What are the strategies for reversing malnutrition in individuals with disabilities?

From the Guidelines

To reverse malnutrition in individuals with disabilities, oral nutritional supplements (ONS) should be offered as a cost-effective way of intervention towards improved outcomes, with a focus on high protein nutrient-specific ONS to maintain functional status and muscle mass, reduce mortality, and improve quality of life. This approach is supported by the most recent and highest quality study, which recommends individualized provision of nutritional support via ONS to reach energy and protein requirements, improving nutritional status, quality of life, and overall survival 1.

Key Strategies for Reversing Malnutrition

• Implement a comprehensive approach combining nutritional assessment, dietary modifications, and supportive interventions
• Develop a personalized nutrition plan that addresses caloric requirements, protein needs (typically 1.2-1.5g/kg body weight daily), and micronutrient supplementation
• Consider texture-modified diets, thickened liquids, or nutritional supplements like Ensure, Boost, or Jevity (1-3 servings daily) for those with swallowing difficulties
• Implement small, frequent meals (5-6 per day) rather than three large ones
• Address physical barriers by providing adaptive eating utensils, proper positioning during meals, and ensuring adequate hydration (1.5-2L daily)

Importance of Multidisciplinary Team

• Involve a multidisciplinary team including dietitians, occupational therapists, and speech pathologists to address specific challenges
• Regular monitoring of weight, laboratory values, and functional status is essential to track progress and adjust interventions accordingly
• This comprehensive approach addresses the complex factors contributing to malnutrition in disability, including physical limitations, medication side effects, and increased metabolic demands, as supported by recent studies 1.

Protein Targets and Nutrition Support

• Protein targets of at least 1.0 g/kg body weight/day have been recommended, but more recent studies support a higher daily protein target of 1.2-1.5 g/kg body weight 1
• To reach high protein targets, several strategies can be used, including ONS, protein-rich hospital menu, food fortification, and high-protein desserts and snacks
• Combination of nutrition with exercise can also have positive effects on daily protein intake and muscle strength, as demonstrated in recent trials 1.

From the FDA Drug Label

Of the 270 patients entered on study, 195 met all inclusion/exclusion criteria, had at least two additional post baseline weight measurements over a 12 week period or had one post baseline weight measurement but dropped out for therapeutic failure 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. Changes in body composition during the 12 study weeks as measured by bioelectrical impedance analysis showed increases in non-water body weight in the MA-treated groups

The strategies for reversing malnutrition in individuals with disabilities are not directly addressed in the provided drug labels. However, the labels do provide information on the use of megestrol acetate in treating anorexia/cachexia and significant weight loss in AIDS patients.

• Key findings from the studies include:
  • Megestrol acetate treatment resulted in statistically significant increases in mean weight change and improvements in appetite compared to the placebo group 2, 2.
  • The 800 mg MA-treated group had the most significant increase in mean weight change, with a mean weight increase of 11.2 pounds from baseline to study week 12 2.
  • Changes in body composition, as measured by bioelectrical impedance analysis, showed increases in non-water body weight in the MA-treated groups 2, 2. However, these findings may not be directly applicable to individuals with disabilities, and therefore, no conclusion can be drawn regarding the strategies for reversing malnutrition in this population.

From the Research

Strategies for Reversing Malnutrition

To address malnutrition in individuals with disabilities, several strategies can be employed:

• Community-based nutrition interventions, which have shown some success in improving health outcomes 3
• Algorithmic approaches to address nutrition-related problems, such as aspiration, laborious meals, and mealtime refusal 4
• Multidisciplinary nutritional assessment programs to identify and treat malnutrition 5, 6
• Comprehensive, multidisciplinary approaches to disease-related malnutrition, coordinated from primary care to hospitals 7

Key Considerations

When implementing these strategies, it is essential to consider the following:

• The importance of interdisciplinary interactions and a team approach to nutritional assessment, therapy, and research 5, 6
• The need for objective outcome measures and inclusion of people with disabilities throughout the development and implementation of programs 3
• The potential for longer hospital stays and higher costs associated with disease-related malnutrition 7
• The importance of addressing the unique nutritional needs and challenges of individuals with developmental disabilities 4, 6