Virtual Medical Centre

Malnutrition

• What is Malnutrition?
• Who gets Malnutrition?
• Predisposing Factors
• Progression
• Probable Outcomes
• How Will Malnutrition Affect Me?
• Clinical Examination
• How is Malnutrition Diagnosed?
• How is Malnutrition treated?
• Malnutrition References

What is Malnutrition?

Malnutrition is a condition in which an individual has insufficient energy to maintain their body's essential functions, including growth, maintenance and movement. It is defined by the British National Institute for Clinical Excellence as "a state in which a deficiency of energy, protein and/or other nutrients causes measurable adverse effects on tissue/body form, composition, function or clinical outcome." As the definition suggests, malnutrition can be further classified as either protein-energy/protein-calorie malnutrition (i.e. a deficiency in protein energy), or micronutrient deficiency (i.e. a deficiency in one or more micronutrients), depending on the specific nature of the nutritional intake/expenditure imbalance. These two sub-types of malnutrition commonly coexist.

Regardless of the type, malnutrition may be a consequence of primary or secondary malnutrition, or both. 

Primary malnutrition refers to malnutrition which is caused by inadequate energy intake. This condition often occurs in relation to food insecurity or when adequate food is not available (in terms of total calories or specific micronutrients). It can also result from poor appetite due to illness or eating disorders such as anorexia nervosa.

Secondary malnutrition arises when an individual's dietary intake is sufficient, but energy is not adequately absorbed by the body as a result of infectious conditions such as diarrhoea, measles or parasitic infections, or medical or surgical problems affecting the digestive system. Malnutrition can also occur as a result of increased metabolic demands following illness or surgery.

Malnutrition is strongly associated with ill health, as both a cause and consequence. Individuals who are malnourished are more susceptible to disease and infection due to impaired immune function, and tend to consult health practitioners more frequently and take longer to recover from episodes of illness or injuries. Illness, and particularly long episodes of illness, can also frequently result in malnutrition, as individuals tend to eat and drink less when they are ill.

Who gets Malnutrition?

Malnutrition affected some 148 million children around the world in 2007, although the vast majority of malnourished children resided in developing countries. In Australia, the 2007 Child Nutrition Survey reported some 5% of children were underweight for their height. In addition the survey revealed that, in a substantial proportion of children, daily intake of some micronutrients was insufficient to meet the children's development needs, indicating the potential for micronutrient deficiencies. For example, calcium intake was insufficient in more than half of all 9-16 year old, while some 15% of 14-16, 6% of 9-13 and 7% of 2-8 year old children did not consume the average requirement for iodine estimated by the National Health and Medical Research Council. Substantial proportions of children in the 14-16 year age group also consumed less than the estimated average requirement for vitamin A, folate, phospohorous, magnesium, iron and zinc.

	Are you getting enough calcium?
	Male	years
	Female	years	Pregnant	Lactating
	Infant	mths

Type in the number of serves of the following foods you get each day, then click 'Evaluate'.
Food Source	Intake	Amount	Calcium (mg)
Milk
- regular		250ml	293
- skim		250ml	319
- reduced fat		250ml	352
- low fat		250ml	416
Flavoured milk
- Chocolate, regular		1(300ml) carton	334
- Chocolate, reduced fat		1(300ml) carton	352
Yoghurt
- plain		1(200g) tub	353
- plain, low fat		1(200g) tub	434
- fruit		1(200g) tub	353
Cheese
- Cheddar		40g	310
- Edam		40g	360
- Parmesan		40g	460
Icecream
- regular		100g	119
- low fat		100g	146
Meat
- Beef, Steak grilled/trimmed		100g	6
- Lamb Chop, midloin, grilled		100g	8
Chicken
- roasted/skin		100g	13
- roasted/no skin		100g	14
Salmon - grilled		100g	21
Eggs - boiled		1 large	25
Broccoli		100g	31
Apricots - dried		50g	33
Almonds		50g	117
Baked Beans		1/2 cup	47
Spinach/Silverbeet		100g	53
Apples		1 medium	8
Oranges		1 medium	38
Bread - wholemeal		1 slice	24

How much calcium do you need daily to maintain good health?

You need to increase your calcium intake by mg to meet your Recommended Daily Intake (RDI) of mg.

This is a healthy amount of calcium when compared to your Recommended Daily Intake (RDI) of mg.

The upper limit of daily calcium intake is 2,500mg. Speak to your doctor or health professional on how to cut down your intake to the appropriate level.

Up until 6 months of age infants should be fed only breast milk or infant formula.

References

1. Foodworks 2007 Version 5.00.1324 (See Calcium Calculator 2009).
2. National Health and Medical Research Council, Nutrient Reference Values for Australia and New Zealand, 2008 [cited 2008 Nov 3]. Available from: http://www.nrv.gov.au/Nutrients.aspx?code=5540006

Disclaimer

This calculator includes a small number of foods that are rich calcium sources, or that are commonly eaten. While the calculator may give an estimate of your calcium intake, it should not be relied upon for an accurate assessment of dietary calcium intake. For a comprehensive dietary assessment, see an Accredited Practising Dietitian.

In England, an estimated 5% of the general population is malnourished, although prevalence is much higher in specific sub groups. In Australian adults, malnutrition has typically been studied in specific subgroups with a high risk of malnutrition, for example hospital inpatients, the elderly and individuals undergoing chemotherapy. A 1997 study in two Sydney hospitals found that 36% of patients admitted to hospital were malnourished. Studies from Britain also indicate that malnutrition and some micro-nutrient deficiencies are common amongst the elderly. For example, amongst elderly individuals in aged care homes, an estimated 35% are deficient in folate and 40% deficient in vitamin C.

Indigenous Australians are also at increased risk of malnutrition due to their typically low socioeconomic status and associated difficulties accessing food. Up to 30% of Indigenous Australians report that being able to access food is a concern to them at least some of the time, indicating that this proportion of the population are at high risk of becoming malnourished. Indigenous women are also more than twice as likely to bear low birth weight infants, demonstrating a higher prevalence of malnutrition in pregnant indigenous women than in the general population of pregnant women in Australia.

Predisposing Factors

Malnutrition occurs throughout the world, however a number of geographic and demographic groups have an increased risk of becoming malnourished. Overall, individuals who reside in developing countries are more likely to suffer from malnutrition than those who reside in developed countries, due to the higher prevalence of poverty and infectious disease in developing nations. However, there are a number of factors which may predispose an individual to malnutrition, regardless of their area of residence.

In general, factors which affect adequate nutrition include:

• Poverty- Individuals from low socio-economic backgrounds and particularly those living in poverty are more likely to be malnourished than individuals from higher socio-economic classes. This is most often primary malnutrition a result of food insecurity (being unable to access adequate sources of nutrition to meet the body's daily demands). Secondary malnutrition (stemming from infectious disease) is also more prevalent in situations of poverty due to overcrowding and poor sanitation (which for example increase the risk of infection) and contributes to the increased incidence of malnutrition amongst the poor.
• History of or recent infectious and parasitic disease, in particular diarrhoea, malaria, or intestinal worms predisposes an individual to malnutrition and these conditions reduce the proportion of nutrients which the body is able to consume;
• History of recent surgery, particularly surgery involving the gastrointestinal system may increase an individual's risk of malnutrition.
• Medications- A number of medications, for example medications used in chemotherapy, can reduce an individual's appetite or lead to eating difficulties (e.g. difficulty swallowing) and therefore predispose an individual to malnutrition.
• Chronic diseases for example HIV is often associated with reduced appetite and food consumption (usually resulting from toxic medication regimes) which in turn causes malnutrition.

Children and Adolescents

In children and adolescents factors which predispose malnutrition include:

• Low birth weight- Individuals born with a low birth weight are more likely to suffer malnutrition throughout their life and are unlikely to "catch-up" in terms of growth.
• Adolescent mothers- Children who were born to adolescent mothers are more likely to be malnourished than those born to older women, as during adolescence, a young woman's body is still developing and the additional stress of pregnancy at this time creates an extremely high risk of the child being born at a low birth weight.
• Not being breastfed- Breast milk is the ideal food for an infant as it is nutritionally balanced and provides antibodies which strengthen the developing infant's immune system reducing the chance of infectious and other diseases which can lead to malnutrition. Children who are not breastfed therefore have a higher risk of becoming malnourished.

Adults

In adults factors which can predispose an individual to malnutrition include:

• Age- Elderly individuals are more likely to suffer from malnutrition than their younger counterparts. For example, patients who were admitted to two Sydney hospitals in a malnourished state were eight years older than individuals who were admitted in an adequately nourished condition.
• Being unable to prepare food- Individuals who are reliant on external help to prepare meals (e.g. the elderly) are less likely to meet their daily nutritional requirements, as food may not be available when they wish to eat it, or may not be prepared to their requirements.
• Pregnancy and lactation- Pregnant and breastfeeding women experience increased metabolic demands, as a result of the demands of their growing foetus or feeding child. For this reason they have a higher risk of becoming malnourished than non pregnant or non breastfeeding women.
• Alcohol or drug abuse are associated with reduced appetite, as well as reduced absorption of specific micronutrients. Alcohol or drug abuse therefore creates an increased risk of malnutrition.

Progression

Malnutrition which is related to poverty often begins early in life, or even in utero (when the foetus is developing in a woman's uterus), and continues throughout the lifecycle. A child who is malnourished early in life is likely to have their growth retarded as a result, and is unlikely to ever "catch-up" in terms of their body size. As adults, they will be shorter and weigh less than their adequately nourished counterparts.

In many cases malnutrition also has inter-generational effects. For example, a woman who suffered from malnutrition as a child, is more likely to bear underweight infants (infants weighing less than 2.5kg) and low birth weight infants are more likely to suffer nutritional problems throughout their lifecycle.

Malnutrition also commonly begins or worsens following a period of illness, when an individual is unable to eat or drink sufficient amounts of energy to fulfill their daily needs. This in turn reduces the body's immune function, leading to longer periods of illness and inadequate food consumption. This is particularly true amongst the elderly.