Malnutrition
What is malnutrition? What is sarcopenia?
The European Society for Clinical Nutrition and Metabolism (ESPEN) defines malnutrition as: “An acute or chronic condition in which a deficiency or imbalance of energy, protein and other nutrients leads to measurable adverse effects on body composition, function and clinical outcomes.”
In other words, malnutrition results from an inadequate nutritional intake relative to the body’s increased needs.
Malnutrition is not only noticeable trough weight loss. A loss of muscle strength, mass and function can also be a cause or consequence of malnutrition. This loss of muscle is called sarcopenia. It is therefore quite possible to be overweight and malnourished at the same time.
An estimated 25% of people over the age of 70 and 40% of those over 80 amay have sarcopenia.
Malnutrition underestimated
Malnutrition is a major problem across all segments of healthcare.
Malnutrition leads to weight loss, a reduction in muscle mass and a decrease in muscle strength, resulting in limited mobility and a loss of independence. The problem of malnutrition has many causes. People with swallowing disorders and dysphagia are at higher risk, and women are more susceptible to malnutrition than men. Cancers (NKO), dementia, Parkinson’s disease, Alzheimer’s disease… as well as financial and emotional concerns, both at home and in care facilities, can contribute to poor nutritional status.
Rapid and systematic detection, prevention and treatment of malnutrition are absolute essential, whether the malnutrition is age-related or disease-related.
ESPEN (European Society for Clinical Nutrition and Metabolism) has established clear guidelines for this: GLIM (Global Leadership Initiative on Malnutrition) and DRM (Disease-related Malnutrition).
Impaired function due to aging and illness
As we grow older, the functioning of our body slows down or becomes disrupted. Our body becomes less efficient at performing basic functions and we begin to develop both physical and physiological problems:
- Reduced resistance to infections due to a decrease in lymphocytes.
- Poorer absorption of nutrients caused by digestive disorders, diarrhea and/or constipation, and a deteriorated state of the small intestinal vili, which are necessary for nutrient absorption.
- Weaker bones and increased risk of fractures due to osteoporosis.
- Less flexible movement due to joint calcification.
- Balance problems and delayed reflexes due to nervous system disorders.
- Fatigue and reduced breathing capacity due to diminished or slower function of the heart, lungs, ….
Fragility or frailty of the elderly
Frailty (fragility) is a syndrome characterized by reduced resilience and diminished reserves, in which a progressive decline acrosse multiple organ systems results in a negative energy balance, reduced skeletal muscle mass (sarcopenia) and reduced strength.
Nearly 40% of people over the age of 65 show signs of frailty. A clear decline in muscle strength is often observed, and/or a decrease in physical activity, and/or slower walking speed, and/or increased fatigue, and/or unintentional weight loss. Early detection is essential, as this stage is still reversible.
To prevent frailty in the elderly, it is recommended to consume between 1,900 and 2,300 kcal of nutrients per day and to increase protein intake to 1 g per kg per day. If fragility is not treated in time, there is a risk of malnutrition, which can lead to dependency.
Nutritional needs in malnutrition
Nutrition must be both enriched and well-balanced.
- PROTEIN: at least 1.5 g/kg body weight/day
Healthy adults need 0.8 g protein/kg body weight/day to maintain all body functions. As we age, or in case of illness, intense physical activity or recovery … the need significantly increases to 1.5 g/kg body weight/day. In extreme cases, it can rise to 2 g/kg body weight/day. For someone weighing 50 kg, this amounts to approximatly 75 to 80 g of protein/day.
Proteins provide energy and are essential building blocjs for the creation and maintenance of muscles. Extra protein is crucial in the prevention and treatment of malnutrition.
- ENERGY: 30 to 40 kcal/kg body weight/day
In older adults and patients, the body is less efficient at fighting infections and performing basic functions. As a result, energy consumption is significantly higher.
- EATING MORE or LARGER PORTIONS? That is not the solution.
It is important to ensure meals are balanced and include sufficient protein sources such as meat, fish, poultry, dairy products, eggs, grains, legumes, …
However, sometimes eating is simply not possible, due to illness, low appetite, difficulties with chewing and swallowing, ….
Solutions and challenges in the prevention and treatment of malnutrition
- Achieving the objective of 2000 kcal and 80 g of protein per day.
Meals and snacks offered must meet the minimum nutritional needs. They should be tasty and stimulate appetite, because the more a meal is appreciated, the better people eat. - Increase energy intake without increasing the volume.
To both achieve the goal and reduce food waste (large plates often remain half untouched), portions must be adjusted to the capabilities of this target group. Older adults and patients need compact, small meals rich in energy and protein. - Adjust portions and plates to their capabilities.
Some elderly and patients have an aversion to food. Serving a large portion can be intimidating. A smaller portion on an appropriate plate can help restore or stimulate appetite. A normal hot meal typically weighs 500 to 600 g, but older people and patients eat a maximum of 200 to 250 g. Therefore, it is very important to add extra protein and energy so that this adapted small meal (200 to 250 g) contains many calories and proteins as a normal portion (500 to 600 g). - Adapted textures and formes.
Difficulty chewing or swallowing is often at the root of malnutrition. Motor problems may also make eating with cutlery impossible, or simply not knowing how to eat properly anymore. Enriched meals with textures adapted according to IDDSI guidelines, enriched finger foods (to eat by hand) and similar options contribute to achieving the intended nutritional goals. - Ensure balanced use of food supplements.
Adapted meals must be carefully considered and aligned with protocols concerning nutritional supplementation. Both should complement each other to meet all nutritional needs. Only this way can malnutrition be prevented or adequately treated.
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