Malnutrition: Are Your Loved Ones At Risk?

Malnutrition is more common than you may think and it could be affecting someone you know and love. When we think of malnutrition, we often assume it’s confined to poverty-stricken or third-world countries, but the prevalence of malnutrition in Australia is high, particularly in older adults.

The World Health Organisation (WHO) defines malnutrition as the deficiencies excesses or imbalances in a person’s intake of energy and/or nutrients. The term malnutrition includes three broad groups of conditions:

• Undernutrition, including wasting, stunting and underweight, often seen in undernourished infants and children
• Micronutrient-related malnutrition, which includes micronutrient deficiencies (a lack of vitamins and minerals that are essential to the body) or micronutrient excess
• Overweight, obesity and diet-related noncommunicable diseases (such as heart disease, stroke, diabetes, and some cancers)

Considering that malnutrition combines both under- and over-nutrition by definition, it’s more easily understood as to why Australia has high rates of malnutrition. However, overweight and obesity are frequently discussed in the True Life hub. As weight loss remains a hot topic, you can read more about weight loss and fat loss here, or learn about how you can use the True Protein whey range to lose weight here.

Less frequently discussed is malnutrition from being undernourished, and so we’ve put together some helpful information to ensure your loved ones remain well-nourished and to understand what you can do to help out.

How big is the issue of malnutrition?

According to the Australian Bureau of Statistics, 93% of Australian adults do not eat enough vegetables on a daily basis. Even more alarming is the fact that more than one third (35%) of our total energy intake is coming from discretionary foods or ‘junk food’. These statistics could be even higher due to the issue of underreporting. We’re only human, and we may not remember (nor want to admit) our undesirable food choices. Factors like this, amongst other lifestyle and medical factors, could put a person at risk of malnutrition over time. Hence why we see malnutrition highly prevalent in older adults.

In the elderly, malnutrition is frequently an undiagnosed medical condition affecting as many as 35-43% of patients in Australian hospitals and 32-72% of residents in aged-care facilities, according to the Dietitians Association of Australia. Understandably, malnutrition has been referred to as a silent epidemic.

Why might someone become malnourished?

Like most medical conditions, the reasons why someone becomes malnourished is multifactorial. Generally, people will become malnourished if they don’t eat enough, and of the right foods, or they cannot absorb these nutrients appropriately by the body. So, why might this occur?

Undesirable food choices

• There is so much misinformation in the world of nutrition that it can be difficult to know what is the best diet choice to make. Sometimes we might not intentionally be choosing undesirable foods but learning about nutrition from credible sources like a healthcare or medical professional, can help you increase your knowledge and confidence in choosing a healthy diet.
• Too much of a particular food or nutrient can displace other essential nutrients. For example, alcohol is very energy-dense and nutrient-poor. In the case of alcoholism, vitamin and mineral deficiencies are common because other whole foods like vegetables and fruit can be displaced. Alcohol itself can also interfere with the normal absorption of specific nutrients.

Reduced or inadequate intake

• Your appetite is not always the best indicator of how much of what foods your body needs. Certain medical conditions and medications can affect your appetite leading to an inadequate intake over time.
• Your nutritional requirements will change over the life stages and so your dietary intake should reflect this. For example, pregnant and breastfeeding women will have increased nutritional requirements to support the growth and development of their baby and maintain good health themselves.
• Swallowing and chewing difficulties can be a complication of a stroke, some cancers, multiple sclerosis, and brain injury. If not appropriately managed then the affected person’s dietary intake will likely fall short.

Medical illnesses

• It could be as simple as falling ill with gastrointestinal upset affecting your appetite and normal digestion. Most of us can bounce back from a bad bout of ‘gastro’ but it could be extremely detrimental to an older person.
• Digestive disorders like coeliac disease, which is an allergy to gluten, a protein found in wheat, rye, barley, and many processed foods. If coeliac disease is improperly managed, chronic inflammation of the bowel can affect absorption of nutrients from the normal digestion of food.
• Some medical conditions can increase your requirements of particular nutrients such as Chronic Obstructive Pulmonary Disease (COPD), kidney failure, liver disease, some cancers and recovery from surgery, burns or trauma. Continuing with the usual dietary intake may not be enough to support these requirements and supplements could be recommended to fill the gap and prevent or treat a deficiency.
• Cancer itself and cancer treatments like radiotherapy and chemotherapy will put extra demands on the body. Specific nutritional requirements can be increased and undesirable side-effects from some treatments, such as a reduced appetite or taste changes, can affect how we eat and our body weight.

Access to food

• The Australian Institute of Health and Welfare reported that basic nutritious foods can be up to 30% more expensive to buy in some rural and remote areas compared to urban areas. If this creates a barrier to purchasing and consumption of foods and food groups then it could result in a nutritional deficiency over time.
• Low-income earners or older Australians receiving the Age Pension can find it financially difficult to consume the best diet and food choices for their particular situation.

Ageing

• Progressive muscle and strength losses start at around the age of 40, which is younger than many may have initially thought. It is estimated that muscle loss is at a rate of 8%, and leg strength losses up to 15% per decade until the age of 70 (1). After 70 years of age, the loss rate increases significantly, as high as 25-40% per decade (1). Although we may not have as much control of systemic and hormonal changes related to age. We make a positive change to our diet and exercise. It is well known that adequate nutrition, specifically energy and protein, has a major impact on muscle mass and strength retention and gain (2).

What are the consequences of malnutrition?

If we are generally well but regularly consume nutrient-poor junk foods over nutrient-rich foods like fresh vegetables, then over time we become at risk of micronutrient deficiencies. Micronutrient deficiencies can also arise from having a limited diet or simply not including enough variety of quality whole foods.
For example, the Gastroenterological Society of Australia reports that iron deficiency is the most common nutritional deficiency worldwide. Depletion of iron stores in the body resulting in iron deficiency can occur in all age groups, particularly in children, women after the onset of menstruation, elderly people, vegetarians (especially vegans) and in socioeconomically disadvantaged populations such as Indigenous Australians and refugees. Iron is found in red meats, organ meats, eggs, nuts, wholemeal pasta and bread, iron-fortified breakfast cereals, dried beans and lentils, and leafy green vegetables (e.g. spinach, kale, and broccoli).

Muscle wastage can result from inadequate energy and protein consumption. As we age, the process of muscle protein synthesis become less efficient compared to when we are younger. Sarcopenia is the medical name for muscle and strength loss overtime-related to aging (1). Losing muscle and becoming underweight can have serious health consequences including general weakness and fragility, lowered immunity, reduced balance and mobility and an increased risk of falls that can result in broken bones and trauma to the body.

What are the signs and symptoms of malnutrition?

As malnutrition can present in different ways with varying severity, the symptoms will differ. Here are some common signs and symptoms of malnutrition in adults to look out for:

• Unintentional weight loss
• Muscle wastage of the arms, legs, and shoulders
• Fatigue, tiredness or weakness
• Reduced appetite
• Poor recovery from illness, surgery or physical activity
• Lowered immunity or frequent illness
• Aches and pains or sore muscles
• Always feeling cold
• Dry, flaky or pale skin
• Hollowing appearance of the eyes and cheekbones
• Reduced sex drive or fertility problems

It’s good practice to have regular medical check-ups and to discuss anything outside of the norm with your doctor. If you or someone you know is experiencing any of these symptoms, we recommend seeking advice from a doctor.

How can I help an older friend or family member?

If from reading this article you feel that someone you care about, maybe a parent or grandparent, is at risk of becoming malnourished then it could be as simple as asking them if they are OK. Try not to be judgemental in your approach, there are many reasons why someone may become undernourished and the solution can be much more complex than telling them to eat more. Encourage them to speak to their doctor first to rule out any underlying medical issues.

Simple dietary and lifestyle strategies that may help include:

• Ensuring enough protein in the diet. One serve of True WPC80 could be an easy and simple addition to the diet as a delicious protein-rich drink.
• Helping with shopping, preparing food and cooking
• Encouraging small and frequent meals/snacks
• Changing the texture of foods for ease of chewing
• For the elderly, ensuring that dentures fit appropriately will help with eating
• Eating at the table with family and friends rather than alone

References

1. Kim TN, Choi KM. Sarcopenia: Definition, Epidemiology, and Pathophysiology. Journal of Bone Metabolism. 2013;20(1):1-10. doi:10.11005/jbm.2013.20.1.1.
2. Morton RW, Murphy KT, McKellar SR, et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Br J Sports Med 2018;52:376-384.