What is the treatment for adult failure to thrive?

Treatment for Adult Failure to Thrive

The treatment for adult failure to thrive requires a comprehensive nutritional rehabilitation approach with high-energy, high-protein dietary interventions targeting 150% of normal caloric requirements for expected weight, combined with identification and management of underlying medical, psychological, and social factors.

Definition and Diagnosis

Adult failure to thrive (FTT) is characterized by:

• Deterioration in biological, psychological, and social domains
• Weight loss or undernutrition
• Lack of obvious explanation for the condition 1

Key diagnostic criteria include:

• Weight below the 10th percentile for age
• Weight that crosses two or more major percentile lines downward
• Weight-for-height below the 10th percentile 2
• Severe malnutrition indicated by weight below 70% of expected weight-for-height (Z-score < -3) 2

Assessment Protocol

Medical Evaluation

• Assess for the four key syndromes predictive of adverse outcomes:
  1. Impaired physical functioning
  2. Malnutrition
  3. Depression
  4. Cognitive impairment 1, 3

Laboratory Assessment

• Complete blood count
• Chemistry panel
• Thyroid-stimulating hormone level
• Urinalysis
• Additional studies based on clinical presentation 3

Nutritional Assessment

• Plot weight on appropriate growth charts
• Calculate weight-for-height ratio
• Determine rate of weight gain/loss
• Evaluate hydration status 2

Treatment Algorithm

Step 1: Nutritional Rehabilitation

• Caloric Requirements: Provide 150% of caloric requirement for expected weight (not actual weight) 4
• Protein Requirements: 3g protein per kg body weight/day 2
• Meal Frequency: Divide into 4-6 meals per day 2

Step 2: Address Underlying Causes

• Medical Factors:

  • Review medications for side effects or interactions
  • Manage chronic diseases
  • Treat infections or inflammatory conditions 3

• Psychological Factors:

  • Treat depression if present
  • Address cognitive impairment
  • Provide appropriate mental health support 1, 3

• Social Factors:

  • Evaluate for social isolation
  • Address food insecurity
  • Assess need for caregiver support 1

Step 3: Nutritional Support Escalation

Based on response to initial interventions:

1. Oral Nutritional Supplements:

   • First-line approach when oral intake is inadequate 5
   • Regular reassessment to determine continued need 5

2. Enteral Tube Feeding:

   • Consider when oral interventions fail
   • Polymeric enteral formulas are typically preferred
   • Route, formula, and timing should be individualized 5

3. Parenteral Nutrition:

   • Reserve for exceptional cases when enteral feeding is not possible
   • Short-term use following major GI surgery
   • May benefit severely compromised patients awaiting transplantation 5

Monitoring and Follow-up

• Adults: Assess every 6 months 2
• Weight Gain Target: 17-20 g/kg/day during recovery phase 2
• Energy Requirements by Age:
  • Adults: Calculate using Schofield's equation for resting energy expenditure plus activity factor 2

Special Considerations

• Refeeding Syndrome: In severely malnourished patients, increase food intake slowly initially and provide phosphate, magnesium, and potassium supplements 6

• End-of-Life Considerations: The diagnosis of failure to thrive in elderly patients should prompt discussion of end-of-life care options to prevent needless interventions that may prolong suffering 3

Multidisciplinary Approach

A multidisciplinary team approach is recommended for persistent or severe failure to thrive, including:

• Primary care physician
• Dietitian
• Social worker
• Mental health professional
• Specialists based on underlying conditions 4

By addressing both nutritional needs and underlying causes, this approach aims to improve overall functional status and quality of life in adults with failure to thrive.