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nutritional disorder (malnutrition)
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:
1) increased serum IgE is common
2) thymic atrophy is common
3) patients often fail to respond to delayed-type hypersensitivity skin testing
Clinical manifestations:
- weight loss > 15%
Laboratory:
1) complete blood count
- absolute lymphocyte count < 1,800/mm3
2) comprehensive metabolic panel
- serum albumin < 3.5 mg/dL
3) serum cholesterol < 160 mg/dL
4) erythrocyte sedimentation rate
5) serum TSH
6) serum 25-hydroxvitamin D
6) serum prealbumin may be useful for monitoring recovery [4]
Radiology:
- chest X-ray
Differential diagnosis:
- cancer
Management:
- all older patients should receive
a) calcium 1200 mg QD
b) vitamin D 800 IU QD [4]
- 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 [4]
- see specific disorders associated nutritional deficiency
- see pressure ulcer
- see unintentional weight loss
Specific
appetite disorder
eating disorder
malabsorption
mineral disorder
nutritional deficiency
nutritional overload
overweight
starvation
vitamin disorder
General
metabolic disease
References
- nlmpubs.nlm.nih.gov/hstat/ahcpr/
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 696-698
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Geriatrics at your Fingertips, 13th edition, 2011
Reuben DB et al (eds)
American Geriatric Society
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010
- Nutrition support in adults
National Institute for Health & Care Excellence (NICE)
http://www.nice.org.uk/page.aspx?o=292900