Malnutrition in patients with malabsorption – maldigestion
Malnutrition in patients with gastrointestinal diseases and disorders is very common.
These situations can be divided into two types of syndromes: maldigestion (when the alteration lies in the digestion of food) and malabsorption (when the problem lies in the normal function of the intestinal mucosa).
From a clinical point of view, the syndromes that most often lead to diagnosis are chronic diarrhea and unexplained weight loss. Analytically, they may suggest the presence of malabsorption, for example, the presence of microcytic or macrocytic anemia, hypocholesterolemia, hypoalbuminemia, hypocalcemia, or coagulation disorders.
POOR TOLERANCE TO ORAL NUTRITIONAL SUPPLEMENTS (ONS)
Poor tolerance to complete oral supplements is a common problem that appears in clinical practice when nutritionally managing patients with malnutrition.
The cause may be due to specific ingredients (such as lactose, fructose or gluten) or to other factors (caloric density, osmolarity, % of long-chain fats, etc.), also affecting patients without previous gastrointestinal diseases or disorders.
The patient profiles that usually present poorer tolerance to ONS are oncology patients, geriatric patients and patients with gastrointestinal disorders, as well as those undergoing antibiotic treatments or other medications that affect normal digestive function.
Nutritional Approach
In addition to causal treatment, it is essential to restore a normal nutritional status as soon as possible. An effective treatment must be guided by prior knowledge of the existing deficiencies:
On the one hand, at the micronutrient level: most deficiencies of trace elements (zinc, copper, vitamin B12, etc.) can be treated with different vitamin and mineral complexes available on the market.
On the other hand, at the macronutrient level: the protein or mixed malnutrition experienced by patients can be addressed with oral nutritional supplements. Isotonic formulas (Osm = 280–295 mOsm/L), those formulated with ingredients with high gastrointestinal tolerability (such as medium-chain triglycerides), and those containing soluble fiber are especially recommended, as well as products free of lactose, fructose and gluten.