Community Nutrition &

Physicians Responsibility
Doctors Responsibility in Nutrition

Tutor A4

Imam Ramdhani A.
Adrian F. Ismiranto

Siti Lika Latifah

Faris Yuflih F.

Chaudry Franciosa L.
Nabilla Rhamdani

Alya P. Khairani
Damaris Adi P.

Herza Fadlinda
Ausi Indriani

Elrika Anastasia W

What is Malnutrition?

Malnutrition essentially means bad nourishment

Clinically, malnutrition is characterized by inadequate or
excess intake of protein, energy, and micronutrients such as
vitamins, and the frequent infections and disorders that result.
People are malnourished if they are unable to utilize fully the
food they eat, for example due to Diarrhoea or other illnesses
(secondary malnutrition) or if their diet does not provide
adequate calories and protein for growth and maintenance
(undernutrition or protein-energy malnutrition).
Malnutrition is a major health problem, especially in
developing countries

 Malnutrition is a major health problem, especially in developing countries

Nutritional status is compromised where people are exposed to high levels of
infection due to unsafe and insufficient water supply and inadequate sanitation
Both malnutrition and inadequate water supply and sanitation are linked to poverty
Malnutrition in all its forms increases the risk of disease and early death
For example, Protein-energy malnutrition, plays a major role in half of all under-five deaths
each year in developing countries (WHO, 2000)
Severe forms of malnutrition include Marasmus; Cretinism and irreversible brain damage due
to iodine deficiency; and blindness and increased risk of infection and death from vitamin A
deficiency

Malnutrition in
Indonesia

Why doctors must have social awareness related to

malnutrition, particularly in developing countries such
as Indonesia?

In doing the works as a Physician, each and every individual must consider whats better for the
society
During the dedication to the society, pay attention to every aspects of health care: promote,
preventive, curative, rehabilitative
Malnutrition continues to be a significant problem all over the world, especially among children.
Poverty, natural disasters, political problems, and war all contribute to conditions -- even
epidemics -- of malnutrition and starvation.
Following careful assessment of the child's nutritional status, initiate nutritional intervention in
collaboration with nutrition support personnel are forms of awareness to malnutrition issues
If the Physicians didnt have the awareness regarding these problems, nobody else will

What a doctor should know and do, when facing a

pediatric patient with malnutrition (related to social
context)?

Protecting and enhancing the nutrition of the society by:

Prenatal nutrition praconceptual and antenatal nutrition must be informed to the mother in
pregnancy age, so that there wont be any malnutrition or stunting
Educate about the hygiene and sanitation to prevent any infectious disease around the patient
Promote about breastfeeding to the mother or soon-to-be mother
Health and educational promotion according to the age of respondent; nutritional advices and
counseling better be given
Scoring, observe, and analyze the nutritional status in some communities
Identification of the causes and do include the family or relations to prevent the re-occurance of
malnutrition
Special program to give the micronutrient supplement or fortification (e.g., Vit D, Iodium)

What a doctor should know and do,

when facing an elderly with
malnutrition?
One of the most basic elements of elder care is ensuring an adequate diet and proper
nutrition
Give advices about basic nutrition that the elder must take each and everyday
Explain every info and advice in a gentle way, make sure that the elders are
understand. Communication is very important
Search for supporting care for the elders: their own family, friends, Aged Care
Assessment Team, Home Based Therapy, or Community center
Not fulfilling this obligation can be seen as an ethical question on the individual as well
as system level
Not only individuals but also healthcare systems can be referred to as unethical if they
lack structure and prerequisites for ethical defensible care

Why malnutrition happens in

elderly?
Medical factors
Poor appetite

Psychological
Confusion

Poor dentition, other oral problems and dysphagia

Loss of taste and smell
Gastrointestinal disorders, for example, malabsorption

Dementia
Depression

Endocrine disorders, for example, diabetes, thyrotoxicosis

Neurological disorders, for example, Parkinson's disease
Lifestyle and social factors
Lack of knowledge about food, cooking, and nutrition
Isolation/loneliness
Poverty
Inability to shop or prepare food

Bereavement
Anxiety

What is the sociocultural aspect of malnutrition

in elderly?
Who should be educated? How to educate?
The Department of Health must lead an awareness campaign to dispel the myth that
becoming thinner is a natural part of the ageing process
Raise awareness among all those working with older people in the community of the signs,
symptoms and consequences of malnutrition and its prevention
Develop appropriate training support for all individuals who may be required to screen for
malnutrition in their older clients.
Ensure appropriateness of use at every stage and continued support for those receiving
training
Older people, their carers and families must be informed about the markers for malnutrition,
its causes, effects and consequences within the context of good nutrition in later life
Communication efforts should involve older people in the design and dissemination of
information on good nutrition to ensure that the appropriate formats and channels are used

Why hospital malnutrition happen?

Why is it regarded as a form of medical
neglect?

Hospital malnutrition can happen in 2 ways:

1. Patient already has the malnutrition and became even worse inside the hospital
due to many factors
2. Patient develop inadequate nutrition inside the hospital during the treatment
Hospital malnutrition is not necessarily a form of medical neglect. It can be because of
the patient cannot cooperate with the treatment in the hospital, for example: they
didnt want to take the food or nutritional supplements because they didnt like it
But it can be because of the physician, nurse, or hospital as well. Missed assessment
of decreasing number of markers in nutritional status can lead to delayed substitution
or supplementation of the treatment to the patient

What is responsibility of a doctor to

avoid hospital malnutrition?

Monitor patients closely for growth and resolution of clinical signs and symptoms of
malnutrition
Follow-up should be based on the severity of the illness, age of the patient, and the
patient's initial response to intervention.
Referred the patients to the Nutritionist to have better details regarding the patients
condition
Assess the nutritional status every now and then: change of body weight, change of
the appetite, symptoms related to gastrointestinal system

What is responsibility of the

hospital to avoid hospital
malnutrition?
Food serviceserve better with good quality of food. Ask patients preverence
regarding the food
Raise the awareness of the patient with malnutrition, listen to what will make them
comfortable staying in the hospital so they can stick to proper nutritional supply of the
hospital
Became aware of patients status to determine whether the patient was already in
malnutrition state before entering the hospital
Develop and execute the clinical pathway of malnutrition in the hospital to avoid
hospital malnutrition in the first place

Can a doctor deliver the responsibility to the

nutritionist? How to collaborate with a
nutritionist?

Yes. Patient can be referred to Nutritionist. But during that time, Physician also in control
and closely observe the patient. Build multidisciplinary terms and good bond with the
Nutritionist for the sake of the patient

References:

http://www.who.int/water_sanitation_health/diseases/malnutrition/en/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563720/
http://emedicine.medscape.com/article/985140-followup#a2648
http://www.thp.org/learn_more/issues/malnutrition
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084475/

Thank you