Primary malnutrition is a condition common in developing nations, but chronic malnutrition is seen in the United States and other developed countries, even as food relief programs attempt to compensate for food shortages in high-poverty areas. Foods high in fat and sugar that fail to improve nutrition can contribute to chronic malnutrition, while also contributing to obesity.
Poor prenatal nutrition and malnourishment of the developing child suppress growth of the central nervous system, musculoskeletal system, and other organs. Not fully developed, the weakened child is predisposed to disease, vulnerable to infection, and likely to fall victim to early death. Among the signs and symptoms of malnutrition in infants and children are failure to thrive, cachexia, substandard weight and height, and low body mass index.
Malnutrition is associated with slow wound healing, immunity disorders, reduced IQ, small adult size, and weakened muscles.
Adolescents and adults lacking in adequate nutritional intake are weakened in the face of disease and infection. Older adults, persons with disabilities, and those who are institutionalized are among the vulnerable population at risk of malnutrition. Persons with malabsorption disorders or diseases that lose or waste nutrients are at risk for severe malnutrition and life-threatening complications. Malnourishment is also associated with cancer and cancer therapies.
Malnutrition manifests in various forms:
- Protein-energy malnutrition – Failure to meet needed dietary intake of calories, especially calories from protein, either because of insufficient consumption or from malabsorption or losses of nutrients.
- Kwashiorkor (edematous malnutrition / dyspigmentation of skin and hair) – Extreme form of protein-energy malnutrition in which protein needs are greatly deficient, leading to severe complications of edema, hepatomegaly, fatty liver, growth failure, and skin dermatoses.
- Marasmus – A condition of starvation characterized by emaciation, failure to thrive, cachexia, muscle atrophy, and loss of subcutaneous body fat, giving the appearance of thin, paper-like skin (dry and loose), abnormal nails, and brittle hair. Also noted are hypothermia, bradycardia, hypotension, irritability, and sagging skin.
- Anorexia nervosa and bulimia – Eating disorders related to distorted body- image and characterized by abstaining from food, obsessive exercise, or binge-eating followed by purging that leave patient malnourished and at risk for life-threatening complications.
- Malabsorption syndrome – Although nutrients may be taken in sufficient quantities, the absorption mechanism fails to function within the gastrointestinal tract and/or the body loses nutrients. Characterized by recurring steatorrhea, diarrhea, abdominal pain, distension, bloating, weight loss, and electrolyte imbalances.
Careful screening is necessary to identify nutritional deficiencies, any comorbidities (malabsorption, food allergies, infectious diarrhea, dehydration), or any risks for complications (refeeding syndrome, cardiac arrest, kidney failure). Lab tests, family history, cultural or religious practices, and questionnaires will help diagnosis.
Management involves patient / parent education and support by a multidisciplinary team that may include a social worker, nurse, pediatrician, registered dietician or nutritionist, and primary care physician. In-patient care provides rehydration, gradual re-feeding to avoid refeeding syndrome and other life-threatening complications, supplementation of vitamins and minerals, and symptomatic support. Support for breastfeeding of neonates and infants includes coaching and nutritional support for nursing mothers. Outpatient care should continue with ongoing measurements of nutritional improvement. Social services, food pantries, and nutritional programs can provide ongoing support, food preparation classes, and dietary monitoring. Hunger relief programs in developing nations, can be enlisted to provide food for refugees and victims of war and natural disasters.
E46 – Unspecified protein-calorie malnutrition
T73.0XXA – Starvation, initial encounter
212968006 – Starvation
272588001 – Malnutrition