Table 8Some physical and psycho-social effects of malnutrition

Adverse effectConsequence
Impaired immune responsesPredisposes to infection and impairs recovery when infected
Impaired wound healingSurgical wound dehiscence, anastamotic breakdowns, development of post- surgical fistulae, failure of fistulae to close, increased risk of wound infection and un-united fractures. All can then lead to prolonged recovery from illness, increased length of hospital stay and delayed return to work
Reduced muscle strength and fatigueInactivity, inability to work effectively, and poor self care. Abnormal muscle (or neuromuscular) function may also predispose to falls or other accidents
Reduced respiratory muscle strengthPoor cough pressure, predisposing to and delaying recovery from chest infection. Difficulty weaning malnourished patients from ventilators
Inactivity, especially in bed bound patientPredisposes to pressure sores and thromboembolism, and muscle wasting.
Water and electrolyte disturbancesMalnourished individuals are usually depleted in whole body potassium, magnesium and phosphate, while simultaneously overloaded in whole body sodium and water. They also have reduced renal capacity to excrete a sodium and water load. This leads to vulnerability to re-feeding syndrome (see section 6.6) and iatrogenic sodium and water overload.
Impaired thermoregulationHypothermia and falls, especially in older people
Vitamin and other deficienciesSpecific vitamin deficiency states e.g. scurvy and vitamin related re-feeding risks e.g. Wernike-Korsakoff syndrome (see section 6.6.3). Mineral deficiencies include iron deficiency anaemia, and magnesium deficiency, which can cause tetany (see also above for electrolyte disturbances). A lack of trace elements can also be a cause of range of problems.290.
Menstrual irregularities/amenorrhoeaInfertility and osteoporosis
Impaired psycho-social functionEven when uncomplicated by disease, patients who are malnourished may experience apathy, depression, self-neglect, hypochondriasis, lack of self esteem, poor body image, possible confusion about slow recovery, lack of interest in food, loss of libido and deterioration in social interactions185,335. Malnutrition may also affect behaviour and attitude.

From: 2, Malnutrition and the principles of nutrition support

Cover of Nutrition Support for Adults
Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition.
NICE Clinical Guidelines, No. 32.
National Collaborating Centre for Acute Care (UK).
Copyright © 2006, National Collaborating Centre for Acute Care.

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