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The Need for Nutrition

By: Marc Evans Abat, MD, FPCP, FPCGMThe Need for Nutrition

There are a lot of eating fads out there – eat only this, eat more of that, or eat based on whatever characteristics you have.  But for some of us, this is not as simple as ‘eating enough’.  We may be at risk for nutritional problems, particularly deficiencies, as we age.

These deficiencies can be either in the macronutrients (i.e. proteins, carbohydrates, and fats) or in micronutrients (i.e. vitamins, minerals or other cofactors).  Here are some reasons why we can have deficiencies in these nutrients:

  • There are changes in the gastrointestinal tract that changes the number of nutrients that are taken in.  The compliance or capacity of the stomach decreases as we age, predisposing to early satiety.  Changes in the digestive enzymes in the gut may reduce the ability to digest food as well as changes in the ability of the intestines to absorb nutrients.
  • Certain conditions that develop over time may affect food intake. Swallowing problems may arise that limit intake to particular food consistencies. Constipation may make us always full. Medical conditions like lung, kidney, heart, gastrointestinal diseases or diabetes may limit intake to certain types of food only.  Medications may also affect appetite or cause symptoms that limit food intake such as nausea.  Neurological and psychological conditions may also affect both appetite (e.g. depression) and nutrition-seeking behaviors (e.g. dementia).  Alcoholism may lead to nutrient losses and impaired nutrient intake.
  • Food quality also affects our nutritional levels.  Food available in general may be lacking in calories or it may not have the proper proportions of both macro- and micronutrients. A patient may just eat oatmeal for most of his meals, while another one may just avoid eating fruits and vegetables. People in certain localities may not have access to certain foods.

How do nutritional deficiencies manifest?  The symptoms can be protean and subtle at one end or grossly devastating in another end. 

  • Deficiency in the total calorie content leads to weight loss.  The weight loss is related to a reduction in total body fat content or protein loss in the form of muscle wasting (sarcopenia).  Immunity will drastically be impaired, leading to repeated infections.  Wound healing may also be affected.
  • Micronutrient deficiencies present with a multitude of manifestations.  Among these include poor tissue integrity leading to bruisability or bleeding, skin rashes and wounds, visual problems, impaired immunity and wound healing, and abnormalities in other biochemical processes. 

Assessment of nutritional deficiencies can be tedious and costly, especially for the micronutrients.  A good history is a place to start – the medical profile, including all symptoms, and medications should be evaluated. The amount of food eaten in a day, supplements, and access to food should be checked.  Socioeconomic factors like finances or assistance in food preparation should also be assessed.  Anthropometric measurements should be made, including height, weight, skinfold thickness, and body mass index.  A thorough physical examination, including neurological exams, should be made to look for findings that may be consistent with deficiencies.  Laboratory examination should be judiciously done to assess for end-organ effects of the deficiencies. Actual measurement of vitamin or mineral levels is appropriate in specific situations.

Correction of nutritional deficiencies entails a multidisciplinary approach.  The appropriate amounts of calories and the proportion of carbohydrates, proteins, and fat should be provided.  Multivitamin and multimineral supplementation is appropriate, especially in situations wherein deficiencies are highly suspected.  Supplementation may need to commence even without laboratory documentation of the deficiency.  The quality of the supplement should also be taken into consideration since not all preparations of the same nutrient are easily absorbable or utilized.  Any medical conditions that may affect food intake should also be corrected.  Medications should be reviewed and dosages/timing should be modified to minimize effects on nutrient absorption.

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