Malnutrition

A state resulting from lack of intake or uptake of nutrition, leading to altered body composition and diminished function.

• Protein-energy malnutrition: Marasmus (chronic energy deficiency) and kwashiorkor (protein deficiency with energy excess).
• Specific nutrient deficiencies: Vitamins, minerals, trace elements.

• Chronic liver diseases (cirrhosis, hepatitis).
• Malabsorptive conditions (coeliac disease, Crohn’s disease, chronic pancreatitis).
• Gastrointestinal malignancies.
• Gastrointestinal fistulas.
• Short bowel syndrome (post-surgical).
• Chronic alcoholism.
• Inflammatory bowel disease.
• Chronic gastrointestinal infections (e.g., giardiasis).

• Weight loss and wasting.
• Muscle atrophy.
• Oedema (especially in kwashiorkor).
• Anaemia.
• Weakness and fatigue.
• Depression and apathy.
• Specific deficiency signs (e.g., glossitis in vitamin B deficiency).

• Blood tests: Full blood count, electrolytes, liver and renal function, vitamin levels, albumin, prealbumin.
• Dual-energy X-ray absorptiometry (DEXA) scan: To assess bone density.
• Endoscopy and colonoscopy if malabsorptive conditions are suspected.
• Stool tests for malabsorption (faecal fat).
• Imaging: Abdominal ultrasound, CT, or MRI.

• Dietary interventions: Tailored to individual needs, fortified foods, oral nutritional supplements.
• Enteral nutrition: Nasogastric or nasoenteric feeding for those who cannot consume sufficient nutrients orally but have a functioning GI tract.
• Parenteral nutrition: For patients with non-functioning or inaccessible GI tract.
• Treating underlying cause (e.g., gluten-free diet for coeliac disease).

• Immunodeficiency leading to infections.
• Osteoporosis and fractures.
• Organ dysfunction (e.g., cardiac, respiratory, renal).
• Wound healing impairment.
• Mental changes, including irritability and depression.

• Malnutrition is due to a lack of intake or uptake of nutrition.
• Multiple causes (often chronic and gastroenterological).
• Clinical features are varied dependent on underlying cause, but often involve weight loss, weakness and fatigue.
• Investigations are varied including blood tests, imaging and stool tests.
• Improving nutrition through dietary interventions and enteral or parenteral nutrition is a key component in management, along with treating underlying cause to reduce possible complications.