Malnutrition: why chocolate is better than soup

July 2, 2015

Malnutrition is not just a problem seen in developing countries; a large number of Australians also suffer from this condition, which has some very serious consequences. Master of Dietetics student Courtney Pharoah discusses the issue of malnutrition and how it can be treated.

Truffles by
Angélica Portales
. CC BY-NC-ND 2.0

In March of this year, the Dietitians Association of Australia put out a press release encouraging people to look out for older family members who might be malnourished and in need of some extra chocolate or hot cross buns at Easter. Predictably, the press release was met with public outcry; why on earth would a dietitian recommend that someone eats chocolate?!

Too often I hear and see comments like this whenever ‘unhealthy’ food choices are promoted by health professionals. These products certainly have their place and can be useful in either preventing or lessening the effects of malnutrition.

I learnt about malnutrition early on in my lecture series as a Deakin Dietetics student. At first it seemed like a straightforward issue and not a big deal. As we progressed through the weeks and topics, however, I began to get a sense of just how important preventing malnutrition is and just what a huge impact it can have on a person’s health.

So what is malnutrition?

Malnutrition can affect anyone in the community, including the overweight. The 2009 Evidence Based Guidelines for the Nutritional Management of Malnutrition suggest that about 10-30% of the community is malnourished and this soars to 40-70% of people in aged care, and 20-50% of patients in hospitals.

Malnutrition is a state of protein and energy deficiency and is defined as in adults by a BMI of less than 18.5 kg/m2 or unintentional loss of weight of 10% or more with evidence of suboptimal intake resulting in severe loss of subcutaneous fat and/or severe muscle wasting.

So, a malnourished person may look wasted away, gaunt, or weak. And when we assess people who are malnourished, their BMI will typically fall outside of the healthy weight range, or they have lost a significant amount of weight over the last six months and are eating very little. Combined, these factors can create a state of malnutrition which if not treated can have some unpleasant and unwanted side effects such as:

• Longer hospital stays
• Poor wound healing
• Decreased tolerance to cancer treatments
• Decreased effectiveness of cancer treatments
• Increased rate of progression of liver and kidney disease
• Increased risk of falls in the elderly
• Decreased muscle mass leading to generalised weakness and decreased respiratory muscles strength which increases the risk of aspiration pneumonia.

So the idea is that we want people to avoid becoming malnourished, or at the very least, to halt unintentional weight loss. There’s no conspiracy here, we really want patients to recover quickly so they don’t have to spend a long time in hospital.

What can we do about it?

We can encourage our patients to consume a diet high in energy and protein. This is a temporary diet meant to protect against unintentional weight loss while a person is unwell.

We can also recommend a few different strategies to patients so they can increase their overall food intake by:

• Having small regular meals throughout the day
• Consuming the most energy dense part of the meal first e.g. eat dessert first, then meat/protein component and then the vegetables
• Encourage frequent consumption of favourite foods
• Swapping tea, water and soup for custard, milk-based drinks, fruit juice and soft drink
• If someone is at home we might recommend that extra fats and oils be added in cooking and that fattier cuts of meat and full cream dairy be consumed

Public perception versus reality

Throughout my short time as a Deakin Dietetics student, I have come to learn of the importance of patients avoiding a state of malnourishment and just how much of a difference a high energy and high protein diet can have on the outcomes for malnourished patients.

Many people believe that we need to stuff patients full of the healthiest food in order to get them well again. For example, some people might believe that a vegetable soup is the best option to feed a sick person because it is very nourishing or healthy. The term ‘nourishing’ means something vastly different to a dietitian, however, and in hospitals nourishing food refers to food that contains plenty of energy and protein, as these will help protect against unintentional weight loss.

For a healthy person, a vegetable soup can be a great option, but patients in hospital often have higher energy and protein requirements because of illness or disease and this can often impact on their appetite or ability to eat so often a creative solution needs to be found to get the most amount of energy in, in the smallest volume of food.

So the reality is that some roast meat, a milk-based drink or a pudding is much higher in energy and protein than a bowl of soup, and a better choice for a malnourished patient who has very little appetite.

In summary, malnutrition is a serious issue facing many members of our community. The effects are many and varied but we can treat it with a high energy, high protein diet. A high energy, high protein diet doesn’t look like a conventionally healthy diet, but it is the best thing for malnourished patients who might need a little extra energy to support them through their illness.

Courtney is currently studying to become a dietitian. She is passionate about challenging the norm of what ‘healthy’ looks like and encourages people to find their healthy, whatever that looks like to them. You can read more of her articles at nogreensmoothies.com and connect with her on Twitter and LinkedIn.