Undernutrition

Once a week, in the morning, with the date. Only the series shows whether there is a direction — and it convinces at the appointment more than any estimate.

Someone who fills up quickly cannot manage bigger portions. Add cream, butter, oil, nut butter, cheese and egg into what is being eaten anyway — same amount, considerably more energy.

Muscle only builds when enough comes together per meal. An egg in the morning, quark or cheese at midday, fish or pulses in the evening works better than everything at once.

After weeks of very little food the first big plate is not a good idea. Phosphate, potassium and magnesium can crash, and vitamin B1 belongs with it. This is the one point where guidance is genuinely needed.

Unintended weight loss is a finding in its own right. Teeth, swallowing, mood, medicines, gut and thyroid belong gone through before it stays at feeding up.

Without loading, what is taken in lands in fat rather than muscle. Twice a week a little resistance is enough to change the direction — even at a great age.

A worm infestation takes nutrients away before they arrive and shows in children as a break in the weight and growth curves, as pallor and as restlessness at night. In children from regions where it is widespread the examination is specific.

A heavy worm load costs children weight, protein and growth even with enough on the plate. Roundworm, whipworm and hookworm belong in the first work-up with origin in warm countries.

A single-celled organism in the small bowel can disturb the uptake of fat, iron and fat-soluble vitamins for months. The stool shines, smells strong and floats; after treatment the lining recovers. The hookworm also takes a little blood every day — the two together explain pallor and stalled growth.

Roundworm, whipworm and hookworm share the same conditions and are usually found together. In children from warm countries they cost weight, iron and growth even with enough on the plate.

Nutritional drinks supply calories and protein — they do not replace food and work best between meals, because otherwise they take the appetite for the meal. In severely undernourished people the first week is critical: give too much too fast and phosphate, potassium and magnesium fall — so it is raised slowly and thiamine given first. Appetite stimulants work weakly and have side effects; looking for the cause achieves more.

Undernutrition counts as unintended weight loss of more than five per cent in three months or more than ten per cent regardless of time, plus a BMI under 20 in people over seventy. Protein needs rise with age to about 1.0 to 1.2 grams per kilo a day. In refeeding severely undernourished people, phosphate, potassium and magnesium fall in the first three to five days — which is why it starts at about half the requirement.

Often others notice before the scales do. One belt hole less or a watch that slides are concrete signs worth taking seriously.

Fat stays, muscle goes. So an unremarkable BMI does not rule out undernutrition — strength says more than the scales.

Less appetite, feeling full quickly, meals skipped. In conversation this piece of information is worth more than any laboratory value.

A pressing denture, an aching tooth or choking while drinking explain a great many cases — and are readily put right if someone asks.

After a loss, living alone or with depression, cooking for one becomes a hurdle. That is no side issue but one of the commonest causes of all.

What a deficiency makes visible on the body — skin, nails, tongue, eyes and nerves. The signs are unspecific: they show where to look, they prove nothing.

The same holds whatever the reason: too little energy over weeks — through illness, sport or too little food — interrupts the cycle.

The value that counts during rebuilding. If it falls in the first days, that is the most important warning sign — together with potassium and magnesium.

Often read as a nutrition value, but above all an inflammation value: in acute illness it falls regardless of eating. It describes the situation but does not measure nutrition.

Two of the gaps that make themselves felt fastest and are the simplest to close.

Anaemia deepens the weakness and is often found in passing during weight loss. An unexplained iron deficiency always needs an explanation of its own.

The single most important hint of worms in the blood. They are raised with worms that travel through tissue — not with giardia, threadworms and amoebae, which stay in the bowel. A normal value therefore rules nothing out.

Commonly low.

Scarce with limited diet.

Often low.

Supports muscle.

Broad cover.

If deficient.

Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.

Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.

Falls with fatty tissue and reports shortage to the brain. The body then throttles everything that costs energy — cycle, warmth, bone building, defences.

Falls quickly with a shortfall and is thus a sensitive measure of the nutritional state — in children it shows as a break in the growth curve.

The body throttles the conversion into the active hormone to save energy. That explains feeling cold, a slow pulse and constipation — and it is not a thyroid illness.

Rises with a lasting shortfall and additionally breaks muscle down. That is the reason why keeping strength counts just as much as the number of calories when rebuilding.

Small frequent meals.

Energy density rather than volume: oil, nuts, full-fat dairy and nutritional drinks deliver a lot in a small amount. After longer starvation the build-up is slow and supervised, because phosphate and potassium otherwise fall.

Without a stimulus the energy supplied tends to be laid down as fat. Light strength training directs it into muscle — in refeeding studies the two belong together.