When you think of malnutrition, images of poverty and emaciation may come to mind. But malnutrition wears many faces and occurs in adults and kids of all ages, sizes and incomes. Read how experts pick up on subtle signs of malnutrition and what you can do to prevent it:
Overweight and Undernourished
It’s no secret that some patients develop malnutrition after weight-loss surgery. But according to new research, some obese patients come to the operating room with already-low levels of key nutrients, especially iron and vitamin D. That’s important, because low vitamin D may boost the risk of inflammation, infection and delayed wound healing after surgery. The bigger implication is that obese people in general may be at risk for malnutrition, although more research with those who aren’t undergoing weight-loss surgery is needed, says Leigh Peterson, a co-author of the new study.
“Obese patients can have malnutrition,” says Peterson, a nutritionist and postdoctoral research fellow at the Johns Hopkins Center for Bariatric Surgery. Believing otherwise is a common misconception. “I think that’s part of the reason our patients aren’t getting tested prior to surgery,” she says. “They think, ‘I eat too much food. Malnutrition is not really an issue for me.'”
Vitamin D has long been tied to bone health, Peterson says, but recent studies also link low levels to increased risk of infection, autoimmune problems and even cancer. Rickets, which involves weak or deformed bones, is resurgent in the U.S., she notes. “We spend a lot of time inside and we don’t get a lot of sun exposure, so it’s becoming more common. Obesity is a risk factor for vitamin D deficiency, too.”
Whether you’re obese, overweight or just not sure you’re eating well, these steps can steer you in the right direction:
— Work with a dietitian to create a healthy meal plan.
— A little sun goes a long way. Spending just 15 minutes outdoors without sunscreen activates vitamin D.
— Ask your health provider if you should have blood testing for possible nutritional deficiencies.
— If key nutrients are low, discuss whether supplements are right for you.
— Mix it up when you eat, Peterson advises. Vary your salad veggies, for instance, and don’t make daily potatoes your sole source of starch.
— Eat the rainbow. “Things that have the same colors tend to have the same nutrients,” she says. “If you don’t like carrots, sweet potatoes have a lot of the same nutrients.”
Kids at Risk
“About 17 percent of U.S. kids are obese,” says Tiffani Hays, director of pediatric nutrition, education and practice for the Johns Hopkins Health System, “and it’s increasing every time we do a survey.” But the rate of under-nutrition among kids is unknown. Fortunately, child malnutrition isn’t common in this country, Hays says: “We see it usually in the context of hospitalized cases. Kids with acute or chronic diseases, kids with specialized health care needs and in a lot of adolescents with disordered eating.”
It’s also an issue in communities with food insecurity — when access to or availability of healthy, nutritious food is lacking. While school lunch and breakfast programs help, Hays says, kids may not have enough time to actually sit and eat. “There’s also a lot of socializing that happens at lunch,” she says. “You’re not required to eat it. And a lot of kids will choose socializing over hunger, if it’s not extreme.”
Kids who don’t take in enough nutrients may just stop growing, Hays says. “You’ll see kids who look fine — they just look a couple years younger than they actually are. Because their bodies conserve and store vitamins and nutrients at the expense of growth and development. They just will not grow taller and their brains will not grow at the normal rate while they’re saving their nutrient resources.”
Calcium and iron deficiencies are big issues for kids, along with gaps in total calories and protein. Infants and toddlers with feeding or weaning issues can get off to a poor nutritional start. “One risk is formula preparation,” Hays says. “Families could possibly be not mixing formula correctly, or they could be trying to make it last longer.” As toddlers reach a certain age, she says, the Women, Infants, and Children (WIC) allotment of formula no longer fully meets their needs.
It’s rare that an older preschooler needs urgent treatment for malnutrition alone, Hays says, but it happens. Immune problems and iron-deficiency anemia can result, with kids having symptoms such as bruising easily or developing frequent infections. Kids with severe food allergies face malnutrition if not properly diagnosed. Parents may try to protect toddlers by overextending breast-feeding or sticking with the few foods older kids can tolerate. “Then, it’s only so long until they have to come in to the hospital,” Hays says. “They need some kind of rehabilitation, and we have to get pretty creative with those kids.” Kids with inflammatory bowel disease can also struggle with maintaining good nutrition.
For any parent, staying on top of nutrition can be a challenge. The following tips can help:
— Keep track of kids’ growth. “Monitoring your child’s growth – where they are on the growth chart and following their growth curve — are very important indicators of proper nutrition,” Hays says.
— As children move on from breast- or bottle-feeding, the American Academy of Pediatrics offers guidelines for possibly adding iron and vitamin supplements, and when to introduce solid foods.
— The USDA website ChooseMyPlate.gov shows parents how to balance kids’ meals.
— Watch out for food-group refusers, Hays says. If a child won’t take any dairy or refuses all meat as a toddler, bring this up with your pediatrician and ask about food alternatives.
— If kids don’t drink milk, consider fortified foods. Calcium-enriched orange, apple and cranberry juices or fortified cereals and breakfast bars can help fill nutrient gaps.
— Be patient with picky eaters. “They will go on food jags where they only like a couple foods at a time,” Hays says. “But if you do keep offering food to them, they do mix it up.”
— Encourage family meals and expose kids to the same foods as the rest of the family. “Expect that kids will try foods from the family table,” she advises, “and they’ll sit and eat there, versus in the car or in front of the TV.”
Spotting Malnutrition in Seniors
Malnutrition among older adults has been called a hidden epidemic, and statistics are sobering. According to the National Council on Aging, about 15 percent of all U.S. seniors face the threat of hunger. Food insecurity increased to nearly 9 percent of senior households in 2013. Seniors in certain groups are at the highest risk for hunger and malnutrition, according to the NCOA. Those who live in Southern states, have disabilities, are African-American or Hispanic, or who live with a grandchild are more vulnerable. Isolation is another factor. If you have an older relative who is living alone, who is no longer able to drive or who has trouble preparing or eating healthy foods, he or she can develop malnutrition.
Terese Scollard, a registered dietitian at Providence Health and Services in Portland, Oregon, says health professionals should use screening tools designed to pinpoint patients at risk for malnutrition. “I highly recommend it be done for seniors annually, or when there has been a medical event or when a surgery is expected,” she says. Older adults, concerned family members or caregivers can fill out a simple nutritional self-assessment. By responding to items on food intake, weight loss, mobility, recent stress and severe sadness, you’re able to score the nutritional status — and know when to consult a health care provider. As an older adult, family member or caregiver, here’s how to make nutrition a priority:
— Keep an eye on eating habits and watch for weight loss.
— Choose food plans that work well for seniors.
— Ask your doctor how prescribed medications can affect nutrition.
— For seniors with difficulty obtaining or preparing healthy food, look into programs like Meals on Wheels.
— Seniors with limited incomes may be eligible for USDA’s Supplemental Nutrition Assistance Program.
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Malnutrition: It’s Not Always What You Think originally appeared on usnews.com
