Malnutrition can have detrimental effects on outcomes and increase health care costs. Registered dietitian nutritionists often are considered the experts on malnutrition, and health care facilities frequently rely on RDNs to determine whether patients or clients have or are at risk for malnutrition.
While factors such as muscle loss and diminished handgrip strength are considered when diagnosing malnutrition in adults, some related contributing factors may be overlooked or underestimated, such as functional mobility. This could potentially be remedied — or at least improved — if RDNs collaborate with fellow health care professionals, particularly physical therapists.
What Is Malnutrition?
The Academy of Nutrition and Dietetics defines malnutrition as the “inadequate intake of protein and/or energy over prolonged periods of time resulting in loss of fat stores and/or muscle stores, including starvation-related malnutrition, chronic disease orcondition-related malnutrition and acute disease or injury-related malnutrition.” Malnutrition can occur in people who are both underweight or overweight (including obese) and is also known as “poor nutrition” or “undernutrition.”
It has been estimated that up to half of all patients entering the hospital are malnourished or at risk for malnutrition. Yet during their stay at an acute care facility, only 7 percent of patients aretypically diagnosed with malnutrition, which can lead to poorer outcomes. For instance, malnourished surgical patients are two to three times more likely to experience complications or death after a procedure, and hospital costs can be twice as much for someone with malnutrition.
- 20 to 50 percent of patients in acute care
- 14 to 51 percent of patients in post-acute care
- 6 to 30 percent of patients in community care
Source: Malnutrition Quality Improvement Initiative
Functional Mobility and Malnutrition
While the cause and remedy of malnutrition may seem as straightforward as making changes to the diet, there are several factors to consider. For example, functional mobility: the ability to move and perform everyday tasks or activities of daily living, such as standing up from a chair, getting out of bed, brushing the teeth or taking a shower — anything that involves moving to perform common daily tasks.
Impaired functional mobility can hinder a person’s access to proper nutrition and hydration. For instance, a decrease in the ability to stand for long periods may render a person unable to cook at home. A decreased ability to walk and drive may prevent someone from being able to go to the grocery store. Additionally, decreased functional mobility can impact fine motor skills such as the ability to hold utensils, pick up a pot or pan, or hold a glass of water long enough to drink.
Understanding a patient’s or client’s functional mobility is critical when making nutrition recommendations for treating or preventing malnutrition. For example, if a patient or client is sent home on enteral or parenteral nutrition, do they have the strength and ability to set it up independently? Can they walk around the house with it, or will it impede their mobility?
TWO OR MORE OF THE FOLLOWING SIX CHARACTERISTICS:
- Insufficient energy intake
- Weight loss
- Loss of muscle mass
- Loss of subcutaneous fat
- Localized or generalized fluid accumulation (edema)
- Diminished functional status (reduced handgrip strength)
Source: Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition), 2012.
“If the RDN knows a patient has difficulty standing up or that they’re weaker in their dominant hand, the nutrition prescription, advice or education will be different based on the person’s ability to move,” says Patrick Berner PT, DPT, RDN, who owns Fuel Physio LLC in South Carolina and serves as adjunct faculty for doctor of physical therapy programs at Baylor University, Anderson University and South College.
Working with Physical Therapists
Berner says collaborating with PTs can help RDNs get a better grasp on a patient’s or client’s functional mobility. He likens it to getting a different perspective or deeper look, since it’s not uncommon for PTs to get more time or more frequent visits with patients and clients in therapy. PTs may be able to answer an RDN’s questions more accurately or more in-depth than the patient or client. “An RDN can get a general sense of mobility status by asking the patient questions, but the difficult component is that the RDN may get a different answer than what the PT assesses,” Berner says. For instance, a patient or client may tell the RDN they can stand, but the PT can provide more detail, such as the person can stand only with assistance and no longer than 10 minutes at a time.
Likewise, Jacob Mey, PhD, RD, a postdoctoral research fellow at Pennington Biomedical Research Center’s Integrated Physiology and Molecular Medicine Lab, at Louisiana State University, believes the benefits and importance of collaborating with PTs is reciprocal. “PTs’ goals are to support the physical recovery of the patient, and we know nutrition can help that recovery,” Mey says. “PTs can reinforce nutrition recommendations from the RDN and give additional feedback from the patient that the RDN may not get.”
Both Berner and Mey stress the need for and benefits of RDNs collaborating with PTs and the entire health care team for the treatment of malnutrition.
For More Information
View the webinar Malnutrition Across the Lifespan: Viewed Through the Lenses of Registered Dietitian Nutritionists and Physical Therapists for tips on reaching out to PTs, ways to foster collaboration between dietetic interns and PT students and more.
Learn about the Nutrition Focused Physical Exam Hands-on Training Workshops and how to attend.
Read the Journal of the Academy of Nutrition and Dietetics article “Malnutrition Care During the COVID-19 Pandemic: Considerations for Registered Dietitian Nutritionists” for guidance on nutrition care for adults with suspected or confirmed COVID-19 infections in various health care settings.
Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. [Malnutrition (undernutrition) (NC4-1)].
Bou?a-Machado R, Maetzler W, Ferreira JJ. What is Functional Mobility Applied to Parkinson’s Disease? J Parkinsons Dis. 2018;8(1):121-130.
Guenter P, Jensen G, Malone, A; et al. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). J Acad Nutr Diet. 2012;112(5):730-738.
Malnutrition Across the Lifespan: Perspectives from Registered Dietitians and Physical Therapists webinar. Accessed August 5, 2020.
Why Malnutrition Matters. MQII Malnutrition Quality Improvement Initiative website. Accessed August 12, 2020.