Malnutrition - What is it exactly?

By Corinne Cox (Advanced Accredited Practicing Dietitian, Meals on Wheels NSW)

What is malnutrition?
Malnutrition occurs over time when a person does not meet their body’s nutritional requirements – this might be due to deficiencies (not enough), excesses (too much) or imbalances in nutrient intake. The term malnutrition refers to both undernutrition and overnutrition. Undernutrition is a huge concern for the older population in Australia (and around the world), and can happen because they are not eating enough food, or eating the wrong type of food, or they are unable to absorb the nutrients from the food that they eat for some reason. Overnutrition is caused by an excessive intake of energy and nutrients, causing imbalances and possibly leading to obesity and diet related diseases.

Effects of malnutrition (undernutrition)
  • Weight loss and muscle wasting which reduces mobility and can lead to falls
  • Poor wound healing, slow recovery from illness
  • Reduced immune function, more likely to get sick
  • Effects on the brain include depression, self-neglect and reduced social interactions
Who is at risk of malnutrition?
  • People over the age of 65 years, especially those living in supported care
  • People with chronic health conditions such as diabetes, kidney disease or chronic lung disease
  • People with chronic conditions such as dementia and cancer
Why are older people at risk of malnutrition?
These things are concerns in the older population, and may contribute to a reduced oral intake (and may lead to undernutrition):
  • a reduced appetite,
  • reduced taste perception,
  • chewing or swallowing difficulties,
  • depression or cognitive decline,
  • following a restricted diet for health reasons e.g. low fat for high cholesterol,
  • reduced ability to digest and absorb nutrients.

What are the nutritional requirements of older people?
Nutritional requirements are different for everyone, and depend on body size, activity level and general health. Nutritional needs are higher if the person is acutely unwell (e.g. has a cold or flu, or is recovering from surgery), or has a chronic condition such as Parkinson’s Disease (where they experience involuntary movements) or dementia. Weight loss is not a normal part of the ageing process, so it should be viewed with concern – it means that the person is not eating enough food to meet their body’s needs. Older adults also need more protein, calcium and vitamin D than younger adults.
What can you do to help if someone is losing weight?
If you know someone who you think is at risk of malnutrition then it is recommended that you talk to their General Practitioner or an Accredited Practising Dietitian to get some assistance, but here are some ideas to help as well:
  • Encourage frequent meals and snacks.
  • Make sure every mouthful counts – offer milk based drinks, or fruit /vegetable juices or even soft drink or cordial as a drink with meals (rather than water or diet drinks) to provide some energy (kilojoules or calories).
  • Increase the energy content of meals and snacks by adding margarine or butter e.g. spread butter (or margarine) on fruit cake, scones, pound cake or sweet biscuits as a snack, or add butter (or margarine) to vegetables to increase flavour and kilojoule content. Add cream or sour cream to soups. Add cheese to anything you can, or add yoghurt, custard or cream to fresh or canned fruit.
These are just a few ideas for ‘Food Fortification’ – look out for more on this in the next edition!