By Dr Ananya Mandal, MD
Malnutrition is caused by lack of essential nutrients in diet. Treatment depends on several factors. These include the severity of malnutrition; the underlying cause of the malnutrition; ability to feed oneself; and ability to eat and digest food normally. In addition age, mental status and place of living of the patient is also considered.
These factors determine the plan of therapy as well as where the patient is treated – at home or under supervision of a nutritional expert or a dietician or other health professionals or at the hospital. 1-5
Treatment of malnutrition at home
This is suitable for patients who are able to eat and digest food normally. Treatment at home involves:
The diet planner and advisor discuss the diet with the patient and makes recommendations and diet plans to improve nutrient intake.
In most patients with malnutrition the intake of protein, carbohydrates, water, minerals and vitamins need to be gradually increased.
Supplements of vitamins and minerals are often advised.
Those with protein energy malnutrition may need to take protein bars or supplements for correction of the deficiency.
The Body Mass Index is regularly monitored to check for improvement or responsiveness to dietary interventions.
Occupational therapists and a team of physicians of different specialities may be necessary for people with disability who cannot cook or shop for themselves or those who have mental disorders, dementia or long term illnesses.
Those who have difficulty in swallowing, chewing or eating may need to be given very soft or pureed food for easy eating.
Treatment of malnutrition at the hospital
The team of physicians and health care providers who manage malnutrition patients includes a gastroenterologist who specializes in treating digestive conditions, a dietician, a nutrition nurse, a psychologist and a social worker.
Nasogastric tube feeding, PEG feeding and intravenous infusion or parenteral nutrition may be done in the hospital for moderate to severely malnourished patients who are unable to take food via the mouth.
Treatment of malnutrition for those who are unable to take food by mouth
Some patients are completely unable to take food by mouth. These patients may be treated by feeding with artificial tubs that are inserted via the nose into the stomach. This is called the nasogastric tube and special nutrient preparations in liquid form are given via these tubes. Nasogastric tubes are designed for short-term use and may be used for up to six weeks.
In some patients a tube may be surgically implanted directly into the stomach. It opens outside over the abdomen. This is called a percutaneous endoscopic gastrostomy, or PEG, tube. Nutrients in the form of liquids may be given via PEG tubes. This is useful in patients with esophageal cancers or other pathologies that make feeding via the mouth and esophagus difficult. These last for around two years and may be replaced thereafter.
Some individuals may need to be given nutrients in the form of injections via infusion directly into the veins of the arms. This is known as parenteral nutrition. This can be done at home under supervision but more often than not, hospital admission may be needed.
Treatment of malnutrition in pregnant women
Pregnant women require more calories and nutrients than non pregnant women as their fetus grows.
This requirement, however, does not translate into “eating for two” as this may lead to excess calorie intake leading to maternal obesity but malnutrition alongside as the vital nutrients may be lacking in diet.
Irin, folic acid and other vitamins and minerals need to be supplemented in women who are pregnant with or without malnutrition as these are often required in higher amounts that normal diet can provide.
Treatment of malnutrition in children
During growth years the requirement of nutrients usually is high and such demands need to be met adequately. Regular visits to the paediatrician for assessment of adequate growth in height and weight is essential.
Malnutrition causes more problems in children than any other age group as they may lead to growth (both physical and mental) retardation and susceptibility to repeated infections.
Children with Protein energy malnutrition (PEM) need to be identified. This includes children with Marasmus and Kwashiorkor. These children require aggressive therapy.
Children with long term diseases need therapy for malnutrition as a prophylactic measure. This includes additional nutrients, vitamins and mineral supplements etc. The underlying disease also needs to be treated adequately to prevent malnutrition.
Children with severe malnutrition need therapy in the hospital. This includes parenteral nutrition and slow introduction of nutrients by mouth. Once their condition stabilises then they can gradually be introduced to a normal diet.
Prevention of malnutrition
A healthy balanced diet is recommended for prevention of malnutrition. There are four major food groups that include:
Bread, rice, potatoes, and other starchy foods. This forms the largest portion of the diet and provides calories for energy and carbohydrates that are converted to sugars which provide energy.
Milk and dairy foods – Vital sources of fats and simple sugars like lactose as well as minerals like Calcium
Fruit and vegetables – Vital sources of vitamins and minerals as well as fiber and roughage for better digestive health
Meat, poultry, fish, eggs, beans and other non-dairy sources of protein – These form the building blocks of the body and help in numerous body and enzyme functions.
In addition all hospital admitted patients, children, pregnant women, elderly in care facilities need to be evaluated for malnutrition.
In children prevention of malnutrition includes practicing exclusive breastfeeding and adequate nutrition of the mother while she is pregnant with the child.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)