Malnutrition is a word or a condition that all of you have heard. But do you know exactly what malnutrition means? Maybe you know, maybe you don’t.

So for all of us to know,

What is malnutrition?

The World Health Organization states that malnutrition refers to, deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilisation ^[1]. This simply means that,

• Low or high nutrient intakes
• Not taking enough nutrients that your body needs to function
• The body’s inability to absorb or use nutrients

Is defined as malnutrition.

Research shows that the malnutrition in Sri Lanka ranges from 24%-74%. Sri Lanka is a country with low middle income ^[2]. With the recent economic and food crisis, the malnutrition status of the country rose rapidly.

Older age is one of the most common factors that can cause among elderly. Malnutrition in elderly can be a challenging health concern if not diagnosed and treated properly. It can weaken the immune system, increase the risk of infection, elevate the risk of falls, fractures and reduce wound healing as well. Malnutrition can cause a variety of other complications that can affect daily living and the quality of life for elderly in general.

Most of us think that malnutrition means low body weight in people who do not or can not eat properly. But is that the only case? Let’s find out.

Types of malnutrition in adults

Malnutrition includes two types of major conditions under it. They are undernutrition and overnutrition. They are made up of macronutrients (proteins, carbohydrates and fats) and micronutrients (vitamins and minerals) imbalances.

1. Undernutrition
   

   As the name implies undernutrition is the condition where the body does not get an enough supply of the nutrients to work in its ideal conditions. This is the condition most popular as malnutrition. The most common micronutrient deficiencies in Sri Lanka are iron, vitamin A and iodine deficiencies ^[3].

2. Overnutrition
   

   This is the condition where the body gets an excessive amount of nutrients, leading to the deposition of body fat. This is the malnutrition condition that causes overweight and obesity ^[4]. Overnutrition is a major reason for a long list of diet related non communicable diseases like heart diseases and type 2 diabetes.

Malnutrition is a widespread nutritional problem. There are a countless number of reasons why elderly can get affected by malnutrition.

Risk factors for malnutrition in Sri Lanka

1. Social and Demography

   • Advancing age
   • Being female
   • Being single
     
     
   • Low education
   • Living alone
   • Having no responsibility in food shopping

2. Financial status

   • Poverty

3. Food and appetite

   • Loss of appetite
   • Smoking and alcohol consumption
   • Betel nut chewing

4. Lifestyle and physical status

   • Being inactive

5. Psychological status

   • Lack of interest
   • Loneliness
     
     
   • Dementia
   • Depression

6. Oral care

   • Tooth loss
   • Swallowing difficulties
   • Tasting difficulties

7. Other diseases

   • Food allergies
   • Diabetes
   • Low vision
   • Cancer
   • Malabsorption
   • Thyroid issues^{[5] [6] [7]}

As you can see, most of these are age related risk factors. Understanding these factors can be very crucial in addressing this problem effectively. Often, these factors interact with each other and can worsen malnutrition. For example, while poverty can limit access to healthy foods, dental problems can reduce the food digestion and absorption. Importantly, elderly who live alone with low incomes are more at risk.

By acknowledging these social, economic, and health-related factors, as well as the influence of cultural practices, we can create a more comprehensive understanding of the challenges of adult malnutrition in Sri Lanka. This knowledge is essential for developing effective interventions and promoting healthy eating habits for a healthier Sri Lankan population.

Symptoms of malnutrition

So what does malnutrition actually look like? Let’s find out.

Undernutrition may look like:

• Weight loss
• Thin arms and legs with edema (swelling due to fluid) in belly and face
• Weakness and faintness
• Irritability and inattention
• Dry skin and rashes
• Hair loss
• Low body temperature
• Low heart rate and blood pressure

Over nutrition may look like:

• Obesity
• High blood pressure
• Insulin resistance
• Heart diseases ^[7]

Until now we have discussed what malnutrition is, its risk factors, signs and its symptoms. Now you may wonder if a person has malnutrition, how to recognize or diagnose it.

How to diagnose malnutrition?

Usually, the mini nutritional assessment short form (MNA-SF), is used to identify malnutrition or specifically, undernutrition in older adults. The most recent version of the MNA-SF consists of 6 questions on food intake, weight loss, mobility, psychological stress or acute disease, presence of dementia or depression, and body mass index (BMI) ^[8].

Other than that, laboratory tests on different proteins (albumin, prealbumin, transferrin, retinal binding protein, insulin-like growth factor-1, and fibronectin), white blood cells, blood glucose are also used to measure nutritional status and diagnose malnutrition ^[9].

How to manage and treat malnutrition?

When treating undernutrition, dietitian advice can be taken to get a tailored dietary plan for the specific nutrition related issues in a elderly patient.

As general instructions, they may suggest:

• Having a healthy and balanced diet
• Eating foods with extra nutrients like proteins and calories
• Getting healthy snacks in between major meals ^[10]

Other than that, undernutrition is generally treated with nutritional supplements. Nutritional supplement formulas with individual micronutrients, high in calories and proteins are given to elderly patients with undernutrition. If the elderly patient is unable to eat or unconscious and can’t get enough nutrients by eating, a feeding tube can be used to make them consume nutrition supplements. The use of feeding tubes are generally done in hospitals under professional medical care ^[11].

Overnutrition is treated using weight, diet and lifestyle changes. Losing weight through diet, exercise plans, medication or medical procedures like surgeries under professional care can help these patients to reverse or reduce the risk of diseases like diabetes ^[7].

Finally, if these are any underlying conditions like mental, thyroid or eating disorders, they also should be addressed gradually under professional medical care.

Conclusion

Early detection and management of malnutrition in Sri Lankan adults is crucial for improved health and well-being. Leaving it unchecked can lead to a cascade of negative consequences, impacting everything from energy levels and immunity to chronic disease risk and overall quality of life. The good news is that malnutrition is preventable and manageable. By seeking professional guidance from doctors or nutritionists, Sri Lankan adults can receive personalised assessments, dietary plans, and support to address any nutritional deficiencies. Early intervention can significantly improve health outcomes and restore a sense of vitality.

Remember, good nutrition is an investment in your health and well-being. By taking proactive steps to address malnutrition and embracing healthy lifestyle choices, Sri Lankan adults can unlock a world of energy, improved physical and mental function, and a stronger foundation for healthy aging. Let good nutrition empower you to live your best life.