Malnutrition is a form of malnutrition. (Malnutrition including without overeating – obesity and metabolic syndrome). It is caused by inadequate nutrient intake, malabsorption, a metabolic disorder, the loss of nutrients through diarrhea or increased nutritional needs, the z. B. present in cancer or infections. Malnutrition takes place in phases; it can develop slowly, if it is caused by anorexia, or very fast, as sometimes happens, if it is caused by a rapidly progressive cancer cachexia. First, the nutrient pool changes in the blood and body tissues, then follow intracellular changes in biochemical processes and cell structures. Finally, the symptoms of malnutrition are visible. A diagnosis is based on history, physical examination, analysis of physical constitution and sometimes on laboratory tests (eg., Albumin).
Malnutrition is a form of malnutrition. (Malnutrition including without overeating – obesity and metabolic syndrome). It is caused by inadequate nutrient intake, malabsorption, a metabolic disorder, the loss of nutrients through diarrhea or increased nutritional needs, the z. B. present in cancer or infections. Malnutrition takes place in phases; it can develop slowly, if it is caused by anorexia, or very fast, as sometimes happens, if it is caused by a rapidly progressive cancer cachexia. First, the nutrient pool changes in the blood and body tissues, then follow intracellular changes in biochemical processes and cell structures. Finally, the symptoms of malnutrition are visible. A diagnosis is based on history, physical examination, analysis of physical constitution and sometimes on laboratory tests (eg., Albumin). Risk factors Malnutrition is associated with numerous disorders and conditions, including poverty and social neglect count. That risk is increasing in certain life stages, such as in infancy, early childhood, youth, pregnancy, lactation and in the elderly. Infancy and childhood In infants and children, malnutrition, developed especially quickly because their need for energy and essential nutrients is very high. Since vitamin K is not easily crosses the placenta, newborns may be undersupplied. Therefore, they receive a vitamin K injection within 1 hour after birth to prevent hemorrhagic disease of the newborn, which can be life threatening. Infants who are fed only breast milk, the little vitamin usually contains D, should also receive vitamin D; they may have a vitamin B12 -Mangelentwickeln when the mother vegan diet. Infants and children who are fed inadequate, are at risk of protein-energy malnutrition (PEU – formerly referred to as protein energy malnutrition) as well as a lack of iron, folic acid, vitamins A and C, copper and zinc exposed. During adolescence, the nutritional needs increase, as growth accelerates. Anorexia nervosa commonly affects particular adolescent Mädchen.Schwangerschaft and lactation The nutrient requirements increase during pregnancy and lactation. Eating disorders such as Pikazismus, d. H. consumer food foreign substances like clay or charcoal, occur in pregnancy. Iron deficiency anemia is as common as caused by folate deficiency anemia. They affect particularly women taking oral contraceptives before pregnancy income (anemia in pregnancy). Vitamin D deficiency is common during late pregnancy and predisposes the child for a reduced Knochenmasse.Alter aging, even when diseases or nutritional deficiencies are not available, accompanied by sarcopenia (progressive loss lean mass). This degradation begins after the age of 40, and eventually leads to the loss of about 10 kg muscle mass in men and about 5 kg in women. Malnutrition contributes to sarcopenia in, and sarcopenia is the cause of many complications due to malnutrition (z. B. decreased nitrogen balance, increased susceptibility to infections). Reduced physical activity Reduced food intake Increased levels of cytokines (in particular interleukin-6) reduced levels of growth hormone and Mechano growth factor (insulin-like growth factor-3) Falling androgen in men decreases by the aging process of: Among the causes of sarcopenia include the following BMR, primarily because the lean body mass is less, just to reduce the body weight, height and skeletal mass. At the age of about 40 to 65 years, the average percentage of body fat as a percentage of body weight increases from 20% to about 30% in men and from 27% to 40% in women. From 20 to 80 years the food supply decreases as a whole, especially this relates to the men. Anorexia due to aging has many causes, including Reduced adaptive relaxation of the fundus of the stomach Increased release and activity of cholecystokinin (the saturation produce) Increased leptin (a Appetitzüglerhormon, which is produced by fat cells) A weakened taste and smell perception that benefit the can detract from meals, but reduces the food intake usually little depression (a common cause) loneliness the inability to shop or prepare meals dementia Some chronic diseases use of some drugs occasionally interfere with anorexia nervosa (as anorexia tardive referred to in the elderly), paranoia or mania food intake. Dental problems limit the ability to chew and consequently the digestion of the consumed meals. Difficulty swallowing are typical of stroke, other neurological diseases in oesophageal candidiasis, or xerostomia. Poverty or physical disabilities affecting access to nutrient-rich foods. For older people who are housed in facilities that are at high risk for the occurrence of protein-energy malnutrition. They are often confused and unable to communicate feelings of hunger or preferences for certain foods. Some of them are not able to eat independently. Chewing and swallowing takes a long time, so that a caregiver needs a lot of patience to enter the assisted sufficient food. In the elderly, particularly those which are housed in facilities that insufficient supply and decreased absorption or synthesis of vitamin D increases the demand for vitamin D, and insufficient exposure to sunlight contributes bei.Krankheiten to vitamin D deficiency, and osteomalacia and medical interventions diabetes, chronic diseases of the gastrointestinal tract, intestinal resections and other gastrointestinal operations impede the absorption of fat-soluble vitamins, vitamin B12, calcium and iron. Diseases such as celiac disease or pancreatic insufficiency leading to malabsorption. A malabsorption optionally converted to iron deficiency and osteoporosis. Abnormal liver function limit the storage of vitamins A and B12 and interfere with the protein and energy metabolism. Renal insufficiency predisposes those affected for developing a protein, iron and vitamin D deficiency. Patients who suffer from cancer, depression or even in AIDS, are anorexic and not getting enough food. Infections, traumatic injuries, hyperthyroidism, severe burns and permanent febrile diseases increase the nutritional requirement for metabolic processes. Each Zytokinanstieg can with muscle loss, lipolysis, low albumin levels and loss of appetite associated sein.Vegetarische food iron deficiency is common in Ovolactovegetariern, but these foods form does not affect good health continues. Vegans can develop a vitamin B12 deficiency, if they do not also use yeast extracts or for Asian cuisine typical fermented foods. Their intake of calcium, iron and zinc is rather low. The exclusive diet of fruit is not recommended because it such a diet of protein, sodium, and many micronutrients mangelt.Diäten Some fad diets lead to vitamin, mineral and protein deficiency, heart rhythm, renal and metabolic disorders, sometimes even death. Very low calorie diets (<400 kcal / day) over a longer period are associated with maintaining health is not vereinbar.Arzneimittel and food supplements (supplements) Many drugs such as appetite suppressants or digoxin decrease appetite, others prevent the absorption or metabolism of nutrients. Some medications (eg. As stimulants) have catabolic effects. Certain drugs such as stimulants initiate degradation processes or block the absorption of other nutrients; z. B. inhibit the anticonvulsants Vitaminresorption.Alkohol - or medicines patients with alcohol or drug addiction neglect their nutritional needs. In addition, absorption and metabolism of nutrients may be impaired. Iv Drug addicts and alcoholics who daily ? 1 liter (quart n. D. Übers .: 1 = 946 ml) consume high percentage drinks typically are malnourished. Alcoholism can lead to a lack of supply of magnesium, zinc and vitamins such as thiamine. Symptoms and complaints The symptoms of malnutrition differ depending on the cause and type of disease image (z. B. protein-energy deficiency, vitamin deficiency). Review The diagnosis of malnutrition is based on the disease and diet history, physical examination, analysis of physical constitution and specific laboratory tests. History To capture the patient's history, the patient should have his food intake (Mini Nutritional Assessment.), Current changes in body weight and risks such as drug and alcohol use are interviewed, which play a role for malnutrition. The unintentional loss of ? 10% of usual body weight within 3 months indicates a malnutrition likely. Questions about the social background should provide information as to whether sufficient funds for food are available and the patient has the opportunity to shop and prepare meals. The examination of the body systems should focus on symptoms of nutrient deficiency (see Table: Symptoms and signs of deficiency). For example, interpret headache, nausea and diplopia indicate a vitamin A hypervitaminosis. Symptoms and signs of deficiency area / system symptoms or signs General appearance Lack wasting energy appearance rash many vitamins, zinc, essential fatty acids rash in sunlight exposure niacin (pellagra) fast le hematoma vitamin C or vitamin K hair and nails thinning hair or hair loss protein premature graying hair is selenium spoon nails Iron Eyes Night blindness Vitamin A Keratomalacia (dehydration and corneal opacity) Vitamin A Cheilosis mouth and glossitis riboflavin, niacin, pyridoxine, iron bleeding gums vitamin C, riboflavin extremity edema protein nervous system paresthesia or numbness in a stocking-glove distribution thiamine (beriberi) tetany calcium , Magnesium Cognitive and sensory deficits thiamine, niacin, pyridoxine, vitamin B12 dementia thiamine, niacin, vitamin B12 posture and musculoskeletal muscle breakdown protein bone deformities (eg. As bow legs, knock knees, scoliosis) Vitamin D, calcium delicate bone or joint pain Vitamin D Vitamin C turgors gastrointestinal tract diarrhea protein, niacin, folic acid, vitamin B12 diarrhea and dysgeusia zinc dysphagia or odynophagia (due Plummer-Vinson syndrome ) iron endocrine system thyroid enlargement iodine Mini Nutritional Assessment. Guigoz Y and Garry PJ. Mini nutritional assessment. A practical assessment tool for grading the nutritional status of elderly patients. Facts and Research in Gerontology. Supplement 2: 15-59, 1994. Rubenstein LZ, Jarker J, Guigoz Y, and Vellas B. Comprehensive geriatric assessment (CGA) and the MCU: An overview of the CGA, nutritional assessment and development of a shortened version of the MNA. In mini nutritional assessment (MNA): Research and practice in the elderly. Vellas B, Garry PJ, and Guigoz Y, editors. Nestle Nutrition Workshop Series. Clinical & Performance programs, vol. 1, Karger, Bale, 1997. ® Societe des Produits Nestle S.A., Vevey, Switzerland, trademark owners. Reprinted with permission. Physical Examination Physical examination should include measurement of height and weight Examination of the distribution of body fat anthropometric measurements of the lean body mass, the Body Mass Index (BMI = weight [kg] / height [m] 2) indicates the relationship between body weight and size again (see table: body mass index (BMI)). Is the body weight <80% of the according to the body size predetermined normal value or the BMI is less than 18, there is a suspicion of malnutrition. Although these results are useful and sufficiently sensitive for the diagnosis of malnutrition, they are not specific enough. Clinical Calculator: Body Mass Index (Quetelet's index) The muscle of the upper arm center provides information on the fat-free body mass. The value of the Tricepshautfalte (TSF = skin fold triceps) and the periphery of the central upper arm derived. Both values ??are measured at the same point, the patient holds his right arm while in a relaxed position. The average size of the middle upper arm is about 34.1 cm for men and 31.9 cm for women (1). (Formula for calculating the muscle of the upper arm in mid cm 2 s. U.) This formula returns standard values ??for the range of the upper arm for fat and bones. The average values ??for the muscle mass of the upper arm are average for men was 54 ± 11 cm 2, for women at 30 ± 7 cm2. A score of <75% of these (age-related) defaults indicates a depletion of lean body mass (see Table: muscle mass of the middle upper arm in adults). The measurement results are influenced by physical activity genetic factors and age-related muscle loss. Muscle mass of the central upper arm in adults Standard (%) Men (cm2) (cm2) exhausted women muscle mass 100 ± 20 * 54 ± 11 30 ± 7 75 40 22 adequately borderline 60 32 18 emaciated 50 27 15 * Average muscle mass of the central upper arm ± 1 standard deviation. From the National Health and Nutrition Examination Surveys I and II. The physical examination should focus on signs of certain nutritional deficiencies. Here are signs of a PEU such. B. edema, massive muscle loss or skin changes observed. Also in the investigation should find such dental problems observing that possibly lead to nutrient deficiencies complaints. In addition, the mental state must be assessed as depression and cognitive weaknesses lead to weight loss. The following assessment tools can be useful: The widespread Subjective Global Assessment (SGA) obtains information from the patient's history (weight loss, change in food intake, gastrointestinal symptoms), results of the physical examination (loss of muscle mass and subcutaneous adipose tissue, edema, ascites) and medical assessment shows the nutritional status. The Mini Nutritional Assessment (MNA) was officially recognized and is used especially for older patients (Mini Nutritional Assessment.). The Simplified Nutrition Assessment Questionnaire (SNAQ), a simple, validated method for predicting future weight loss can also be applied (the Simplified nutrition assessment questionnaire (SNAQ).) The Simplified nutrition assessment questionnaire (SNAQ). Testing To what extent laboratory tests are necessary, it is not clear, and depending on the circumstances under which the malnutrition of a patient occurred. the cause can be clearly identified and eliminated, if for. B. a patient who survived a stay in the wilderness, tests offer little benefits. In other cases, a more detailed evaluation is necessary. A determination of serum albumin level is most commonly performed in laboratory tests. A drop in albumin levels or low levels of other proteins such as prealbumin (transthyretin), transferrin, retinol binding protein indicate a protein deficiency or protein-energy malnutrition. Worsens the state of malnutrition, the albumin value decreased slowly; the prealbumin - transferrin - and retinol-binding protein levels decline rapidly. The determination of the albumin value is inexpensive and can be more reliable conclusions on disease progression and mortality, as the values ??of the remaining proteins. However, the influence of albumin depends on disease progression and mortality from both non-food-related as well as dietary factors. Inflammation produce cytokines, the reason why albumin and other markers dietary protein leak into the adjacent body tissue and serum levels fall. Since the values ??for pre-albumin, transferrin, and retinol-binding protein fall in hunger states faster than albumin, their determination is partly used to diagnose the occurrence of an acute condition, or to assess hunger. However, it is not established whether these proteins are more sensitive or specific than albumin. The lymphocyte count, which often decreases with increasing malnutrition, can optionally be determined. Malnutrition leads to a significant decline in CD4 + T lymphocytes, this count is therefore for patients who are suffering from AIDS, not useful. With skin tests using antigens to a weakening of cell-driven immune response at PEU and other appearances can malnutrition notice (examination of patients with suspected immunodeficiency: Clarification). Selective laboratory tests such as determining the vitamin and mineral levels support the diagnosis of individual Nährstoffmängel.Evaluationshinweis 1. McDowell MA, Fryar CD, Ogden CL, Flegal KM: Anthropometric reference data for children and adults: United States, 2003-2006. Natl Health Stat Report Oct 22 (10): 1-48 of 2008.