Lab Testing for Malnutrition

 Malnutrition just means ‘bad nutrition.’ This is a condition where a disparity exists between how much food and nutrients a body needs for optimal functions and growth and the actual amount it takes in or absorbs.  This imbalance usually happens with undernutrition, and so that’s the primary emphasis of this content. However, it can be the result of overnutrition, too. 

Chronic overnutrition can result in obesity and even metabolic syndrome, which is a set of multiple risk factors usually characterized by unhealthy levels of lipids, hypertension/high blood pressure, abdominal obesity, and insulin resistance, which is a reduced ability for processing glucose. Those who have metabolic syndrome are known to have higher risks of developing both cardiovascular disease and type 2 diabetes. Another unusual form of overnutrition is that of mineral or vitamin toxicity. This usually happens with excessive supplementation, for example, with higher doses of specific fat-soluble vitamins, like vitamin A, coming from supplements instead of food. Symptoms of toxicity depend on the particular substance or substances that are ingested, how severe the overdose is, and whether the situation is chronic or acute. 

Undernutrition happens if one or more crucial nutrients aren’t present or even available in sufficient quantities for normal function and development of the human body. This can happen because of increased levels of demand, an increase in losses, insufficient volumes of intake, or even a disease or condition which lowers the body’s power to absorb and digest nutrients from food. Even though the necessity of adequate nutrition is an eternal constant, the specific demands any human body has will vary over the course of time. 

During the time of pregnancy, sufficient nutritional support is essential for a fetus to grow and develop normally. Folic acid deficiency during pregnancy might result in birth defects and raise the risks of preterm delivery and low birth weight. 

Kids might develop marasmus, which is a condition where the person is severely deficient in protein and calories due to a serious shortage of food consumption. Marasmus often involves stunted growth and a thin body. If a child has enough calories but not enough protein, then they might develop kwashiorkor, which is a condition characterized by delayed development, apathy, an enlarged liver, and edema/fluid accumulation. Deficiencies in particular vitamins might also impact the formation of bones and tissue. For example, vitamin D deficiency impacts bone formation, resulting in rickets. Around the globe, roughly 1 in 3 childhood fatalities are related to malnutrition somehow. Intestinal parasites and food shortages are the primary causes of malnutrition throughout the developing world. In the United States, the majority of instances of malnutrition are attributable to imbalanced and poor diets. 

Acute conditions, including trauma, infections, serious burns, and surgery, all have the capacity to seriously increase a human body’s nutritional requirements for a short while. Those who are malnourished for a stretch of time might have a poorer prognosis and weakened immune systems. They often need more time to heal from their surgical procedures, and so they need more days of hospitalization. Given this, quite a few doctors screen and also monitor the specific nutritional status of any hospitalized patients. Patients that have surgery typically have evaluations both in advance of their surgery and also during their recovery. 

Chronic diseases might be related to nutrient loss, heightened demands for nutrients, and/or malabsorption. Malabsorption might happen in the event of chronic diseases, which include pernicious anemia, pancreatic insufficiency, cystic fibrosis, and celiac disease. Higher rates of nutrient loss can happen with excessive bleeding, diarrhea, and chronic kidney disease. There are times that both conditions and their respective treatments can result in malnutrition because of lowered intake. One instance of this would be cancer and chemotherapy that result in lower appetite, nausea, and difficulty swallowing. Those who are chronic abusers of alcohol and/or drugs might get insufficient nutrition, fail to absorb sufficient nutrition, and just lose nutrients. 

Senior citizens don’t need as many calories, but they still need proper and sufficient nutritional support. They’re often less capable of absorbing nutrition, given how they have lower production levels of stomach acid. They might also have one or even multiple chronic ailments that might impact their nutritional status at the time. Simultaneously, they might even have a hard time making meals and even have lower access to various nutritious foods. Older individuals also commonly eat less given a lowered sense of smell, not as much appetite, and mechanical complications with chewing and/or swallowing. 

Symptoms/Signs 

General malnutrition is something that usually develops quite slowly over the course of many months, if not years. As the stores of nutrition in the human body are depleted, there are changes that start happening down at the very cellular level, which impacts biochemical processes, negatively influencing the ability of the body to fight infections.

In time, various symptoms might start emerging, including but not limited to, the following: 

  • In children and youth, listlessness, bloated abdomen, and slow/delayed growth 
  • Anemia 
  • Joint/bone pain 
  • Brittle, malformed (spooned) nails 
  • Brittle and thinning hair 
  • Chronic diarrhea 
  • Dry, scaly skin 
  • Goiter, or enlarged thyroid gland 
  • Edema, or fluid accumulation 
  • Mental changes including irritability and confusion 
  • Slow healing of wounds 
  • Weight loss, weakness, and less muscle mass 

Certain nutrient deficiencies might result in characteristic symptoms. For example, a lack of vitamin B12 might lead to nerve damage resulting in numbness, tingling, and burning in the extremities. On the other hand, insufficient vitamin A might result in higher sensitivity to light and night blindness, whereas not enough vitamin D might trigger osteomalacia, bone malformation, and bone pain. How serious the symptoms are usually depends on how long the deficiency transpired and how intense it was. Certain changes, especially to the nerves and bones, might not be reversible. 

Tests for nutritional deficiencies and current status: 

  • Iron tests include ferritinserum iron, and transferrin and iron-binding capacity. 
  • Trace minerals and vitamins tests include magnesiumcalciumB vitaminsB12 specificallyvitamin Dvitamin A, and folate
  • Prealbumin is frequently used as a malnutrition marker, but the levels of this particular protein might be impacted by several conditions aside from malnutrition. Research is ongoing to understand further what roles prealbumin plays in the human body, particularly for reasons behind changes noticed during a time of illness, as well as the clinical utility of any and all prealbumin testing. 
  • Albumin was used previously alongside or even in lieu of prealbumin for the evaluation of nutritional status. Currently, it’s more frequently employed to screen for and assist with the diagnosis of kidney or liver disease. 
  • Leptin: Suppressed levels of this might indicate patients with malnutrition, but this test isn’t available widely just yet. 
  • Celiac Disease blood tests measure the amount of particular antibodies that are present in the blood. 

Laboratory tests for general screening and monitoring include: 

Albumin 

Complete Blood Count (CBC) 

Comprehensive Metabolic Panel (CMP) 

Total Protein 

Lipid Panel 

Non-laboratory tests 

  • Imaging and radiographic sans may be utilized to gauge internal organ health and bone/muscle growth and development: 
  • X-rays 
  • Computed Tomography (or CT) 
  • Magnetic Resonance Imaging (or MRI) 

Undernutrition treatment modalities include: 

  • Reestablishing missing nutrients by eating nutrient-rich foods and taking supplements for specific deficiencies.  For people with severe malnourishment, reestablishing missing nutrients needs to be done slowly while the body adjusts. 
  • Regular monitoring of people with chronic malabsorption disorders or nutrient-losing or protein-losing conditions.  A treatment plan is critical to prevent a recurrence.