CLINICAL APPROACHES TO MALNUTRITION IN CHRONIC DISEASE PATIENTS

Nutrition care process to be a clinical, structured, and personalized approach — driven by interprofessional collaboration and technological integration— can transform outcomes for chronic metabolic disease patients.

- Bhakti Samant

Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization. The double burden of malnutrition consists of both under-nutrition and overweight and obesity, as well as diet-related non-communicable diseases. It is a silent epidemic frequently overlooked in patients who have chronic diseases. Whether the patient has cancer, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), liver cirrhosis, or heart failure, disease-related malnutrition [DRM] has a significant impact on the clinical outcome. For the healthcare areas, it's important not to sideline malnutrition as it adds value in patient care.

Understanding DRM plays a pivotal role. It is a multifactorial condition resulting from the interplay between inadequate food intake, catabolic stress, inflammation and altered metabolism. The systemic Inflammation during a chronic disease state triggers hyper-metabolism, leading to proteolysis and lipolysis, resulting in loss of muscle and a decline in functional capacity.

Patients with chronic metabolic diseases may be presented with:

• Reduced dietary intake due to the presence of Anorexia, gastrointestinal symptoms or drug-nutrient interaction.

• Increased nutrient requirement due to reduced intake as increased metabolic demands and impaired metabolism causing malabsorption.

• Muscle loss leading to diseases such as Sarcopenia and cachexia.

There are multiple clinical implications of malnutrition in chronic disease as it's associated with:

• Higher infection rates

• Delayed recovery or impaired wound healing

• Increased length of hospital stay

• Poor tolerance to the treatment

• Increased mortality and morbidity