What are the treatments for reversing malnutrition?

From the Guidelines

To reverse malnutrition, a comprehensive approach including gradual refeeding, nutrient supplementation, and addressing underlying causes is essential, with the most recent and highest quality study 1 emphasizing the importance of optimizing nutritional status before elective surgery in patients with inflammatory bowel disease (IBD). The approach should begin with small, frequent meals that slowly increase in caloric content to avoid refeeding syndrome, which can cause dangerous electrolyte shifts.

• Provide a balanced diet rich in proteins (1-1.5g/kg body weight daily), complex carbohydrates, healthy fats, and micronutrients.
• Essential supplements include multivitamins, vitamin D (800-1000 IU daily), vitamin B complex (particularly B12 and folate), iron (ferrous sulfate 325mg daily for deficiency), zinc (20-40mg daily for 2-3 months), and calcium (1000-1200mg daily).
• Ensure adequate hydration with 2-3 liters of fluid daily. For severe malnutrition, medical supervision is crucial, possibly requiring specialized formulas like F-75 followed by F-100, or commercial products such as Ensure or Boost (1-2 servings daily) as recommended by 1 and 1. Treat any underlying conditions contributing to malnutrition, such as infections, malabsorption disorders, or mental health issues. Monitor weight gain (aiming for 0.5-1kg weekly in severe cases), electrolytes, and clinical symptoms regularly. The recovery process works by gradually rebuilding tissue, replenishing nutrient stores, and restoring metabolic function while carefully managing the body's adaptation to increased nutrition to prevent complications. In patients undergoing surgery, nutritional support should be initiated in the presence of malnutrition, in those at nutritional risk at the time of surgery, and in patients who are either unable to eat within 5 days postoperatively or cannot achieve an oral intake of > 50% of the recommended intake within 7 days postoperatively, as suggested by 1.

From the FDA Drug Label

The percent of patients gaining five or more pounds at maximum weight gain in 12 study weeks was statistically significantly greater for the 800 mg (64%) and 400 mg (57%) MA-treated groups than for the placebo group (24%). Mean weight increased from baseline to last evaluation in 12 study weeks in the 800 mg MA-treated group by 7.8 pounds, the 400 mg MA group by 4. 2 pounds, the 100 mg MA group by 1.9 pounds and decreased in the placebo group by 1. 6 pounds. A statistically significant difference was observed between the 800 mg MA-treated group and the placebo group in the change in caloric intake from baseline to time of maximum weight change. Thiamine hydrochloride injection is effective for the treatment of thiamine deficiency or beriberi whether of the dry (major symptoms related to the nervous system) or wet (major symptoms related to the cardiovascular system) variety Thiamine hydrochloride injection is also indicated in patients with established thiamine deficiency who cannot take thiamine orally due to coexisting severe anorexia, nausea, vomiting, or malabsorption.

Treatments for Reversing Malnutrition:

• Megestrol Acetate (MA): may be used to treat malnutrition, as it has been shown to increase weight and improve appetite in patients with anorexia/cachexia 2.
• Thiamine Hydrochloride Injection: may be used to treat thiamine deficiency, which can contribute to malnutrition, especially in patients who cannot take thiamine orally due to severe anorexia, nausea, vomiting, or malabsorption 3.

From the Research

Treatments for Reversing Malnutrition

The following treatments can help reverse malnutrition:

• Dietary advice encouraging the use of energy- and nutrient-rich foods 4
• Oral nutritional supplements (ONS) to improve energy, protein, and micronutrient intakes 5, 6, 4
• Parenteral nutrition and intravenous glucose with thiamine supplementation to correct malnutrition and prevent complications such as Wernicke's encephalopathy 7
• Liquid oral nutritional supplements (ONS) to effectively improve nutritional intake and reduce mortality in individuals with multimorbidities 6
• Dietary modifications, including fortification and extra snacks, as part of oral nutritional support 5

Effective Delivery of Nutrition Interventions

The health system plays a crucial role in delivering nutrition-specific interventions, including:

• Providing health services and facilitating care seeking for services 8
• Having a skilled and motivated health workforce, an effective supply chain, demand for services, and access to services 8
• Encouraging the delivery of nutrition interventions at every client-provider interaction and generating demand for services 8

Benefits of Nutritional Interventions

Nutritional interventions can have several benefits, including:

• Improving weight, body composition, and grip strength 4
• Reducing mortality in individuals with multimorbidities 6
• Decreasing the number of hospital readmissions and improving functional measures 5, 6
• Generating savings in health costs and reducing the economic burden of malnutrition 5, 6