Malnutrition

Page last reviewed: 13/07/2011

Malnutrition is a serious condition that occurs when a person's diet does not contain enough nutrients to meet the demands of their body.

This can affect growth, physical health, mood, behaviour and many of the functions of the body.

You can also become malnourished if your diet does not contain the right balance of nutrients.

It is possible to eat a diet high in calories but containing few vitamins and minerals. This means you can become malnourished, even though you might also be overweight or obese. Being malnourished does not always mean that you are skinny.

 

Symptoms of malnutrition

The most common symptom of malnutrition is unplanned weight loss. If you lose 10% of your body weight in the course of three months and are not dieting it could be a sign that you are malnourished.

Other symptoms include:

  • lack of strength or energy to undertake routine activities, or poor physical performance
  • lack of energy and breathlessness (due to anaemia)
  • changes to skin and nails

Things to look out for in children include:

  • inability to concentrate or becoming unusually irritable
  • failure to grow to their expected adult height (stunted growth)

When to see your GP

If your BMI is lower than 18.5 or you experience the symptoms listed above it is recommended that you see your GP. Find out how to calculate your BMI.

Your child's weight and physical development should be regularly assessed by your GP or a public health nurse in their first few years of life. If you have any concerns about your child's development or health you should contact your GP.

Treatment

The main treatment option for somebody who is able to eat normally is to provide food that has an extra nutrient content, such as high-protein snack bars.

In cases where people are unable to eat there are two main treatment options:

  • a feeding tube can be used to provide nutrients directly into the digestive system
  • a drip can be used to provide nutrients and fluids directly into one of the blood vessels

Who is affected

High risk groups include:

  • older people over the age of 65, particularly if they are staying in a care home or nursing home
  • people with long-term conditions such as diabetes or kidney disease
  • people with cancer
  • people who abuse drugs and/or alcohol
  • people on low incomes

Older people may become malnourished gradually if poor health begins to affect their ability to feed themselves properly. Malnutrition then, in turn, makes their health worse.

Obese
Obesity is when a person has an abnormally high amount of body fat.

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Healthy diet

Eating a healthy, balanced diet is vital for maintaining health and fitness. To stay healthy, we need to eat foods from a number of different food groups, including:

  • carbohydrates
  • proteins
  • fats
  • dairy

A healthy, balanced diet also includes a minimum of five daily portions of fruit and vegetables, containing essential vitamins and minerals.

Nutrients

There are two main groups of nutrients:

  • Macronutrients are the main nutrients that provide the body with energy and help growth. They include carbohydrates, protein and fats.
  • Micronutrients are vitamins and minerals that are required for many specialist functions inside the body. For example, you require a regular intake of iron to help in the production of new red blood cells.

Page last reviewed: 13/07/2011

Adults

The most common symptom of malnutrition is unplanned weight loss. If you lose 10% of your body weight in the course of three months and are not dieting, it could be a sign that you are malnourished.

For example, a healthy weight for a woman who is 5ft 8 inches tall (173cm) would be around 10 stone (63 kilos). So, for a woman of this weight and height, losing a stone without dieting could be a sign of malnutrition. 

In adults, a useful method of assessing whether you are malnourished is to measure your body mass index (BMI). This is your weight in kilograms divided by your height in metres squared.

For most adults a healthy BMI is between 18.5 and 24.9. This means that:

  • a BMI between 17 and 18.5 could suggest you are mildly malnourished
  • a BMI between 16 and 18 could suggest you are moderately malnourished
  • a BMI of under 16 could suggest you are severely malnourished

Other symptoms include:

  • weakening of the muscles, which then begin to waste away
  • feeling tired all the time and lacking energy
  • increased vulnerability to infection
  • delayed wound healing
  • dizziness
  • irritability
  • your nails become brittle
  • your skin becomes dry and flaky
  • persistent diarrhoea
  • depression
  • in women, periods become irregular or stop altogether

Children

Symptoms of malnutrition in children can include:

  • failure to grow at the expected rate, both in terms of weight and height
  • changes in behaviour such as appearing unusually irritable, sluggish or anxious
  • changes in hair and skin colour
  • hair loss
  • swelling of the stomach and legs (this last symptom usually only occurs if a child is severely malnourished)

Vitamin and mineral deficiency

Even if your BMI is in the healthy range you may still not be getting enough vitamins and minerals.

Physical signs that you may have a vitamin or mineral deficiency include:

  • skin problems or rashes
  • swelling of your tongue
  • poor vision at night or in dim light
  • you feel out of breath and tired all the time (due to anaemia)
  • you experience a constant ringing or buzzing in your ears (tinnitus)
  • paleness inside the mouth or eyelids (due to anaemia)
  • pain in the bones or joints

When to see your GP

If your BMI is lower than 18.5 or you experience the symptoms listed above it is recommended that you see your GP.

Your child's weight and physical development should be regularly assessed by your GP or a public health nurse in their first few years of life.

If you have any concerns about your child's development or health, contact your GP.

Glossary

Depressed
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.

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Page last reviewed: 13/07/2011

Malnutrition is caused by a person not receiving enough nutrients, which stops the body functioning as it should. 

In developing countries, this is often the result of lack of food. In Ireland malnutrition can be caused by several different circumstances and conditions. These are listed below.

Physical factors

Physical factors can contribute to malnutrition. For example:

  • If your teeth are in a poor condition, eating can be difficult or painful.
  • You may find swallowing food difficult or painful. The medical term for this is dysphagia and it can have a range of causes such as a blockage in your throat, damage to the nerves used in swallowing or sores in your mouth.
  • You may lose your appetite as a result of losing your sense of smell and taste. This can sometimes occur after a severe head injury or brain tumour.
  • You may have a physical disability or other impairment that makes it difficult for you to cook for yourself.

Social factors

Social factors that can contribute to malnutrition include:

  • a low income
  • limited knowledge about nutrition
  • limited knowledge about cooking - older men who become widowed may have trouble adapting to cooking healthy meals for themselves, as might younger students leaving home for the first time
  • living alone and being socially isolated
  • having reduced mobility and lack of transport
  • abusing drugs
  • abusing alcohol

Medical conditions

Medical conditions that can contribute to malnutrition include:

  • having an eating disorder, such as anorexia nervosa, which means that the amount of food you eat is very small
  • having a health condition that causes a lack of appetite, such as cancer, liver disease, active infection, persistent pain or nausea
  • having a mental health condition such as depression or schizophrenia which, if severe, may affect your ability to look after yourself
  • having a health condition that disrupts your body's ability to digest food or absorb nutrients, such as Crohn's disease or ulcerative colitis
  • having dementia - people with dementia may be unable to communicate their needs when it comes to eating
  • persistent diarrhoea
  • persistent vomiting
  • taking many different types of medication at the same time - there are more than 250 types of medicine known to disrupt the body's ability to absorb and then break down nutrients
  • your body has an increased demand for energy, for example if it is trying to heal itself after a serious injury such as a burn

Children

In Ireland, the most common causes of malnutrition in children are long-term health conditions that either:

  • cause lack of appetite
  • disrupt the normal process of digestion
  • cause the body to have an increased demand for energy

Examples of these types of conditions include:

  • childhood cancers, such as acute lymphoblastic leukaemia, which is a cancer of the white blood cells
  • congenital heart disease, which is when a child is born with one or more defects affecting their heart
  • kidney failure, which is where the kidneys lose most or all of their functions
  • cystic fibrosis, which causes a build-up of thick, sticky mucus in the lungs and digestive system and prevents digestive enzymes being released from the pancreas

Malnutrition due to inadequate food intake in this country is rare, although it may occur if children are being neglected or abused.

If you are concerned that a child may be at risk of neglect or abuse you should inform your HSE

Depressed
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Diarrhoea
Diarrhoea is the passing of frequent watery stools when you go to the toilet.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.
Vomiting
Vomiting is when you bring up the contents of your stomach through your mouth.

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Malnutrition in children

Malnutrition due to lack of food is rare in Ireland, although it may occur if a child is being neglected.

If you are concerned that a child may be at risk of neglect or abuse,contact the HSE Child Care Service through your local health centre.

Page last reviewed: 13/07/2011

A diagnosis of malnutrition is made based on the following factors:

  • your body mass index (BMI), which is your weight in kilograms divided by your height in metres squared
  • whether you have unintentionally lost weight in recent months
  • your ability to feed yourself
  • whether something, such as a health condition, has meant that you are no longer able to absorb nutrients from your diet

You would normally be considered malnourished if:

  • you have a BMI of less than 18.5 or you have unintentionally lost more than 10% of your body weight during the last 3-6 months, or
  • you have a BMI of less than 20 and you unintentionally lost more than 5% of your body weight during the last 3-6 months

You would normally be considered at high risk of becoming malnourished if:

  • you have eaten little or nothing for the last five days or are likely to eat little or nothing for five days or longer
  • you do not absorb nutrients from food well, for example you have a condition such as Crohn's disease that is causing inflammation inside your digestive system
  • you have an underlying condition or other factor that means your body is likely to use up nutrients at a higher rate or have an increased need for nutrients

For example, people recovering from serious burns have a higher demand for nutrients as their body requires extra energy to help it repair itself.

A vitamin or mineral deficiency can normally be diagnosed with a blood test.

Diagnosing malnutrition in children

Diagnosing malnutrition in children involves taking a measurement of their weight and height and then comparing it against what would be the expected average height and weight for a child of that age.

Some children will be below average as they are naturally smaller, but a significant drop below the expected level for an individual could be a sign of malnutrition.

Slower than expected growth can also be a sign of malnutrition in children. A child who is growing less than 5cm a year could be malnourished.

Blood tests can also be used to measure levels of protein in the blood. Low levels of protein would suggest that a child is malnourished.

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Page last reviewed: 13/07/2011

Treatment for malnutrition varies depending on a number of factors, such as:

  • whether you are mildly, moderately or severely malnourished
  • the underlying cause of your malnutrition
  • whether you are able to cook healthy meals for yourself
  • whether you are able to eat and digest food normally

Depending on these factors you will either be treated at home under the supervision of a dietitian or other qualified health professional, or admitted to hospital.

Treatment at home

The dietitian will discuss with you what changes you should make to your diet. Recommended diet plans will depend on your individual circumstances but it is likely you will be advised to increase gradually your intake of protein, carbohydrates, water, minerals and vitamins. You may also be given additional supplements or foods that are especially high in energy, such as high protein bars.

Your body mass index (BMI) will be regularly measured to monitor your improvement.

You can also discuss the cause of your malnutrition with your dietitian as you may need additional support. For example, if poor mobility makes it difficult for you to cook for yourself you may benefit from having a part-time carer to help you with shopping and cooking.

If you find it difficult to swallow food or drink you may need to eat very soft or pureed food or require an artificial method of feeding, which is usually a feeding tube. There are two types of feeding tubes:

  • a tube that is passed down your nose and into your stomach (nasogastric tube)
  • a tube that is surgically implanted directly into your stomach (percutaneous endoscopic gastrostomy, or PEG, tube)

Nasogastric tubes are designed for short-term use and may be considered if you are likely to need a feeding tube for up to six weeks.

PEG tubes are designed for long-term use and last for around two years before they need to be replaced.

If you have a condition that severely affects your ability to digest food, or your digestive system has been damaged, then you may need to be fed nutrients through a tube directly into your veins. This is known as parenteral nutrition.

While it is possible to have parenteral nutrition at home, access to the equipment is often limited so you may be required to visit the hospital on a daily basis, at least at first. Your GP will be able to advise on the treatment that will be best for you.

Treatment in hospital

If you are admitted to hospital with malnutrition you may be seen by a number of different health professionals who will be involved in your care. This may include:

  • a doctor who specialises in treating digestive conditions (a gastroenterologist)
  • a dietitian
  • a nurse specialising in nutrition 
  • a pharmacist
  • a psychologist
  • a social worker

If you are able to swallow food without any difficulty then you can be treated with a high energy diet.

If you are unable to swallow food, you will required either a feeding tube (if your digestive system is working properly) or parenteral nutrition (if your digestive system is not working properly).

You may also require additional treatment for the underlying cause(s) of your malnutrition.

The medical term for having problems swallowing is dysphagia. Read more about the treatments for dysphagia.

If your malnutrition is due to a digestive condition such as Crohn's disease then you may require a short-term course of corticosteroids (steroid medication) to reduce inflammation inside your digestive system.

The amount of time you will spend in hospital depends on your general state of health and the underlying cause of your malnutrition.

Treating children

In the Ireland most cases of malnutrition are caused by long-term health conditions, not lack of food, so they do not usually require hospital treatment.

These types of cases can usually be treated by giving your child additional nutrients, usually supplements and high-protein food. The underlying cause of their malnutrition may also need to be treated.

For example, children who become malnourished as a result of cystic fibrosis (a condition that 'clogs' up the lungs and digestive system with a sticky mucus) will need to take a medication before eating that makes it easier for the body to digest food.

In the rare case of a child being severely malnourished due to a lack of food, they are given a special feeding formula called F-75 that increases the amount of calories (energy) they are getting.

Severely malnourished children need to be fed and rehydrated with great care and so cannot be given a normal diet straight away.

Once their condition stabilises then they can gradually be introduced to a normal diet.

Malnutrition due to lack of food is a child protection issue so the police and social services need to be informed.

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Stomach
The sac-like organ of the digestive system. It helps digest food by churning it and mixing it with acids to break it down into smaller pieces.

Useful Links

http://www.indi.ie/

Page last reviewed: 13/07/2011

As a lack of essential nutrients is one of the main causes of malnutrition, the best way to prevent the condition is to eat a healthy, balanced diet.

For otherwise healthy people, a recommended diet would be a diet that contains foods from all the major food groups.

The four main food groups are:

  • fruit and vegetables
  • bread, rice, potatoes, pasta and other starchy foods
  • milk and dairy foods
  • meat, fish, eggs, beans and other non-dairy sources of protein

Foods and drinks high in fat or sugar are not essential and should be consumed in small amounts.

If your malnutrition (or risk of malnutrition) is caused by an underlying health condition such as Crohn's disease you may have more complex dietary needs or require additional items in your diet such as supplements. Your GP or the doctor in charge of your care will be able to advise you.

Useful Links

http://www.indi.ie/

 

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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