Malnourished
Aladino Bharudin
Results: In the systematic review, 25 of the 28 studies used the Mini-Nutritional Assessment (long or short form) for malnutrition screening. For frailty assessment, 23 of the 28 studies focused on the physical frailty phenotype, of which 19 followed the original Fried phenotype. Fifteen studies analyzed the association between malnutrition and frailty, which was significant in 12 of these. The meta-analysis included 10 studies with a total of 5447 older adults. In this pooled population of community-dwelling older adults [mean (standard deviation) age: 77.2 (6.7) years], 2.3% was characterized as malnourished and 19.1% as physically frail. The prevalence of malnutrition was significantly associated with the prevalence of physical frailty (P < .0001). However, the syndromes were not interchangeable: 68% of the malnourished older adults was physically frail, whereas only 8.4% of the physical frail population was malnourished.
Conclusions: The systematic review and meta-analysis revealed that malnutrition and physical frailty in community-dwelling older adults are related, but not interchangeable geriatric syndromes. Two out of 3 malnourished older adults were physically frail, whereas close to 10% of the physically frail older adults was identified as malnourished.
Background: International guidelines on the nutritional management of patients with cancer recommend intervention with dietary advice and/or oral nutritional supplements in patients who are malnourished or those judged to be at nutritional risk, but the evidence base for these recommendations is lacking. We examined the effect of oral nutritional interventions in this population on nutritional and clinical outcomes and quality of life (QOL).
Methods: Electronic searches of several databases including MEDLINE, EMBASE, and CINAHL (from the first record to February 2010) were searched to identify randomized controlled trials of patients with cancer who were malnourished or considered to be at risk of malnutrition and receiving oral nutritional support compared with routine care. We performed a meta-analysis using a fixed effect model, or random effects models when statistically significant heterogeneity was present, to calculate relative risk (mortality) or mean difference (weight, energy intake, and QOL) with 95% confidence intervals (CIs). Heterogeneity was determined by using the χ(2) test and the I(2) statistic. All statistical tests were two-sided.
Conclusion: Oral nutritional interventions are effective at increasing nutritional intake and improving some aspects of QOL in patients with cancer who are malnourished or are at nutritional risk but do not appear to improve mortality.
Among MSD children, 35% were malnourished compared with 24% of MD children (P < 0.001). Malnourished MSD children more commonly reported symptoms of fever, abdominal pain, and straining compared with their malnourished MD counterparts. Children with MSD were less likely to present with vomiting. Malnourished children with MD were associated with receiving oral rehydration solution (ORS) treatment at home or seeking other treatment at home more often compared with malnourished children with MSD (Table 2).
Of malnourished MD cases, 44% had rotavirus antigen in their stool compared with 17% of MSD cases (P < 0.001). Additionally, significantly more MSD children had some strain of Shigella in their stool compared with MD children (P < 0.001). Among the malnourished children, S. flexneri accounted for 52% of all Shigella isolates, and it was followed by S. sonnei (34%), S. boydii (12%), S. dysenteriae (3%), and Shigella like-organism (SLO; < 1%) (Table 2).
The multivariate model suggests that older malnourished children were two-fold more likely to be MSD compared with MD than younger malnourished children, showing increased disease severity among older malnourished children compared with younger children. This finding may be explained by the protective immunological effects of breastfeeding amongst infants and young children that older children lack.37 A significant association was observed between mother's schooling and nutritional status of the child; however, no such relationship was observed with disease severity. The reason for this finding is unclear.
In the current study, children who had MSD were more likely to report with symptoms of fever, abdominal pain, and straining compared with children with MD, and they were less likely to have vomiting and cough. These findings are usually associated with Shigella in relation to MSD. Shigella was found to be associated with MSD among malnourished children. Shigella-infected children are found to be often malnourished because of their poor immune responses, which may be caused by loss of appetite and consequent inadequate intake, increased catabolism, damage of intestinal epithelium, reduced absorptive functions, and loss of nutrients in stool as well as protein loosing enteropathy.40,41 Interestingly, no such significant relationship was found in cases of V. cholerae.
In the present study, malnourished children with MSD were five times more likely to suffer from shigellosis than MD children. Moreover, well-nourished children with MSD were six-fold more likely to develop shigellosis compared with MD children in the univariate model; however, no such relationship was observed in multivariate analysis of malnutrition.
Methods: Clinical and anthropometric methods for case detection of severely malnourished children in the community were reviewed with regard to their ability to reflect both mortality risk and nutritional status.
Undernutrition can also cause acute problems, like hypoglycemia (low blood sugar). This condition can cause lethargy, limpness, seizures, and loss of consciousness. Children are particularly at risk and can become hypoglycemic after 4 to 6 hours without food. Dehydration can also occur in malnourished people, and can be life-threatening, especially in babies and small children.[citation needed]
Protein-calorie malnutrition can cause cognitive impairments. This most commonly occurs in people who were malnourished during a "critical period ... from the final third of gestation to the first 2 years of life".[71] For example, in children under two years of age, iron deficiency anemia is likely to affect brain function acutely, and probably also chronically. Similarly, folate deficiency has been linked to neural tube defects.[72]
Undernutrition most commonly results from a lack of access to high-quality, nutritious food.[5] The household income is a socio-economic variable that influences the access to nutritious food and the probability of under and overnutrition in a community.[78] In the study by Ghattas et al. (2020), the probability of overnutrition is significantly higher in higher-income families than in disadvantaged families.[20] High food prices is a major factor preventing low income households from getting nutritious food [1][5] For example, Khan and Kraemer (2009) found that in Bangladesh, low socioeconomic status was associated with chronic malnutrition since it inhibited purchase of nutritious foods (like milk, meat, poultry, and fruits).[79] Food shortages may also contribute to malnutritions in countries which lack technology. However, in the developing world, eighty percent of malnourished children live in countries that produce food surpluses, according to estimates from the Food and Agriculture Organization (FAO).[80] The economist Amartya Sen observes that, in recent decades, famine has always been a problem of food distribution, purchasing power, and/or poverty, since there has always been enough food for everyone in the world.[81]
The United Nations has reported on the importance of nutritional counselling and support, for example in the care of HIV-infected persons, especially in "resource-constrained settings where malnutrition and food insecurity are endemic".[150] UNICEF provides nutritional counselling services for malnourished children in Afghanistan.[151]
Severely malnourished individuals can experience refeeding syndrome if fed too quickly.[168] Refeeding syndrome can result regardless of whether food is taken orally, enterally or parenterally.[168] It can present several days after eating with potentially fatal heart failure, dysrhythmias, and confusion.[168][169]
In malnourished people with diarrhea, zinc supplementation is recommended following an initial four-hour rehydration period. Daily zinc supplementation can help reduce the severity and duration of the diarrhea. Additionally, continuing daily zinc supplementation for ten to fourteen days makes diarrhea less likely to recur in the next two to three months.[172]
Food and drink can help prevent dehydration in malnourished people with diarrhea. Eating (or breastfeeding, among infants) should resume as soon as possible.[160] Sugary beverages like soft drinks, fruit juices, and sweetened teas are not recommended as they may worsen diarrhea.[173]
Reduced-osmolarity ORS is the current standard of care for oral rehydration therapy, with reasonably wide availability.[175][176] Introduced in 2003 by WHO and UNICEF, reduced-osmolarity solutions contain lower concentrations of sodium and glucose than original ORS preparations. Reduced-osmolarity ORS has the added benefit of reducing stool volume and vomiting while simultaneously preventing dehydration. Packets of reduced-osmolarity ORS include glucose, table salt, potassium chloride, and trisodium citrate. For general use, each packet should be mixed with a liter of water. However, for malnourished children, experts recommend adding a packet of ORS to two liters of water, along with an extra 50 grams of sucrose and some stock potassium solution.[177]
Hypothermia (dangerously low core body temperature) can occur in malnutrition, particularly in children. Mild hypothermia causes confusion trembling, and clumsiness; more severe cases can be fatal. Keeping malnourished children warm can prevent or treat hypothermia. Covering the child (including their head) in blankets is one method. Another method is to warm the child through direct skin-to-skin contact with their mother or father, then covering both parent and child.
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