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A dietitian’s perspective: The struggle with malnutrition

Malnutrition Awareness Week takes place from Sept. 28 to Oct. 2.

In response, the following article was contributed by Carly Moss, an inpatient clinical dietitian at GRHealth:

For the past few decades, evidence of America’s battle against obesity has been everywhere. It has galvanized health care professionals and researchers into action, instigated new government programs and served as a hot topic in the media. But more recently, another battle that is just as crucial to the health and wellbeing of millions of Americans has started to gain attention.

Malnutrition is a foreign concept to many – something almost unheard of in this country in this day and age – but in reality, it is a burden within our very own communities. Every day malnutrition impairs quality of life, increases health care costs and hinders patient recovery from illness and injury. The belief that malnutrition is a non-issue in our country is just one of the many myths surrounding this topic. Here are some other misconceptions to consider:

Myth: All Americans have access to a good food supply.

Simply put, malnutrition is imbalanced nutrition, whether it’s an imbalance in protein and caloric intake or in vitamin and mineral intake. Unfortunately, many Americans live in environments that are conducive to imbalanced nutrition. According to a 2011 report by the Centers for Disease Control and Prevention, Richmond County alone has six food deserts, defined as areas that lack access to affordable, healthy foods. People living in such areas may struggle with maintaining balanced nutrition, which can ultimately lead to nutrient deficiencies and even malnutrition. Although poor food accessibility is a risk factor for malnutrition, it is actually not the primary one. This leads to another common misconception about malnutrition.

Myth: Food insecurity is the main culprit in malnutrition.

This may be true in parts of the world where food insecurity is widespread rather than isolated in food deserts. In the United States, however, injury and illness are the major contributors to malnutrition. Those of us who work in a hospital setting know that malnutrition is prevalent among those struggling with various chronic illnesses, including cancer, liver cirrhosis, kidney disease and severe gastrointestinal disorders to name just a few. Malnutrition is also not uncommon among patients with major trauma and injury. In fact, studies have shown anywhere from 20-50 percent of hospitalized patients are malnourished. The development of malnutrition is often multifactorial. These patients have increased protein and caloric needs due to chronic inflammation, wounds, malabsorption and hypermetabolism. At the same time, food intake tends to be poor due to food intolerances, inability to prepare foods or feed oneself, chewing and swallowing difficulty, depression or a combination of these factors. Over an extended period of time, these factors can ultimately result in malnutrition.

Myth: Malnutrition is easy to recognize.

Many people visualize malnutrition as wasting and atrophy to the point of a skeletal appearance, but malnutrition is rarely so obvious or dramatic. In fact, malnutrition can occur in people who are normal weight and overweight as well as those who are underweight. Diagnosing malnutrition requires physical examination to look for muscle and fat loss in certain areas of the body as well as a thorough assessment of body weight history, nutrient intake, gastrointestinal symptoms and functional capabilities. There is no foolproof lab test that acts as a marker for malnutrition, making the condition even harder to recognize.

Myth: Malnutrition is easy to treat.

Recommending increased food intake is rarely sufficient for treating malnutrition. As mentioned previously, most malnourished individuals already face many obstacles to meeting their nutrient needs. The challenge may be even greater if the malnourished individual lives in a food desert with poor access to healthy foods. It takes a multidisciplinary team to develop a nutrition plan appropriate for a malnourished patient, execute the plan and monitor progress. Some malnourished patients may require artificial nutrition support, which can be given through feeding tubes or as an intravenous infusion. In other cases, a malnourished individual may need to change the types of foods they are eating rather than the amount. There is hardly ever a simple, one-time solution for malnutrition. Just as malnutrition takes time to develop, it also takes time and effort to resolve.

Good nutrition is a vital aspect of recovery and healing, but it can also be very difficult to maintain for those dealing with illness and injury. This presents a challenge for these individuals as well as the family members and health care professionals caring for them. The first step to addressing the challenge is awareness of malnutrition and its risk factors and recognizing its presence within our own community.

Malnutrition is a burden to those who struggle with it, but the good news is that with the right plan of care, it can be managed and even reversed. In many cases, food and nutrition can truly act as medicine by improving quality of life, restoring strength and functional capabilities and aiding healing and recovery. The challenge is real, but in Augusta and across the country our health care professionals are equipped better than ever to help patients and their families meet it.

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Carly Moss is an inpatient clinical dietitian at GRHealth where she works with a variety of patient populations. Her interests include nutrition support therapy, nutrition in critical illness, and education. She was recently voted Preceptor of the Year for the Augusta Area Dietetic Internship.

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