contribute to early deaths for mothers, infants and young children, and impaired physical and brain development in the young. At the same time, growing rates of overweight and obesity worldwide are linked to a rise in life threatening chronic diseases such as cancer, cardiovascular disease and diabetes . Did you know that malnutrition during early pregnancy can leave long lasting impact in the child.

However, that s not all. There are a number of other harmful effects of malnutrition. Here are some of them.

Infections: First off, if your body is not getting proper nutrition for a long while, you will start losing your lean body mass. Abnormal loss of lean body mass will make your body highly susceptible to infection.
Sarcopenia: Sarcopenia is the age related loss of skeletal muscle mass and strength. This affects balance, gait, and overall ability to perform daily tasks. Research shows that older adults with malnutrition and/or sarcopenia are at risk of increased morbidity and mortality, decreased quality of life and functioning and increased re-hospitalization, length of hospital stay, and healthcare costs. Researchers found that older adults reporting unintentional weight loss were 1.67 times more likely to experience mortality than those who reported no weight loss. [5] Here's why the elderly are more likely to suffer from malnutrition.
Poor wound healing: Your body needs a lot of energy during the wound-healing process. This energy for building new cells comes from body energy stores and protein reserves. This can be very challenging if you are undernourished and malnourished. Malnourished patients can develop pressure ulcers, infections, and delayed wound healing that result in chronic non-healing wounds. Chronic wounds are a significant cause of morbidity and mortality for many patients and therefore constitute a serious clinical concern, says Dr. Joyce Stechmiller at University of Florida College of Nursing.
Cachexia: Also known as wasting syndrome, this disorder is evidenced by unintentional severe weight loss. However, simply increasing nutritional intake is not going to resolve the issue. That s because cachexia has an immune disorder component as well. Cachexia is associated with quite a few serious medical conditions such as cancer, HIV /AIDS, congestive heart failure, rheumatoid arthritis, tuberculosis, chronic obstructive pulmonary disease (COPD), and Crohn s disease.

How to deal with malnutrition

Malnutrition is not an inevitable side effect of ageing, but many changes associated with the process of ageing can promote malnutrition. For example, ageing is frequently associated with decreases in taste acuity and smell, deteriorating dental health, and decreases in physical activity, which may all affect nutrient intake. Any change in nutrient intake can lead to malnutrition with its potentially serious consequences.

Your nutritional deficiency will be diagnosed during routine blood tests and history of eating habits and diet.

Treatment depends on the severity of malnutrition but it essentially includes a feeding program with a specially planned diet and, if required, nutritional supplements. For example, if you are anaemic, your doctor will ask you to consume more meat, poultry, vegetables, and cereals. Maybe you will need to change your eating habits. Or, maybe, you will be advised to consume 250 to 600 calories more than you normally eat.

Research reveals that appetite stimulants, fish oil, and resistance training can be helpful in conjunction with adequate energy and protein intake to address sarcopenia and cachexia. [6]

If you are suffering from condition /illness that contributes to malnutrition, you will have to treat those underlying conditions.

Severely malnourished people should receive artificial nutritional support that includes tube feeding (enteral nutrition) and parenteral feeding in which sterile liquid is fed directly to the bloodstream intravenously.

Sometimes, malnutrition is caused by dietary deficiency of vitamins and minerals. According to the FAO, vitamin A deficiency, iron deficiency anaemia and iodine deficiency disorders are the most common forms of micronutrient malnutrition.

Iron deficiency is common in pregnant women. In case of iron deficiency, consume lot of dark leafy greens, red meat, and egg yolks.

Iodine deficiency can occur in anyone. Some seafood are good sources of iodine and adding iodine to salt is a common and effective method of preventing iodine deficiency.

Ultimately, eating a healthy balanced diet that consists of foods from all major food groups, is the only way to ensure that you get the correct amount of nutrients.

Reference

1. Mauldin, K and O Leary-Kelley C. New Guidelines for Assessment of Malnutrition in Adults: Obese Critically Ill Patients. Critical care nurse. 2015. 35.4: 24-30.

2. Kvamme J, Gr nli O, Florholmen J, Jacobsen B. Risk of malnutrition is associated with mental health symptoms in community living elderly men and women: The Troms Study. BMC Psychiatry. 2011;11(1):112. doi:10.1186/1471-244x-11-112.

3. Dray X, et al. Malnutrition in adults with cystic fibrosis. European Journal of Clinical Nutrition (2005) 59, 152 154. doi:10.1038/sj.ejcn.1602039.

4. Hickson M. Malnutrition and ageing. Postgraduate Medical Journal. 2006;82(963):2-8. doi:10.1136/pgmj.2005.037564.

5. Maurits F. J. Vandewoude, Carolyn J. Alish, Abby C. Sauer, and Refaat A. Hegazi, Malnutrition-Sarcopenia Syndrome: Is This the Future of Nutrition Screening and Assessment for Older Adults? Journal of Aging Research. Vol. 2012, Article ID 651570, 2012. doi:10.1155/2012/651570.

6. Alison Yaxley and Michelle D. Miller, The Challenge of Appropriate Identification and Treatment of Starvation, Sarcopenia, and Cachexia: A Survey of Australian Dietitians. Journal of Nutrition and Metabolism. Vol. 2011, Article ID 603161, 2011. doi:10.1155/2011/603161

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