Malnutrition: Treatments and Prevention

Treatments for malnutrition

The type of malnutrition treatment recommended depends mainly on its severity, and whether the patient has an underlying condition/illness which is a contributory factor. If so, that underlying illness/condition needs to be treated or addressed.

NICE (National Institute for Health and Clinical Excellence), UK, has guidelines for malnutrition treatment.⁸

They state that the needs and preferences of the patient need to be taken into account. The patient, along with healthcare professionals, should be able to make informed decisions about care and treatment.

NICE guidelines say that individuals who are receiving nutritional support, as well as their caregivers (UK: carers):

• Should be fully informed about their treatment
• Should be given tailored information
• Should be given the opportunity to discuss diagnosis, treatment options and relevant physical, psychological and social issues.
• Should be given contact details of relevant support groups, charities and voluntary organizations.

When a diagnosis of either malnutrition or malnutrition risk has been made, the healthcare professional (either a doctor or dietician) who is responsible for the patient will devise a targeted care plan.

The care plan

Aims for treatment will be set out, which should include the treatment for any underlying conditions/illnesses which are contributory factors to the malnutrition.

Typically, treatment will include a feeding program with a specially planned diet, and possibly some additional nutritional supplements.

Severely malnourished patients, or individuals who cannot get sufficient nutrition by eating or drinking may need and should receive artificial nutritional support.

The patient will be closely monitored for progress. Their treatment will be regularly reviewed to make sure their nutritional needs are being met.

Diet

A good healthcare professional will discuss eating and drinking with the patient and provide advice regarding healthy food choices. The aim is to make sure the patient is receiving a healthy, nutritious diet.

The doctor or dietitian will work with the patient to make sure enough calories are being consumed from carbohydrates, proteins, fats and diary, as well as vitamins and minerals. If the patient cannot get their nutritional requirements from the food they eat, oral supplements may be needed. An additional 250kcal to 600kcal may be advised.

Artificial nutritional support

There are two main types of artificial nutritional support, mainly for patients with severe malnutrition:

• Enteral nutrition (tube feeding) - a tube is placed in the nose, the stomach or small intestine. If it goes through the nose it is called a nasogastric tube or nasoenteral tube. If the tube goes through the skin into the stomach it is called a gastrostomy or percutaneous endoscopic gastrostomy (PEG) tube. One that goes into the small intestine is called a jejunostomy or percutaneous endoscopic jejunostomy (PEJ) tube.
• Parenteral feeding - a sterile liquid is fed directly into the bloodstream (intravenously). Some patients may not be able to take nourishment directly into their stomach or small intestine.

Monitoring progress

The patient will be regularly monitored to check that he/she is receiving the right amount of calories and nutritional needs. This may be adjusted as the patient's requirements change. Patients receiving artificial nutritional support will be switched over to normal eating as soon as they are able to.

Preventing malnutrition

Malnutrition is caused mainly by not consuming what the National Health Service (NHS), UK, calls "the right balance of nutrients from major food groups". These include:

• Carbohydrates
• Fruit and vegetables
• Protein
• Dairy - vegans are able to find abundant nutrients from non-animal sources (see: The Vegan Diet)
• Fats.

The average human should drink at least 1.2 liters of fluid per day.

Ulcerative colitis

A fairly common chronic (long-term) disease that causes inflammation of the colon (the large intestine). It is a form of inflammatory bowel disease. When inflammation is only in the rectum the disease is called ulcerative proctitis. The inflammation may extend into the upper parts of the colon.Universal colitis or pancolitis is when the whole colon is involved.

Patients with ulcerative colitis commonly lose weight because their body is unable to absorb nutrients properly. Consuming plenty of fluids, and eating regularly (five or six small meals daily), as well as taking food supplements may help to prevent ulcerative colitis.

Crohn's disease

An ongoing condition that causes inflammation of the digestive tract, or the GI (gastrointestinal) tract (the gut). Crohn's disease may also be called ileitis or enteritis. Crohn's disease can affect any part of the gut, from the mouth all the way down to the anus. In the majority of cases the lower part of the small intestine - the ileum - is affected. Patients with Crohn's disease can feel pain; the condition makes the intestines empty frequently, resulting in diarrhea. Although preventing Crohn's disease is unlikely, following treatment carefully helps prevent malnutrition considerably.

Celiac disease

Celiac disease (UK: Coeliac disease) is also known as gluten intolerance. If you suffer from Celiac disease you have a genetic disorder that makes you intolerant to gluten. It is caused by a reaction to gliadin (a gluten protein found in wheat). It can affect all types of people. However, it seems to be more prevalent among people of Northern European descent. Patients who follow a well-balanced, healthy, gluten-free diet are less likely to suffer from malnutrition.

Alcohol abuse

People who are addicted to alcohol and abuse alcohol may sometimes suffer from malnutrition. The only effective way to address this is to treat the alcoholism. There are several ways of treating alcoholism. The first step for the alcoholic it to acknowledge that there is an alcohol dependency problem. The next step is to get help.