Undernourishment is widespread and has serious consequences

Undernourishment typically affects the elderly, those with diseases, addicts, and people with eating disorders. The condition increases the risk of serious diseases and repeated hospitalizations and is an enormous economic burden to society. Many undernourished people suffer from loss of appetite, a problem that can often be stimulated with improved diets and supplements of B vitamins.

Undernourishment is a concealed community problem that affects an increasing number of people. It is often the weak groups that fail to complain about their situation. Hospital patients and nursing home residents primarily receive treatment for their diagnosed problems, while their undernourishment flies under the radar. The healthcare system may provide these patients with a diet scheme but it is not followed up, which means that their undernourishment becomes an increasing threat to their health, simply because they don't get sufficient amounts of the essential nutrients.

What is undernourishment?

A person is considered to be undernourished if his or her BMI (Body Mass Index) is lower than 18.5, and if it appears to affect that person's health. Also, it is seen as a sign of undernourishment if a person's body weight has gone down by 5-10 percent in the course of 3-6 months, or if the person has suffered a daily energy deficit of around 30 percent.
Doctors typically look at energy, which is a measure of the calories consumed. However, it is every bit as important to look at the intake of empty calories, which are known to result in an additional lack of vitamins, minerals, and other nutrients.

The consequences of undernourishment

The symptoms are insidious and appear all of a sudden. They may lead to an array of symptoms such as fatigue, sleep disorders, impaired immune system, frequent infections, loss of muscle mass, and increased risk of dementia and osteoporosis.

Many undernourished people have impaired quality of life and are too weak to be able to manage on their own. They are enrolled in nursing homes ahead of time, they are hospitalized more frequently, it takes longer for them to rehabilitate, and they have increased mortality.

The lack of knowledge and experience among doctors and nurses when it comes to undernourishment is largely due to the fact that they receive minimal training in nutrition, but also that nutritional therapies have low priority compared with other medical treatments. Because undernourishment typically affects the older people, the problem is expected to become increasingly worse as a result of the rapidly growing number of seniors.

Loss of appetite and the overlooked problem of low stomach acid and lack of B vitamins

It is commonly known that undernourishment may be caused by chronic diseases, depression, medicine, alcoholism, drug abuse, bad teeth and reduced saliva production (mouth dryness caused by medicine), all of which can lead to reduced appetite.
An overlooked yet common factor is low stomach acid that is rather common among older people. Because low stomach acid often gives the same symptoms as too much stomach acid, this condition is normally treated with antacids, but they only make matters worse.
Lack of stomach acid impairs the digestion, especially the digestion of protein, and may in itself cause loss of appetite and an aversion towards meat and animal protein. A consequence of low stomach acid may also be impaired uptake and utilization of calcium, iron, magnesium, vitamin B12 and vitamin B1, which are nutrients with numerous functions in the body. This may easily become a vicious cycle.

Did you know that many older and undernourished people with diagnoses such as dementia and Alzheimer's disease simply lack vitamin B12 and may need injections of the nutrient because of problems with malabsorption?

Vitamin B1 and appetite

Even minor vitamin B1 deficiencies may cause loss of appetite and persistent nausea. Common causes of vitamin B1 deficiency include unbalanced diets, overconsumption of sugar, coffee, alcohol and other stimulants plus diuretics and antacids, which are widely prescribed to the elderly and to those with reduced appetite.

More focus on treating the causes of undernourishment

Because the different B vitamins work as a team, it is best to receive vitamin B1 as part of a strong B vitamin complex, at least if the aim is to stimulate the appetite in a natural way. Bitter compounds from foods such as radishes, cabbage, rucola, and artichoke also help to stimulate the stomach acid and digestive enzymes. Furthermore, physical activity and fresh air increase the appetite.

The culinary quality, cozy surroundings and socializing also mean a lot. Because the food in hospitals and nursing homes is usually not all that appetizing, this leaves room for improvement, just like meal plans must be followed up in order to make them stick.
Patients who are unable to meet their daily requirements for calories and nutrition with normal healthy meals may benefit from nutritional drinks or tube feeding (gavage).

References:

https://www.kost.dk/sites/default/files/uploads/public/underernaering_publikationsmallpdf.com.pdf

http://www.fmfnet.dk/fakta-om-underernaering/

http://nyheder.ku.dk/alle_nyheder/2015/01/aeldre-hvidbog/

http://www.hsph.harvard.edu/nutritionsource/b-12-deficiency/

http://www.netdoktor.dk/vitaminer/vitaminb1.htm

https://en.wikipedia.org/wiki/Achlorhydria

https://dsr.dk/sygeplejersken/arkiv/sy-nr-1999-46/notes-on-nursing-kapitel-6-og-7-ernaering-a-la-nightingale