Nutrition

Decreased food intake despite food being available; increased nutritional requirements; inadequate availability, quality or presentation of food; failure to recognise and treat malnutrition.

A state of nutrition in which a deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue, body form and function.

Decreased respiratory function; decreased cardiac function; reduced mobility; increased risk of infection; impaired wound healing; increased risk of complications such as malabsorption.

Step 1 – BMI score; Step 2 – unplanned weight-loss score; Step 3 – acute disease effect score; Step 4 – overall risk of malnutrition score; Step 5 – management guidelines.

Yes. Malnutrition can occur at any body weight, including in people who are overweight or obese.

Anthropometry – weight, height, BMI and weight history; Biochemistry – relevant blood tests and biochemical evidence of nutritional problems; Clinical status – diagnosis, medical history and medications; Dietary intake – food and fluid intake, feeding route and allergies; Estimated requirements – energy, protein and fluid requirements.

Weight (kg) divided by height (m) squared.

25 kg/m².

18.5 kg/m².

An indirect measurement used when a direct measurement, such as height or weight, cannot be obtained.

Knee height; demispan; ulna length.

Mid-upper arm circumference (MUAC).

They may introduce measurement errors and lead to inaccurate estimates of height, weight and BMI.

Less than 23.5 cm.

Greater than 32 cm.

Fat mass – estimated using skinfold thickness; fat-free mass and muscle mass – estimated using measures such as mid-upper arm muscle circumference.

Peripheral oedema; ascites.

A test using a handgrip dynamometer to measure grip strength, which provides an indication of muscle strength and functional status.

Inflammation; sepsis; increased capillary permeability; reduced albumin synthesis in liver disease; increased albumin loss through the kidneys or gastrointestinal tract.

Not necessarily. Albumin is a negative acute-phase protein and is often reduced during inflammation or illness; it is not a reliable standalone marker of nutritional intake.

A potentially fatal condition caused by severe fluid and electrolyte shifts and associated metabolic changes when nutrition is reintroduced to a severely malnourished patient.

Glucagon levels rise; insulin levels fall; the body initially uses glycogen stores before increasing fat and fatty acid metabolism; protein is broken down for gluconeogenesis; intracellular stores of electrolytes may become depleted.

Metabolism shifts from fat oxidation towards carbohydrate metabolism; insulin secretion increases; insulin drives phosphate, potassium and magnesium into cells, causing low blood levels; sodium and water retention may also occur.

Weakness; paraesthesia; seizures; rhabdomyolysis; osteomalacia; respiratory muscle weakness; cardiac dysfunction or failure.

Tetany; paraesthesia; seizures; ataxia; tremor; cardiac arrhythmias; anorexia; abdominal pain.

Muscle weakness or paralysis; paraesthesia; rhabdomyolysis; cardiac arrhythmias; cardiac arrest; constipation or ileus.

Patients with very little or no nutritional intake for more than five days; BMI below 16 kg/m²; low phosphate, potassium or magnesium before feeding; a history of alcohol misuse or drug misuse; significant recent weight loss or prolonged poor intake.

To maintain immune function; preserve organ function; promote wound healing; enhance recovery and improve patient outcomes.

Oral; nasogastric; nasojejunal; gastrostomy; jejunostomy; orogastric; parenteral nutrition via peripheral or central venous access.

Oral nutritional supplement drinks; powdered supplements; juice-based supplements.