How is malnutrition treated?
Recognising the problem is the most important first step. Once individuals and those involved in their care are aware of the problem, often simple measures to increase food intake may be enough to reverse the downward cycle. We know for example that giving nutritional supplements to malnourished patients reduces complications such as wound breakdown by 70% and death by 40%.
Once an individual has been assessed as being at risk of malnutrition it is always necessary to assess the problem in more detail and identify any other factors that are contributing to the problem. Treatment should always be tailored to the needs of the individual, but in general, if a person is able to eat and does not have a diminished appetite, then the first step would to encourage this with a “Food first” approach. This may be in the form of advice on meals, snacks, nourishing drinks and food fortification, but should include setting goals of treatment and a plan for monitoring to ensure that these goals are met.
If simple measures are not working or where the patient has a reduced appetite, then an assessment and support from a dietitian may be needed. In addition to fortifying food and increasing what you eat , there are many different oral nutritional supplements. These should usually only be used under the supervision of a dietitian or doctor. It is also possible that you may need to take a vitamin and mineral supplement – but only if advised to do so by the professional treating you.
For patients who are unable to eat, nutrition can be provided by tube feeding – either into the gut (Enteral) or directly into the bloodstream via a vein (Parenteral). In the UK, both Enteral and Parenteral feeds are manufactured to contain all the nutrients your body needs.
Enteral tube feeding (Enteral Nutrition / EN)
The commonest type of enteral tube feeding uses a tube that is passed through the nose and down into the stomach (a nasogastric tube). This is usually for short term feeding (less than 4 weeks) to provide nutritional support as a patient recovers from illness.
For longer term feeding into the stomach, a tube is usually placed through the abdomen directly into the stomach (a PEG tube, or Percutaneous Gastrostomy tube).
If it is not possible to use the stomach, it is also possible to place tubes into the jejunum (the first part of the small intestine or small bowel). These can either be nasojejunal tubes (short –term) or jejunostomy tubes which are place through the abdominal wall directly (long-term).
For more information on enteral feeding please visit the PINNT website.
Parenteral Nutrition (PN)
If it is not possible to use your gut for nutrition (for example in patients who have lost part of their gut or in whom the gut does not work properly to be able to absorb nutrients) then nutrients can be given directly into the blood stream. The sterile feed is given through a small tube (catheter) placed in a vein and is tailored to ensure that you are given all the nutrients that your body needs. For most patients this is done whilst they are in hospital for no more than a few weeks as they recover from illness. However for some patients, this is their only means of nutrition and they learn to do this themselves at home (Home Parenteral Nutrition or HPN).
For more information on Parenteral Nutrition please visit the PINNT website.