disorders of nutrition
Undernutrition
Diagnosis of Undernutrition
A doctor's evaluation Sometimes blood tests Doctors can usually diagnose undernutrition by asking questions about diet and weight loss and by doing a physical examination (see also Evaluation of Nutritional Status ). Severe, long-standing undernutrition can usually be diagnosed based on the person's appearance and history. Doctors may also ask questions about the ability to shop for and prepare food, the presence of other disorders, the use of medications or other substances, mood, and mental function. They may use standardized questionnaires to help them obtain relevant information. The answers to these questions may help confirm the diagnosis, particularly when undernutrition is less obvious, and may help identify a cause. Identifying the cause is particularly important in children. As part of the physical examination, doctors do the following: Measure height and weight Determine the body mass index ( Obesity ) Estimate the amount of muscle and fat in the mid upper arm by measuring the circumference of the upper arm and the thickness of a fold of skin on the back of the left upper arm (triceps skinfold) Check for other symptoms that may indicate undernutrition (such as changes in the skin and hair and accumulation of fluid in the limbs or abdomen) What they find helps them confirm the diagnosis and determine how severe undernutrition is. Whether tests are done depends on the circumstances. For example, if the cause is obvious and can be corrected, tests are usually not needed. The test most often done is a blood test to measure the level ofalbumin(which decreases when people do not consume enough protein). Doctors may also measure the number of certain types of white blood cells (which decreases as undernutrition worsens). Other blood tests, including a complete blood count, are usually done. Tests may be done to check how well the immune system is functioning. A substance that contains an antigen (which normally triggers an immune reaction) is injected under the skin. If a reaction occurs within a certain amount of time, the immune system is functioning normally. A delayed reaction or no reaction indicates a problem with the immune system, which may be due to undernutrition. If doctors suspect a vitamin or mineral deficiency, blood tests to measure levels of those nutrients are usually done. If doctors suspect the cause is another disorder, other tests may be done to help identify the cause. For example, if people have diarrhea that is severe or persists despite treatment, doctors may check a sample of stool for microorganisms that can cause infection. Tests, such as urine tests and chest x-rays, may be done to look for infections. Undernutrition in older adults is serious because it increases the risk of fractures, problems after surgery, pressure sores, and infections. If any of these problems occur, they are more likely to be severe in people who are undernourished. Older adults are at risk of undernutrition for many reasons. Age-related changes in the body:In the aging body, production of and sensitivity to hormones (such as growth hormone,insulin, and androgens) change. As a result, older adults lose muscle tissue (a condition called sarcopenia). Undernutrition and decreased physical activity worsen this loss. Also, the age-related loss of muscle tissue accounts for many of the complications of undernutrition in older adults, such as a higher risk of infections. As people age, their need for nutrients increases but they burn fewer calories. So older adults need to consume foods that contain a lot of nutrients but are low in calories. Such a diet may be hard to follow. Older adults tend to feel full sooner and have less of an appetite. Thus, they may eat less. They may also eat less because as people age, the ability to taste and smell decreases, reducing the enjoyment of food. The ability to absorb some nutrients is reduced. Some older adults produce less saliva, resulting in dental problems and difficulty swallowing. Disorders:Many disorders that contribute to undernutrition are common among older adults. Depression None Overview of Stroke None Osteoarthritis (OA) None Overview of Malabsorption None Overview of Cancer None Dementia None Dental problems(such as ill-fitting dentures or gum disease) may make chewing and thus digesting food more difficult. Anorexia Nervosa None Medications:Many of the medications used to treat disorders common among older adults (such as depression, cancer, heart failure, and high blood pressure) can contribute to undernutrition. Medications can increase the body’s need for nutrients, change how the body uses nutrients, or decrease the appetite. Some medications cause diarrhea or have side effects that interfere with eating, such as nausea and constipation. Living situation:People who live alone may be less motivated to prepare and eat meals. They may have limited funds, causing them to buy cheap, less nutritious food or less total food. They may be physically unable or afraid to go out to buy food or may not have transportation to a grocery store. People who live in institutions have even more obstacles to adequate nutrition. They may be confused and unable to say when they are hungry or what they would like to eat. They may be unable to choose foods they like. They may be unable to feed themselves. If they eat slowly, especially if they need to be fed by a staff member, the staff member may not have or allow enough time to feed them adequately. Inadequate exposure to sunlight combined with inadequate consumption of food and age-related changes can lead to Vitamin D Deficiency . People who are hospitalized sometimes have the same problems. Prevention and treatment:Older adults can be encouraged to eat more, and food can be made more appealing. For example, strongly flavored or favorite foods, rather than low-salt or low-fat foods, can be served. Older adults may be following a special diet (such as a low-salt diet) because they have a disorder (such as Overview of Kidney Failure or People who need help with grocery shopping or feeding themselves should be given more help. For example, they may need for meals to be delivered to their home. Occasionally, people are given a medication to stimulate their appetite (such asdronabinol) or to increase the amount of muscle tissue (such as nandrolone ortestosterone). Depression and other disorders, if present, should be treated. Treating these disorders may remove some of the obstacles to eating. For older adults living in institutions, making the dining room more attractive and giving them more time to eat may enable them to eat more. 