Malnutrition - A Disease Caused by Disease
by A. Kenneth Olson, M.D., Ph.D.
Food provides the energy, essential fats, proteins, vitamins, minerals, and trace elements which our bodies require to maintain health and to help restore health after disease occurs. If the body does not fully receive daily all of the essential categories of nutrients listed, each organ system of the body will tend to function less efficiently and at levels significantly less than optimally. This nutritional lack is called malnutrition and may be manifested by a wide number of significant symptoms ranging from lack of energy and fatigue to death, which occurs with advanced stages of malnutrition.
Malnutrition is a disease which commonly occurs throughout the world and is not limited to the wasted, starvation picture portrayed in undeveloped, third world cultures. In our country it is estimated that 25% of the non-hospitalized elderly population meet standard criteria for the diagnosis of malnutrition. Finally, it is estimated that approximately 25-50% of ill individuals at the time of admission to a hospital already meet standard criteria for malnutrition. Thus, with such a high prevalence of malnutrition present amongst ill persons, this represents a disease state in epidemic proportions. It is particularly notable that this occurs within the context of an otherwise highly developed, wealthy culture.
The development of malnutrition is usually the result of an interaction of several factors which create a decreased nutrient (food) intake relative to the body's physiologic needs. The most important factor is loss of appetite. This may occur in the presence of virtually any disease state and/or its treatment. For example, loss of appetite and weight loss may occur with cancer, heart disease, lung disease, digestive disorders, infection and fever, chronic pain, or depression. Loss of appetite and weight loss may also occur with therapies that include surgery, medication, chemotherapy, radiation, or treatments for chronic pain. Inactivity secondary to the presence of a disease and its treatment may also reduce appetite. Finally, increased nutritional needs are often seen in a diseased state and its treatment and is related to the physiologic stresses associated with the disease itself. Thus, the diseased person with poor appetite cannot keep up with the increased nutritional demands. Malnutrition is the result. This is an example of how the presence of one disease state becomes the cause of another disease state i.e., malnutrition in this case.
The practical consequence of the presence of malnutrition associated with another disease is this: there is no organ system which functions normally (let alone optimally) in the presence of a malnourished state. Persons with disease and with an associated malnourished state are at higher risk to have a more prolonged illness, a poorer response to other therapies given, longer hospital stays, increased complication rates including infection, and higher costs in general associated with their medical care. Studies have also demonstrated that there may be a lower likelihood for people to return to the hospital setting for treatment when their nutritional state is properly maintained.
Malnutrition is a disease process frequently precipitated by the presence of another disease. It is virtually 100% treatable. When recognized and treated properly, it frequently allows patients to experience a significantly higher quality of life, increased sense of well being, and an enhanced ability to more effectively respond to all other therapies being rendered.