nutritional disorder (malnutrition)

Introduction

State of nutritional insufficiency.

Etiology

• inadequate dietary intake
• defective assimilation or utilization of food ingested
• risk factors for poor nutritional status
  • alcohol or substance abuse
  • cognitive impairment
  • lack of exercise
  • depression & other mental health disorders
  • poor functional status
  • impecunity
  • limited education
  • immobility or lack of transportation
  • chronic disease
  • medications
  • poor dentition
  • restricted diet, poor eating habits
  • social isolation

Pathology

• increased serum IgE is common
• thymic atrophy is common
• patients often fail to respond to delayed-type hypersensitivity skin testing

Clinical manifestations

• weight loss > 15%

Laboratory

• complete blood count
  • absolute lymphocyte count < 1,800/mm3
• comprehensive metabolic panel
  • serum albumin < 3.5 mg/dL
• serum cholesterol < 160 mg/dL
• erythrocyte sedimentation rate
• serum TSH
• serum 25-hydroxvitamin D
• serum prealbumin may be useful for monitoring recovery

Radiology

• chest X-ray

Differential diagnosis

• cancer

Management

• all older patients should receive
  • calcium 1200 mg QD
  • vitamin D 800 IU QD
• adequate hydration
• if possible, remove disease-specific dietary restrictions
• no appetite stimulants are RDA-approved to treat malnutrition
• protein & energy supplements (Ensure etc) may have some benefit
• enteral nutrition is preferred over parenteral nutrition
• see specific disorders associated nutritional deficiency
  • see pressure ulcer
  • see unintentional weight loss

More general terms

• metabolic disease

More specific terms

• appetite disorder
• eating disorder
• malabsorption
• mineral disorder
• nutritional deficiency
• nutritional overload
• overweight
• starvation
• vitamin disorder