Malnutrition management

Filteau, S. M. (2000). Role of breast-feeding in managing malnutrition and infectious disease. Proc. Nutr. Soc. 59, 565-572. 

We found that supplementation of vitamin A in the form of an aerosol is an effective, safe, and routinely manageable method to enhance vitamin A and RBP concentrations. Consequently, this modality of treatment may serve as an alternative vitamin A therapy during chronic or acute episodes of malnutrition, malabsorption, or in case of insufficient compliance to other therapies and might be useful in respiratory diseases associated with vitamin A deficiency. 

Table 24-1. Time Frame for Management of a Child with Severe Malnutrition ...

World Health Organization Management of Severe Malnutrition A Manual for Physicians and Senior Health Workers. WHO, Geneva, Switzerland, 1999. 

The treatment for these disorders is limited. Antipruritic agents and UDCA are indicated for itching. Good dietary management lowers the risk of malnutrition. Bi-phosphonates and calcium can have a positive effect on bone density. As yet, there is no medical treatment available for the often annoying chronic fatigue syndrome. Liver transplantation may ultimately be indicated. 

Copper occurs in many foods particularly good sources are liver, kidney, shellfish, nuts, raisins, and dried legumes. Copper deficiency due to diet is rare except in malnutrition and in children with chronic diarrhea. It occurs in total parenteral nutrition with fluids low in copper, particularly following intestinal resection and in patients who receive large amounts of zinc to improve wound healing or for management of sickle cell anemia. Copper is often removed from prepared foods to increase their shelf life. 

Although the cost-benefit analysis of nutrition intervention is weak, the issue that seems clear is that malnutrition is associated with significant morbidity and mortality in numerous disease states and clinical settings. Furthermore, it is likely that improved patient outcomes can be achieved by a systematic approach to identify the presence of risk factors for malnutrition, quantitate the degree of malnutrition, and initiate nutrition management. The clinician s responsibilities in the management of nutrition disease include the following ... 

Pure red cell aplasia that responded to the administration of riboflavin was reported in patients with protein depletion and complicating infections. Nutritionists induced riboflavin deficiency in human beings and demonstrated that a hypoproliferative anemia resulted within a month. The spontaneous appearance in human beings of red cell aplasia due to riboflavin deficiency undoubtedly is rare, if it occurs at all. It has been described in combination with infection and protein deficiency, both of which are capable of producing a hypoproliferative anemia. However, it seems reasonable to include riboflavin in the nutritional management of patients with gross, generalized malnutrition. 

Nutritional support is especially important for patients who have spent several weeks or months in an ICU. Malnutrition is commonly associated with prolonged hospitalization (18) and it is aggravated by diminished swallowing, profound dyspnea, and depression. Therefore, all patients are evaluated at baseline for nutritional supplementation. For those who are unable to sustain an adequate oral intake, enteral and sometimes parenteral nutrition may be necessary. For other patients, the advice of the dietitian is invaluable in managing obesity or weight loss and maintaining a healthy weight. 

Therefore, nutritional assessment and management is an important therapeutic option among patients with chronic respiratory diseases (10), especially those requiring prolonged mechanical ventilation (PMV) in ICU (11). Table 1 emphasizes the effects of malnutrition on the respiratory function in patients in ICU. However, specific nutritional deficiencies such as hypophosphatemia (12) have been associated with respiratory failure and impaired lipid synthesis (13) and may cause an abnormal increase in the fat mass. 

Malnutrition is still an underestimated problem in the ICU among patients with chronic respiratory failure, and, therefore, a nutritional assessment is an important part of the management of patients requiring ventilation (90). Appropriate nutrition makes a valuable contribution to outcomes in the ICU and whether feeding is oral, enteral, or parenteral, it should be organized to provide the best caloric and metabolic daily intake. 

Cheung, K., Lee, S.S., and Raman, M. (2012) Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clinical Gastroenterol Hepatol 10, 117-125. 

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