MALNUTRITION
Malnutrition – the deficit, excess, or imbalance in a person’s intake of energy and nutrients.
Malnutrition includes:
Undernutrition – occurs when nutrition reserves are depleted, and nutrient and energy
intake are not sufficient to meet daily needs.
Overnutrition – refers to the ingestion of more food than is required for body needs.
Forms of Undernutrition:
1. Wasting – indicates recent and severe weight loss. Low weight for height.
2. Stunting - the result of chronic or recurrent undernutrition. Low height-for-age.
Severe or Continuous Undernutrition can lead to:
1. Kwashiorkor – predominantly a protein deficiency.
2. Marasmus - deficiency of all macronutrients – protein, carbohydrates and fats.
Causes:
Socioeconomic factors
Physical Illnesses
Incomplete diets
Drug-Nutrient Interactions
Oral health of geriatric patients
Clinical Manifestations:
Weight loss.
A lack of appetite or interest in food or drink
Tiredness and irritability
An inability to concentrate.
Loss of fat, muscle mass, and body tissue
A higher risk of getting sick and taking longer to heal.
Longer healing time for wounds.
PROGNOSIS:
In 2022, 2.5 billion adults were overweight, including 890 million who were living with
obesity, while 390 million were underweight.
Globally in 2022, 149 million children under 5 were estimated to be stunted (too short for
age), 45 million were estimated to be wasted (too thin for height), and 37 million were
overweight or living with obesity.
Nearly half of deaths among children under 5 years of age are linked to under nutrition.
These mostly occur in low- and middle-income countries. The developmental, economic,
social and medical impacts of the global burden of malnutrition are serious and lasting, for
individuals and their families, for communities and for countries.
PATHOPHYSIOLOGY
PREDISPOSING FACTORS:
PRECIPITATING FACTORS:
Older adult MALNUTRITION
Limited financial NN Chronic alcohol use
resources Prolonged illness
Poor diet practice Major surgery
Swallowing problems Protein-calories deficiency
Adequate response of
ADRENAL CORTEX
Muscle protein mobilized Optimal increase in plasma Inhibited growth hormone
cortisol response
Normal plasma amino acid Normal plasma free fatty acid Growth retardation
Normal lipoprotein synthesis No fat deposits in the liver SIGNS & SYMPTOMS:
Hypoglycemia
Hypoxia
Too many red blood cells
Failure to maintain normal
body temperature
Low APGAR score
SIGNS & SYMPTOMS: Feeding problems
Nausea Neurological problems
Loss of appetite
Unexplained weight loss
Fatigue
Body weakness
SURGICAL MANAGEMENT
Nasogastric tube – It is commonly used for short-term feeding or medication when a
person is unable to eat or swallow normally.
Gastrostomy tube – used for long-term feeding in individuals who allows the delivery of
liquid nutrition directly into the stomach, providing essential nutrients to maintain proper
nutrition and hydration.
MEDICAL MANAGEMENT
Dietary Changes: A healthcare provider may recommend dietary modifications to ensure
adequate intake of essential nutrients.
Nutritional Supplements: nutritional supplements such as oral nutritional supplements
or vitamin and mineral supplements may be prescribed to help meet the body's nutritional
needs.
Monitoring and Assessment: Regular monitoring of weight, nutritional status, and
overall health is essential to track progress and make adjustments to the treatment plan as
needed.
Medical Treatments: Treatment of underlying medical conditions that contribute to
malnutrition, such as gastrointestinal disorders or metabolic conditions, is an important
aspect of medical management.
Medication Management: In some cases, medications may be prescribed to address
symptoms or complications of malnutrition
Education and Support: Providing education on proper nutrition, meal planning, and
lifestyle Changes, as well as emotional support, can be beneficial in the management of
malnutrition.
LABORATORY FINDINGS
Low Serum Albumin: Indicates protein deficiency and impaired liver function.
Low Prealbumin (Transthyretin): Reflects recent protein intake and liver function.
Low Total Protein: Suggests overall protein deficiency.
Low Transferrin: May indicate iron deficiency anemia commonly associated with
malnutrition.
Electrolyte Imbalances: Such as low levels of potassium, magnesium, and phosphorus
due to inadequate intake.
Anemia: Reduced levels of red blood cells and hemoglobin, often caused by deficiencies
in iron, vitamin B12, or folate.
Vitamin Deficiencies: Low levels of specific vitamins such as vitamin D, vitamin B12,
and folate.
Abnormal Liver Function Tests: Elevated liver enzymes (ALT, AST) due to liver
dysfunction caused by malnutrition.
Decreased White Blood Cell Count: As a result of impaired immune function due to
malnutrition.
OBESITY
Obesity – is an excessively high amount of fat or adipose tissue that presents a negative effect on
health.
Obesity can be categorized as:
Obese (Class I) – 30.0 -34.9
Obese (Class II) – 35.0 – 39.9
Obese (Class III) – 40.0 and higher
Causes:
Inactivity, having a sedentary lifestyle.
Unhealthy eating (foods high in calories)
Lack of sleep
Genetics
Pregnancy
Aging
Certain medications
Medical conditions
Manifestations:
Having a BMI of 30.0 or more.
Excess body fat, particularly around the waist
Shortness of breath
Sweating more than usual
Snoring
Trouble sleeping
Inability to perform simple physical tasks you could easily perform before weight gain.
Fatigue, which can range from mild to extreme.
Pain, especially in the back and joints
Psychological issues such as negative self-esteem, depression, shame, and social isolation
PATHOPHYSIOLOGY
O B E \S I T Y
PREDISPOSING FACTORS: PRECIPITATING FACTORS:
Genetics Pregnancy
Medications Heart disease and
(antidepressants, stroke
antipsychotic, beta- Type 2 diabetes
blockers)
High stress level
Environmental
factors
Lifestyle factors
Socioeconomic
factors
Expanded adipose tissues with
accumulation of ECM and
inflammatory cells
Excessive weight gain
SIGNS & SYMPTOMS:
Having a BMI of 30.0 or more
Excess body fat, particularly around
the waist
Shortness of breath
Sweating than usual
Snoring
Trouble sleeping
Inability to perform physical tasks
Fatigue
Pain
Psychosocial issues
PROGNOSIS:
In 2022, 1 in 8 people in the world were living with obesity.
Worldwide adult obesity has more than doubled since 1990, and adolescent obesity has
quadrupled.
In 2022, 2.5 billion adults (18 years and older) were overweight. Of these, 890 million were
living with obesity.
In 2022, 43% of adults aged 18 years and over were overweight and 16% were living with
obesity.
In 2022, 37 million children under the age of 5 were overweight.
Over 390 million children and adolescents aged 5–19 years were overweight in 2022,
including 160 million who were living with obesity.
SURGICAL MANAGEMENT
Endoscopic sleeve gastroplasty. This procedure involves placing stitches in the stomach
to reduce the amount of food and liquid the stomach can hold at one time.
Intragastric balloon for weight loss. In this procedure, you have a small balloon placed
into the stomach. Intragastric balloons are left in place for up to 6 months and are then
removed using an endoscope.
Adjustable gastric banding. In this surgery, an inflatable band placed around the outside
of the stomach divides it into two pouches.
Gastric bypass surgery. In gastric bypass, also called Roux-en-Y (roo-en-wy) gastric
bypass, the surgeon creates a small pouch at the top of the stomach.
Gastric sleeve. In this surgery, part of the stomach is removed, creating a smaller
reservoir for food. It's a less complicated surgery than gastric bypass.
Bariatric Surgery: This surgical procedure helps promote weight loss by restricting food
intake or altering the digestive process.
MEDICAL MANAGEMENT
Lifestyle Modifications: This includes changes in diet and physical activity.
Behavioral Therapy: Counseling and behavioral therapy can help individuals develop
healthy eating habits, address emotional eating, and make sustainable lifestyle changes to
support weight loss.
Medications: These medications work by suppressing appetite, increasing metabolism,
or reducing fat absorption.
Nutritional Counseling: Nutritional counseling can help individuals make healthier food
choices and develop sustainable eating habits.
Physical Therapy: Physical therapy or exercise programs tailored to individual needs
can help improve fitness levels, support weight loss, and enhance overall well-being.
Psychological Support: Addressing underlying emotional factors, stress, or mental
health conditions that may contribute to obesity is essential for successful weight
management. Therapy or support groups can be beneficial in addressing these aspects.
Regular Monitoring and Follow-Up: Ongoing monitoring of weight, body
measurements, and health markers is important to track progress and make adjustments to
the treatment plan as needed.
LABORATORY FINDINGS
Elevated Lipid Levels: High levels of triglycerides and LDL cholesterol, and low levels
of HDL cholesterol, increasing the risk of cardiovascular disease.
Elevated fasting blood glucose levels and/or elevated hemoglobin A1c: indicating
impaired glucose metabolism and potential development of type 2 diabetes.
Elevated Liver Enzymes: Increased levels of alanine aminotransferase (ALT) and
aspartate aminotransferase (AST), suggesting non-alcoholic fatty liver disease (NAFLD)
or non-alcoholic steatohepatitis (NASH) commonly associated with obesity.
Elevated levels of C-reactive protein (CRP) and interleukin-6 (IL-6): indicating
chronic low-grade inflammation associated with obesity.
Increased levels of leptin and decreased levels of adiponectin: contributing to insulin
resistance and metabolic dysfunction.
Elevated levels of uric acid: potentially leading to gout or kidney stones.
Elevated levels of brain natriuretic peptide (BNP) or troponin: indicating stress on the
heart due to obesity-related conditions such as hypertension or heart failure.
