Malnutrition isn't just about lack of food. It's an imbalance that impacts muscle and organ mass, leading to diminished physical and mental function and poor clinical outcomes. Over the past 50 years, our understanding of malnutrition has evolved, recognizing it as a serious consequence of chronic and acute diseases.
Two Key Pathways of Malnutrition:
1. Deficiency-Related Pathway:
Caused by inadequate intake or absorption of nutrients.
Conditions like dysphagia after a stroke and short bowel syndrome fall into this category.
·The body adapts by slowing metabolism, protecting protein stores, and relying on body fat for energy.
2. Inflammation-Related Pathway:
Triggered by diseases with underlying inflammation, such as cancers, infections, and critical illnesses.
Unlike simple food deprivation, inflammation increases resting energy expenditure and muscle protein breakdown.
High levels of C-reactive protein (CRP) in chronic diseases like COPD and kidney failure lead to poor nutritional responses and ongoing tissue erosion.
Modern science highlights that malnutrition isn't just about food scarcity. It's deeply linked to underlying health conditions and inflammation. Chronic illnesses and poor health today often have roots in disease-related malnutrition, which can result from decreased appetite and food intake, increased catabolism and tissue breakdown, or both. Recognizing these pathways allows for better-targeted treatments and improved outcomes for those affected.
Let's move away from the classical concept of malnutrition and embrace a nuanced understanding to help those in need.
Cederholm, T. and I. Bosaeus, Malnutrition in Adults. New England Journal of Medicine, 2024. 391(2): p. 155-165.
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