How Malnutrition Affects The Digestive System

A healthy diet according to the National Health Service (2019) Eatwell guide that comes from each food group to achieve a healthy balanced diet. The recommended daily calorie intake per day for women is 2000kcal and for men 2500kcal this includes food and drink. The eat well guide suggests five portions of fruit and vegetables a day, a good source of fiber, minerals, and vitamins that come from these food groups. The British Nutrition Foundation (2018) recommends 30grams of fiber a day per adult. Starchy carbohydrates should make up a third of the food we eat, choose high fiber wholegrain varieties. Starchy foods are the main source of nutrients include bread, brown pasta, and rice (NHS, 2019). Milk, cheese, and yogurt a good sources of protein they include some vitamins mostly important for calcium. Bones need calcium to keep them strong vitamin D helps the body absorb calcium. Lentils, beans, and peas are a good substitute for meat as they are low in fat high in fiber. Two portions of fish a week are recommended, include oily fish salmon, or mackerel. Eggs and meat provide vitamins and minerals. Choose unsaturated fats rapeseed, olive, and sunflower oils. Other foods high in fat, salt, and sugar should be eaten less often, these foods include biscuits, cake, chocolate (NHS, 2019). To maintain the right balance daily is recommended but weekly is acceptable, it does not need to be with every meal. The BNF (2018) says there is evidence to suggest that the energy mix in diet can influence disease. Too much fat can be associated with coronary artery disease and alcohol can increase the risk of cancer. Phase one research carried out individual interviews across Great Britain from mixed age groups and families to see how well the plate met the needs of the consumer. The eat-well guide has some advantages such as raw items worked better than cooked. Disadvantages it did not include water or meet some special dietary requirements. Overall, the study found a high level of consistency across the nations and ethnicity, in terms of perceived accessibility and value (Public Health England, 2015).

Digestive system

The digestive system can be described as a series of tube-like organs which pass through the body starting at the mouth to the anus, also known as the alimentary canal. Connected with other organs such as the pancreas, liver, and gallbladder they all produce and release enzymes (Lean, Fox and Cameron, 2006). Chemical and Mechanical digestion are the two methods used to break down food in the body, digestion starts in the mouth. Saliva contains enzymes that start the chemical breakdown of food continuing into the stomach. Gastric juices and hydrochloric acid create a liquid called chyme. Chemical digestion continues to the small intestine where nutrients are absorbed into the bloodstream to be used by the cells (Khan academy, 2020). Mechanical digestion begins with teeth, chewing breaking down large particles of food. Muscles in the alimentary canal continue to move food through the digestive system. Excretion is a process where waste and excess water are removed from the body (Khan academy, 2020). Macronutrients (macro means large) are carbohydrates, protein, and fats, nutrients needed in large amounts. According to Sharma and Kolahdooz (2015, p. 31) macronutrients are usually expressed as grams per day. They are a major food source needed in a healthy diet, consisting of hydrogen, carbon, and oxygen atoms. They provide the body with energy, growth, and general maintenance (British Nutrition Foundation, 2018). Amylase a starch digestive enzyme begins the breakdown of carbohydrates in the mouth. Protease enzymes are responsible for the breakdown of protein into amino acids. Proteins, however, are digested in the stomach and intestine, helped by pepsin and hydrochloric acid a strong acid that kills any harmful bacteria that may be found in food. Lipase enzymes turn fat into fatty acids and glycerol. Fat digested in the intestine is helped by bile made in the liver, bile is not an enzyme (BBC, 2020). Micronutrients (meaning small) are vitamins and minerals needed in small amounts usually expressed as micrograms per day, absorbed through the bloodstream. All vitamins and minerals should come from a varied and healthy diet. They also contain fiber and important dietary requirements, essential for gut health, and helps reduce the risk of disease. Water is not always included in the definition of nutrition, it is essential for life and health (BNF,2018).

How substrates are converted into useable energy

As described in Salters's (1999) higher chemistry book ‘scientists often think of the ‘lock and key analogy, in which the enzyme is the lock and the substrate is the key’. In this theory, as it opens the shape must be complimentary as this shape cannot change. Enzymes are proteins made of molecules that have active sites and the substrate will fit exactly (My Tutor, 2019). Some enzymes can break down complex molecules into simple molecules, others build up complex molecules from simple ones. Enzymes need a moderate temperature, suitable Ph and substrates of an adequate amount to function effectively (Torrence et al. (2002). Metabolism is defined as all chemical changes within the cells, tissues, and organisms that maintain homeostasis. Cellular metabolism is a complex biochemical reaction anabolism meaning maintenance, catabolism breakdown (Cell Signaling Technology, 2020). “Cellular respiration (CR) refers to the breakdown of glucose and other respiratory substrates to make energy-carrying molecules called Adenosine triphosphate” (ATP) (BBC, 2020).

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Chronic obstructive pulmonary disease

This essay will use Chronic Obstructive Pulmonary Disease (COPD) as both emphysema and chronic bronchitis are no longer used, both are included in the diagnosis of COPD. COPD is the name for a group of lung conditions that cause breathing difficulties. It includes Emphysema damage to the air sacs (alveoli) in the lungs and Chronic Bronchitis Long term inflammation of the airways (bronchi) (National Health Service, 2019). According to British Lung Foundation statistics (2020) COPD patients have varying degrees of both emphysema and chronic bronchitis. Predominantly caused by smoking other factors include occupational exposures, such as harmful dust and chemicals (National Institute for Health and Care Excellence, 2016). In the UK an estimated three million people have COPD two million people are undiagnosed (2016). BLF research suggests the probability of COPD is growing, diagnosis has increased by 27% in the last decade. New research is needed to ascertain the current prevalence of the disease (BLF, 2020). The British Thoracic Society conducted an analysis from 2004-2012 that stated men are more likely to be diagnosed with COPD than women. Rare to be diagnosed under the age of forty, this increases with age affecting 9% over seventy (British Medical Journal, 2016). BLF statistics 2004-12 reported that more people were diagnosed with COPD in the north of the UK including Scotland, North East, and North West of England (BLF, 2020). COPD is one of the three leading contributors to respiratory mortality in the UK. In 2012, 29,776 people died from COPD of these 15,245 males and 14,531 females, 2,719 aged 15-64 and 27,056 aged 65 and above (BLF,2020).

Diet and nutrition are important for patients living with COPD to help maintain strength, fitness and to help fight infection. Food groups include proteins essential for muscle strength including those that help with breathing. Carbohydrates for energy, including starchy foods. Fruit and vegetables are essential for vitamins and minerals helping boost the immune system. Dairy food will help maintain strong bones (BAPEN, 2020).

Malnutrition and hydration

The British Association for Parenteral Enteral Nutrition (2018) define ‘malnutrition as a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue, body form, function, and clinical outcome’. The Malnutrition prevention program was set up by the Malnutrition Taskforce (MTF) involving local stakeholders including NHS trusts, GP surgeries, care homes, and community groups. Age UK is one of the founding members reporting that 1 in 10 people over the age of 65 are malnourished or at risk of malnutrition (MFT, 2019). Malnourishment can increase GP visits and hospital admissions due to long-term health problems. Reasons older people can lose interest in food and appetite are due to loss of loved ones, increasing financial strains, and loneliness. Underlying health problems like COPD, increased breathlessness can affect mobility so not getting to the shops. Poor-fitting dentures or poor oral hygiene make eating difficult (MFT, 2019). Age UK has Nutrition and Hydration week 16th-22nd March 2020 celebrating food and drink and the importance in our health, energy levels, and quality of life. Hydration helps improve concentration, balance, skin, memory, and mood. Aim to drink 6-8 glasses of water a day, and if your struggling with drink ice lollies, jellies and extra milk on cereals can help with fluid intake (Age UK, 2020). Fluids are important for many important processes in the body such as oxygen and nutrients to cells, the blood to carry glucose, water helps digestion, and keeps skin healthy. The body is designed to control its own temperature so if we sweat and lose fluids a stable temperature could be compromised. We need to keep hydrated to prevent feelings of dizziness, headaches, lethargy, and poor concentration. Elderly people struggle with bowel movements and reoccurring urinary tract infections when dehydrated. The best indication of good hydration is the color of urine, the darker it is the more fluids are needed (The Association of UK Dietitians, 2019).

Malnutrition is a common problem in COPD patients, 35% of hospitalized patients and 22% of outpatients are at risk of developing malnutrition (Collins et al, as cited in British Journal of Nursing, 2019). Causes of malnutrition in COPD the disease effects breathlessness, anorexia, inflammation, and low BMI (Body Mass Index). A ‘malnutrition universal screening tool’ (MUST) was developed by the Malnutrition Advisory Group and is regularly reviewed since its launch in 2003. Staff in hospitals, primary care, and care homes use the MUST tool to aid the implementation of the new NICE Quality Standard for Nutritional Support of Adults (BAPEN, 2016). Causes of malnutrition in COPD patients include psychological e.g. motivation, apathy, and depression. Social factors e.g. social isolation, whilst environmental factors include living conditions, and access to shops (Malnutrition pathway, 2020). ‘Pulmonary cachexia’ is defined as a complex metabolic syndrome associated with an underlying illness’ (Shepherd and Bowell, 2019). ‘Pulmonary cachexia’ is defined as a complex metabolic syndrome associated with an underlying illness.