Treatment – Chronic Illness-Related Malnutrition
Jennifer Doley, Mary J. Marian in Adult Malnutrition, 2023
Treatment for malabsorption disorders, like other conditions that can lead to chronic malnutrition, is best addressed by treating the underlying cause. Malabsorption is more challenging in that it is generally not inherently curative, thus is best addressed by appropriate disease management. Treatment may include medications to increase GI absorptive capacity, disease management to reduce exacerbation of inflammation, and pancreatic enzyme replacement. However, MNT is one (or in some cases the only) treatment for chronic disease-related malnutrition caused by malabsorption. Successful MNT strategies depend on the condition and should be individualized to the patient, as symptoms and food intolerances can vary widely. Interventions may include avoidance of offending nutrients or foods, diet changes to reduce inflammation, and increasing overall intake to compensate for GI losses. See Table 12.4 for common causes, diagnostic tests and treatment for malabsorption.
Nutritional Deficiencies
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Vitamin B6 deficiency may be inherited or acquired. Inborn errors leading to vitamin B6 deficiency may affect its synthesis, transport, or intracellular metabolism. Acquired vitamin B6 deficiency commonly occurs in association with: Alcohol dependence.Pregnancy.Older age.Hemodialysis and peritoneal dialysis.Malabsorption syndromes.Drugs: isoniazid, penicillamine, cycloserine, theophylline, and hydralazine. Vitamin B6 deficiency has also been described in association with phenytoin and carbamazepine.
Gastrointestinal system
Jagdish M. Gupta, John Beveridge in MCQs in Paediatrics, 2020
6.12. Which of the following statements is/are correct in regard to coeliac disease?The gluten-free diet should be continued throughout life.There is an increased incidence in close relatives of affected children.The malabsorption is due to pancreatic deficiency.It is diagnosed on the basis of symptomatic response to a gluten-free diet.Clinical onset is usually recognizable by 4 months of age.
Autoimmune disorders associated with common variable immunodeficiency: prediction, diagnosis, and treatment
Published in Expert Review of Clinical Immunology, 2022
Niloufar Yazdanpanah, Nima Rezaei
Chronic enteropathy (with a pooled prevalence of 5.6% (95% CI: 2.4–8.8, I2 = 91.2) resulted from 2527 patients’ data [197]) with an inflammatory phenotype and in association with autoimmunity, splenomegaly, and hyperplasia of the lymphoid tissue has been reported in CVID patients [9,203]. Although the most common GI complication in CVID is persistent or transient diarrhea, a phenotype of inflammatory bowel disease mimicking ulcerative colitis or Crohn’s disease has been observed (calculated pooled prevalence for IBD-like disease in CVID was 7.6% [197]). The condition results in malabsorption, blood loss, and weight loss. This type of GI complication is recognized after establishing the CVID diagnosis; however, it could be the primary presenting symptom in some cases [204,205].
Nutrition Intake and Nutrition Status of Pancreatic Cancer Patients: Cross-Sectional and Longitudinal Analysis of a Randomized Controlled Exercise Intervention Study
Published in Nutrition and Cancer, 2022
Dorothea Clauss, Ingeborg Rötzer, Christine Tjaden, Thilo Hackert, Joachim Wiskemann, Karen Steindorf
Moreover, our results suggest that the patients have apparently eaten an adequate diet. This can be seen in the good energy supply of the patients. Also, the fact that only two patients received parenteral nutrition shows that the energy amount was obtained mainly from food and not from supplements. However, we do not know whether they were also sufficiently nourished. Metabolic parameters such as albumin and C-reactive protein (CRP) provide important additional information about whether the energy intake was adequate, or whether malabsorption is present or not. For example, Hypoalbuminemia, defined as a serum albumin level <35 g/L, is a common surrogate marker of malnutrition (32). Malabsorption is the inadequate absorption of nutrients from food into the body’s circulation (3) due to a disruption of flow of pancreatic enzymes. An inadequate intake of nutrients combined with a pathologic process of increased nutrient consumption may result in a catabolic state (1). In addition to metabolic parameters such as albumin and CRP, a stable body weight may also be used as a marker for an adequate energy intake. The body weight of our study population was stable or increased minimally over the study period. If this aspect of stable body weight is taken into account, the energy intake of our patients would seem to have been adequate. However, we had no data on albumin or CRP, so we could not conclude with certainty whether the nutrients that the patients ingested with their food were actually absorbed by their bodies.
Celiac disease antibody levels reflect duodenal mucosal damage but not clinical symptoms
Published in Scandinavian Journal of Gastroenterology, 2021
Aki J. Käräjämäki, Juha Taavela, Christian Nielsen, Mårten Lönnqvist, Marcus Svartbäck, Katri Kaukinen, Risto Tertti
Although one would logically assume that the symptoms of CD and duodenal damage are linked, the literature is highly controversial on this matter. Some studies have not found any association between symptom severity and duodenal damage [14–16]. However, in a large patient cohort utilizing precise continuous Vh/CrD measurements of duodenal damage, a significant, albeit very small, correlation between gastrointestinal symptoms and architectural duodenal damage could be shown [17]. Hence, it seems that the logically assumed link between symptom severity and disease activity seems to be very low in CD patients and rarely seen in clinical practice. Interestingly, in the present study, those CD patients whose tTG-ab was elevated more than ten-fold above ULN had fewer GI symptoms than those with lower tTG-ab titer. Additionally, the patients with high tTG-ab had more severe duodenal damage at the time of diagnosis and, presumably because of it, more often signs of malabsorption, such as microcytosis, an undirect surrogate of iron deficiency, and low vitamin D level. Presumably, malabsorption may be one reason behind the greater prevalence of general disease symptoms as well.
Related Knowledge Centers
- Anemia
- Calcium
- Chloride
- Gastrointestinal Tract
- Malnutrition
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- Sodium
- Small Intestine
- Nutrient
- Vitamin