Changes

Sensory and cognitive factors affect intake of food predominantly. Foods sensory properties like taste, smell, texture, appearance, and food type to be consumed affect satiation in the initial period. These sensory specific properties of food are linked with the sensory specific satiety. Sorensen LB et al have reviewed the multiple aspects related to sensory perception of food and their role in appetite regulation. Sensory-specific satiety has an important influence on the amount of food eaten. Palatability of food greatly influences appetite and food intake. Increase in food variety observed rise in quantity of food and energy intake. This study also reviewed standard procedure to test sensory-specific satiety and identified flavor, texture and appearance-specific satieties.  

Sensory and cognitive factors affect intake of food predominantly. Foods sensory properties like taste, smell, texture, appearance, and food type to be consumed affect satiation in the initial period. These sensory specific properties of food are linked with the sensory specific satiety. Sorensen LB et al have reviewed the multiple aspects related to sensory perception of food and their role in appetite regulation. Sensory-specific satiety has an important influence on the amount of food eaten. Palatability of food greatly influences appetite and food intake. Increase in food variety observed rise in quantity of food and energy intake. This study also reviewed standard procedure to test sensory-specific satiety and identified flavor, texture and appearance-specific satieties.  

Variety in food and pleasantness of food to sensory organs increase the intake of food. De Graaf C et al concluded that pleasantness of food affect satiation but do not have significant effect on satiety. <ref>De Graaf C, De Jong LS, Lambers AC. Palatability affects satiation but not satiety. Physiol Behav. 1999;66(4):681-688. doi:10.1016/s0031-9384(98)00335-7 </ref>, <ref>Raynor HA, Epstein LH. Dietary variety, energy regulation, and obesity. Psychol Bull. 2001;127(3):325-341. doi:10.1037/0033-2909.127.3.325 </ref>

Variety in food and pleasantness of food to sensory organs increase the intake of food. De Graaf C et al concluded that pleasantness of food affect satiation but do not have significant effect on satiety. <ref>De Graaf C, De Jong LS, Lambers AC. Palatability affects satiation but not satiety. Physiol Behav. 1999;66(4):681-688. doi:10.1016/s0031-9384(98)00335-7 </ref> <ref>Raynor HA, Epstein LH. Dietary variety, energy regulation, and obesity. Psychol Bull. 2001;127(3):325-341. doi:10.1037/0033-2909.127.3.325 </ref>

The sensory-specific satiety phenomenon has been explained by Rolls et al with reference to sight and test of food.<ref>Rolls ET, Rolls BJ, Rowe EA. Sensory-specific and motivation-specific satiety for the sight and taste of food and water in man. Physiol Behav. 1983;30(2):185-192. doi:10.1016/0031-9384(83)90003-3</ref>, <ref>Rolls BJ, Van Duijvenvoorde PM, Rolls ET. Pleasantness changes and food intake in a varied four-course meal. Appetite. 1984;5(4):337-348. doi:10.1016/s0195-6663(84)80006-9</ref>. Study of Spetter M S et al shows that oral food ingestion evokes greater neural activation of brain signaling pathways specifically in the midbrain, amygdala, hypothalamus, and hippocampus area neural activity related to sensory-specific satiety.<ref>Spetter M S,  de Graaf C,  Mars M, Viergever MA,  Smeets PAM . The sum of its parts—effects of gastric distention, nutrient content and sensory stimulation on brain activation. PLoS ONE. 2014; 9(3): e90872: doi:10.1371/journal.pone.0090872 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090872</ref>

The sensory-specific satiety phenomenon has been explained by Rolls et al with reference to sight and test of food.<ref>Rolls ET, Rolls BJ, Rowe EA. Sensory-specific and motivation-specific satiety for the sight and taste of food and water in man. Physiol Behav. 1983;30(2):185-192. doi:10.1016/0031-9384(83)90003-3</ref> <ref>Rolls BJ, Van Duijvenvoorde PM, Rolls ET. Pleasantness changes and food intake in a varied four-course meal. Appetite. 1984;5(4):337-348. doi:10.1016/s0195-6663(84)80006-9</ref>. Study of Spetter M S et al shows that oral food ingestion evokes greater neural activation of brain signaling pathways specifically in the midbrain, amygdala, hypothalamus, and hippocampus area neural activity related to sensory-specific satiety.<ref>Spetter M S,  de Graaf C,  Mars M, Viergever MA,  Smeets PAM . The sum of its parts—effects of gastric distention, nutrient content and sensory stimulation on brain activation. PLoS ONE. 2014; 9(3): e90872: doi:10.1371/journal.pone.0090872 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090872</ref>

2. '''Gastric mechanism of satiation:'''

2. '''Gastric mechanism of satiation:'''

The satiety quotient (SQ) - GREEN SM et al developed a satiety quotient (SQ) to assess an eating episode's satiating effect. This is considered as a remarkable contribution in the field in quantifying satiating effects of foods. This quotient relates food intake with the rate of return of motivation to eat post ingestion, which is predictive of energy intake. Thus, for a person, the satiety quotient will vary based on weight, macronutrient composition, and energy density of food.<ref>Green SM, Delargy HJ, Joanes D, Blundell JE. A satiety quotient: a formulation to assess the satiating effect of food. Appetite. 1997 Dec;29(3):291-304. doi: 10.1006/appe.1997.0096. PMID: 9468762. https://doi.org/https://doi.org/10.1006/appe.1997.0096</ref>

The satiety quotient (SQ) - GREEN SM et al developed a satiety quotient (SQ) to assess an eating episode's satiating effect. This is considered as a remarkable contribution in the field in quantifying satiating effects of foods. This quotient relates food intake with the rate of return of motivation to eat post ingestion, which is predictive of energy intake. Thus, for a person, the satiety quotient will vary based on weight, macronutrient composition, and energy density of food.<ref>Green SM, Delargy HJ, Joanes D, Blundell JE. A satiety quotient: a formulation to assess the satiating effect of food. Appetite. 1997 Dec;29(3):291-304. doi: 10.1006/appe.1997.0096. PMID: 9468762. https://doi.org/https://doi.org/10.1006/appe.1997.0096</ref>

Low satiety phenotype - ‘Low satiety phenotype’ is associated with specific behavioral and metabolic profiles that could explain their susceptibility to overeating. These individuals do not recognize their appetite sensation before and after meal. This is considered as an important step in individualized obesity treatment.<ref>DrapeauV, Gallant A.The low satiety phenotype. In: Blundell JE, Bellisle F, ed. Satiation, Satiety and the Control of Food Intake: Woodhead Publishing Series in Food Science, Technology and Nutrition; 2013:Pages 273–297. https://doi.org/10.1533/9780857098719.5.273 </ref>

Low satiety phenotype - ‘Low satiety phenotype’ is associated with specific behavioral and metabolic profiles that could explain their susceptibility to overeating. These individuals do not recognize their appetite sensation before and after meal. This is considered as an important step in individualized obesity treatment.<ref>DrapeauV, Gallant A.The low satiety phenotype. In: Blundell JE, Bellisle F, ed. Satiation, Satiety and the Control of Food Intake: Woodhead Publishing Series in Food Science, Technology and Nutrition; 2013:Pages 273–297. https://doi.org/10.1533/9780857098719.5.273</ref>

'''Research tools to assess digestive fire (Jathragni)-'''

'''Research tools to assess digestive fire(Jathragni)-'''

Wholesome diet is considered as the prime factor for nourishment and growth of a human being. Nourishing benefits of diet is subjected to the status of [[agni]].Thus [[agni]] is an important facilitator between health and food. Assessment of the status of jatharagni is an essential component in maintenance of health as well as while treating diseased conditions. Singh A, Patwardhan K et al have developed and validated a self-assessment tool to estimate Agnibala. The study also evaluates the practical utility of developed tool by recording serum lipid parameters. Lipid parameters vary significantly according to the status of agni . Eswaran H T et al have prepared an agni assessment scale with total 64 questions to evaluate the four types of nature of digestive fire (jatharagni). The study has validated the scale for internal consistency. Validation is essential for accuracy and reproducibility . Patil VC, Baghel MS et al have developed formulae for assessment of the digestive function (agni) in during administration of internal oleation . Agni performs various functions of digestion, metabolism and assimilation. Gastric secretions is a digestive fluid, formed in the stomach and contain numerous compounds including hydrochloric acid (HCL), pepsin, lipase, mucin. Kulatunga et al assessed the status of agni in the patients of pandu roga and find out its relationship with the acidity of gastric secretions by use of fractional test meal examination. Their study concluded that HCL reduction in patients of anemia seriously affects the protein and iron absorption; thus Hypochlohydria (found in 72.8% of the patients) indicates hypofunction of [[agni]].

Wholesome diet is considered as the prime factor for nourishment and growth of a human being. Nourishing benefits of diet is subjected to the status of [[agni]].Thus [[agni]] is an important facilitator between health and food. Assessment of the status of jatharagni is an essential component in maintenance of health as well as while treating diseased conditions. Singh A, Patwardhan K et al have developed and validated a self-assessment tool to estimate Agnibala. The study also evaluates the practical utility of developed tool by recording serum lipid parameters. Lipid parameters vary significantly according to the status of [agni]]. <ref>Singh A, Singh G,  Patwardhan K, Gehlot S. Development, Validation and Verification of a Self-Assessment Tool to Estimate Agnibala (Digestive Strength). J Evid Based Complementary Altern Med. 2017 Jan;22(1):134-140. doi: 10.1177/2156587216656117. Epub 2016 Jul 4.</ref>Eswaran H T et al have prepared an agni assessment scale with total 64 questions to evaluate the four types of nature of digestive fire (jatharagni). The study has validated the scale for internal consistency. Validation is essential for accuracy and reproducibility.<ref>Eswaran HT, Kavita MB, Tripaty TB, and Shivakumar. Formation and validation of questionnaire to assess Jāṭharāgni. Anc Sci Life.2015 Apr-Jun; 34(4): 203–209.

</ref> Patil VC, Baghel MS et al have developed formulae for assessment of the digestive function (agni) in during administration of internal oleation.<ref>Patil VC, Baghel MS, Thakar AB. Assessment of Agni (digestive function) and Koshtha (bowel movement with special reference to Abhyantara Snehana (internal oleation). Ancient Sci. Life. 2008; 28:26-28</ref> Agni performs various functions of digestion, metabolism and assimilation. Gastric secretions is a digestive fluid, formed in the stomach and contain numerous compounds including hydrochloric acid (HCL), pepsin, lipase, mucin. Kulatunga et al assessed the status of agni in the patients of pandu roga and find out its relationship with the acidity of gastric secretions by use of fractional test meal examination. Their study concluded that HCL reduction in patients of anemia seriously affects the protein and iron absorption; thus Hypochlohydria (found in 72.8% of the patients) indicates hypofunction of [[agni]].<ref>Kulatunga R D H, Rai N P, Ali Z. Status of Agni in Pandu Roga (anemia) and its association with the acidity of gastric secretions-A Clinical Study. IAMJ: Volume 7, Issue 1, January – 2019.</ref>

'''Understanding links between mental health and gastrointestinal track mediated through gut microbiota-'''

'''Understanding links between mental health and gastrointestinal track mediated through gut microbiota-'''

The microbiome is the collective genome of all the microorganisms (bacteria, fungi, protozoa and viruses) living in a particular environment, especially living on and inside the human body. Microbiota is the community of microorganisms. Collective genome of various microorganisms of gastrointestinal (GI) tract, termed as gut microbiome .

The microbiome is the collective genome of all the microorganisms (bacteria, fungi, protozoa and viruses) living in a particular environment, especially living on and inside the human body. Microbiota is the community of microorganisms. Collective genome of various microorganisms of gastrointestinal (GI) tract, termed as gut microbiome.<ref>Valdes AM, Walter J, Segal E, Spector TD. Role of the gut microbiota in nutrition and health. BMJ. 2018 Jun 13;361:k2179. doi: 10.1136/bmj.k2179. PMID: 29899036; PMCID: PMC6000740.</ref>

Gut microbiome plays a significant role in intestinal physiology and regulation. Gut microbiota produces microbial metabolites like short-chain fatty acids (SCFAs) mainly acetate, propionate, and butyrate; promotes local intestinal immunizations and systemic immunity  .Gut microbiome has a regulatory role in behavior and cognition and it is exercised through gut-brain axis .

 

Gut microbiome plays a significant role in intestinal physiology and regulation. Gut microbiota produces microbial metabolites like short-chain fatty acids (SCFAs) mainly acetate, propionate, and butyrate; promotes local intestinal immunizations and systemic immunity  .<ref>Yoon MY, Lee K, Yoon SS. Erratum to: Protective role of gut commensal microbes against intestinal infections. J Microbiol. 2015 Jan;53(1):90. doi: 10.1007/s12275-015-0705-7. Erratum for: J Microbiol. 2014 Dec;52(12):983-9. Yoon, My Young [corrected to Yoon, Mi Young]. PMID: 25557484. </ref> <ref>Zhang H, Sparks JB, Karyala SV, Settlage R, Luo XM. Host adaptive immunity alters gut microbiota. ISME J. 2015 Mar;9(3):770-81. doi: 10.1038/ismej.2014.165. Epub 2014 Sep 12. PMID: 25216087; PMCID: PMC4331585.</ref>Gut microbiome has a regulatory role in behavior and cognition and it is exercised through gut-brain axis.<ref>Mohajeri MH, Brummer RJM, Rastall RA, Weersma RK, Harmsen HJM, Faas M, Eggersdorfer M. The role of the microbiome for human health: from basic science to clinical applications. Eur J Nutr. 2018 May;57(Suppl 1):1-14. doi: 10.1007/s00394-018-1703-4. PMID: 29748817; PMCID:PMC5962619.https://link.springer.com/article/10.1007/s00394-018-1703-4</ref>

 

Review article of Clair R. Martin et al states that Gut microbes communicate to the central nervous system through at least 3 parallel and interacting channels involving nervous, endocrine, and immune signaling mechanisms. Based on preclinical and clinical evidence from various studies, scholars have concluded that  brain by affecting community structure and functions of gut microbiota can modulate regional gut motility, intestinal transit and secretion, and gut permeability, and potentially through the luminal secretion of hormones that directly modulate microbial gene expression .  

Review article of Clair R. Martin et al states that Gut microbes communicate to the central nervous system through at least 3 parallel and interacting channels involving nervous, endocrine, and immune signaling mechanisms. Based on preclinical and clinical evidence from various studies, scholars have concluded that  brain by affecting community structure and functions of gut microbiota can modulate regional gut motility, intestinal transit and secretion, and gut permeability, and potentially through the luminal secretion of hormones that directly modulate microbial gene expression.<ref>Martin CR, Osadchiy V, Kalani A, Mayer EA. The Brain-Gut-Microbiome Axis. Cell Mol Gastroenterol Hepatol. 2018 Apr 12;6(2):133-148. doi: 10.1016/j.jcmgh.2018.04.003. PMID: 30023410; PMCID: PMC6047317.</ref>

Research validates the important role of brain and mental health in digestion and metabolism. Mental health is closely linked with gastrointestinal health. Emotions like stress, anxiety, mood swings may trigger stomach problems and gastrointestinal disturbances affect mental health   . Probiotic consumption also has been reported to reduce self-reported feelings of sadness and aggressive thoughts . Study of Sudo et al supports that the hyypothalamic–pituitary–adrenal (HPA) reaction to stress is influenced greatly by gut microbiota     .Based on extensive preclinical evidence and clinical observations showing bidirectional signaling pathways of BGM axis, Mayer et al proposed a systems biological model of bidirectional BGM interactions, which revalidate the impact of  mental health on gastrointestinal health and vice versa .  

Research validates the important role of brain and mental health in digestion and metabolism. Mental health is closely linked with gastrointestinal health. Emotions like stress, anxiety, mood swings may trigger stomach problems and gastrointestinal disturbances affect mental health.<ref>Park AJ, Collins J, Blennerhassett PA, Ghia JE, Verdu EF, Bercik P, Collins SM. Altered colonic function and microbiota profile in a mouse model of chronic depression. Neurogastroenterol Motil. 2013 Sep;25(9):733-e575. doi: 10.1111/nmo.12153. Epub 2013 Jun 17. PMID: 23773726; PMCID: PMC3912902.</ref> <ref>Washabau, R. J. (2013). Chapter 41 - Antispasmodic Agents (R. J. Washabau & M. J. B. T.-C. and F. G. Day (eds.); pp. 481–485). W.B. Saunders. https://doi.org/https://doi.org/10.1016/B978-1-4160-3661-6.00041-9

https://www.sciencedirect.com/topics/immunology-and-microbiology/gut-brain-axis</ref> Probiotic consumption also has been reported to reduce self-reported feelings of sadness and aggressive thoughts.<ref>Steenbergen L, Sellaro R, van Hemert S, Bosch JA, Colzato LS. A randomized controlled trial to test the effect of multispecies probiotics on cognitive reactivity to sad mood. Brain Behav Immun. 2015 Aug;48:258-64. doi: 10.1016/j.bbi.2015.04.003. Epub 2015 Apr 7. PMID: 25862297.</ref> Study of Sudo et al supports that the hyypothalamic–pituitary–adrenal (HPA) reaction to stress is influenced greatly by gut microbiota.<ref>Sudo N, Chida Y, Aiba Y, Sonoda J, Oyama N, Yu XN, Kubo C, Koga Y. Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. J Physiol. 2004 Jul 1;558(Pt 1):263-75. doi: 10.1113/jphysiol.2004.063388. Epub 2004 May 7. PMID: 15133062; PMCID: PMC1664925.</ref> <ref>Bowey E, Adlercreutz H, Rowland I. Metabolism of isoflavones and lignans by the gut microflora: a study in germ-free and human flora associated rats. Food Chem Toxicol. 2003 May;41(5):631-6. doi: 10.1016/s0278-6915(02)00324-1. PMID: 12659715.</ref> <ref>Pinto-Sanchez MI, Hall GB, Ghajar K, Nardelli A, Bolino C, Lau JT, Martin FP, Cominetti O, Welsh C, Rieder A, Traynor J, Gregory C, De Palma G, Pigrau M, Ford AC, Macri J, Berger B, Bergonzelli G, Surette MG, Collins SM, Moayyedi P, Bercik P. Probiotic Bifidobacterium longum NCC3001 Reduces Depression Scores and Alters Brain Activity: A Pilot Study in Patients With Irritable Bowel Syndrome. Gastroenterology. 2017 Aug;153(2):448-459.e8. doi: 10.1053/j.gastro.2017.05.003. Epub 2017 May 5. PMID: 28483500.</ref>Based on extensive preclinical evidence and clinical observations showing bidirectional signaling pathways of BGM axis, Mayer et al proposed a systems biological model of bidirectional BGM interactions, which revalidate the impact of  mental health on gastrointestinal health and vice versa.<ref>Mayer EA, Labus JS, Tillisch K, Cole SW, Baldi P. Towards a systems view of IBS. Nat Rev Gastroenterol Hepatol. 2015 Oct;12(10):592-605. doi: 10.1038/nrgastro.2015.121. Epub 2015 Aug 25. PMID: 26303675; PMCID: PMC5001844.</ref>

'''Insufficient /Deficient Quantity of Food'''-  

'''Insufficient /Deficient Quantity of Food'''-  

Malnutrition generally implies undernutrition but also includes other deviations like energy undernutrition and over-nutrition. Malnutrition starts due to deficiencies of specific nutrients or from diets based on inadequate and or inappropriate combinations or proportions of foods. Undernutrition is caused primarily due to an inadequate intake of dietary energy. The impact of a deficient diet on an individual is mainly depending on age factor. Age reflects the condition of body tissues. Body tissues (dhatu) attain different stages form immature growing state of childhood, to the attainment of all the qualities and strength of body tissues in young age, which further slowly enters the state of depletion in old age. Nutritional requirement of body tissues differs according to age. Considering the age of a person, consequences arise due to inadequate diet is discussed under two categories- a) Childhood age  b) Adult age.

Malnutrition generally implies undernutrition but also includes other deviations like energy undernutrition and over-nutrition. Malnutrition starts due to deficiencies of specific nutrients or from diets based on inadequate and or inappropriate combinations or proportions of foods. Undernutrition is caused primarily due to an inadequate intake of dietary energy. The impact of a deficient diet on an individual is mainly depending on age factor. Age reflects the condition of body tissues. Body tissues (dhatu) attain different stages form immature growing state of childhood, to the attainment of all the qualities and strength of body tissues in young age, which further slowly enters the state of depletion in old age. Nutritional requirement of body tissues differs according to age. Considering the age of a person, consequences arise due to inadequate diet is discussed under two categories- a) Childhood age  b) Adult age.

World health organization explains the malnutrition phenomenon of childhood age under four categories: Stunting, Wasting and overweight and underweight

World health organization explains the malnutrition phenomenon of childhood age under four categories: Stunting, Wasting and overweight and underweight.<ref>United Nations Children’s Fund, World Health Organization, World Bank Group. Levels and trends in child malnutrition: Key findings of the 2012 Edition of the Joint Child Malnutrition Estimates. United Nations Children’s Fund; 2012. www.who.int/nutgrowthdb/estimates</ref> <ref>United Nations Children’s Fund, World Health Organization, World Bank Group. Levels and trends in child malnutrition: Key findings of the 2018 Edition of the Joint Child Malnutrition Estimates. United Nations Children’s Fund; 2018. www.who.int/nutgrowthdb/estimates</ref>

    

    

1.'''Stunting''' (height-for-age below –2 SD) refers to a child who is too short for his or her age. It is the devastating result of poor nutrition during early childhood. These children fell to attain complete possible height. It also hampers cognitive development.

1.'''Stunting''' (height-for-age below –2 SD) refers to a child who is too short for his or her age. It is the devastating result of poor nutrition during early childhood. These children fell to attain complete possible height. It also hampers cognitive development.

'''Determinants of under nutrition'''-   

'''Determinants of under nutrition'''-   

Faustin Habyarimana found key determinants of malnutrition of children below five years of age: age, gender, birth weights, mother’s knowledge of nutrition, birth order, incidence of recent fever, multiple pregnancies, education level of the mother, age of the mother at childbirth, body mass index, prevalence of anemia, province, source of drinking water and wealth quintiles. A positive correlation between stunting and underweight and wasting and underweight was also found.

Faustin Habyarimana found key determinants of malnutrition of children below five years of age: age, gender, birth weights, mother’s knowledge of nutrition, birth order, incidence of recent fever, multiple pregnancies, education level of the mother, age of the mother at childbirth, body mass index, prevalence of anemia, province, source of drinking water and wealth quintiles. A positive correlation between stunting and underweight and wasting and underweight was also found.<ref>F. Habyarimana , T. Zewotir , S. Ramroop. Key determinants of malnutrition of children under five years of age in Rwanda: Simultaneous measurement of three anthropometric indices. African Population Studies. Vol. 30, No. 2, 2016</ref>

'''Consequences of under-nutrition:'''  The consequences of poor nutrition include impaired growth, poor cognitive and social development, poor school performance, increased risk of morbidity and mortality and reduced productivity later in life . Malnutrition in children’s by impacting cognitive functions, further impend individuals’ ability to lead productive lives and thus contribute to poverty.

'''Consequences of under-nutrition:'''  The consequences of poor nutrition include impaired growth, poor cognitive and social development, poor school performance, increased risk of morbidity and mortality and reduced productivity later in life.<ref>Boah M, Azupogo F, Amporfro DA, Abada LA. The epidemiology of undernutrition and its determinants in children under five years in Ghana. PLoS One. 2019 Jul 31;14(7):e0219665. doi: 10.1371/journal.pone.0219665. PMID: 31365528; PMCID: PMC6668784.</ref> Malnutrition in children’s by impacting cognitive functions, further impend individuals’ ability to lead productive lives and thus contribute to poverty.

'''Under-nutrition in adults-'''

'''Under-nutrition in adults-'''

Under-nutrition in adults can be correlated with the etiopathogenesis of Karshya described in Ayurveda classics.  Undernourishment may be caused by the lack of one or more nutrients (under‐nutrition), or an excess of nutrients (over‐nutrition). Physiological changes associated with the process of ageing may further support malnutrition.

Under-nutrition in adults can be correlated with the etiopathogenesis of Karshya described in Ayurveda classics.  Undernourishment may be caused by the lack of one or more nutrients (under‐nutrition), or an excess of nutrients (over‐nutrition). Physiological changes associated with the process of ageing may further support malnutrition.<ref>Guyonnet S, Rolland Y. Screening for Malnutrition in Older People. Clin Geriatr Med. 2015 Aug;31(3):429-37. doi: 10.1016/j.cger.2015.04.009. Epub 2015 May 13. PMID: 26195101.</ref> <ref>Elia M. Defining, Recognizing, and Reporting Malnutrition. Int J Low Extrem Wounds. 2017 Dec;16(4):230-237. doi: 10.1177/1534734617733902. Epub 2017 Nov 16. PMID: 29145755.</ref>

 

Determinants- Hickson M has Categorized the causes of malnutrition under three category as medical factos (like poor appetite, physical disability, endocrine disorders etc), lifestyle and social factors (lack of knowledge of nutrition, loneliness, povery etc.) and psychological factors .  Morley JE has enumerated the major causes of malnutrition as lack of food, paranoia, emotional factors (like depression), inappropriate dieting, anorexia, problem with feeding (tremors, dementia, functional impairment, and dysphagia), Enteral problems (e.g., gluten enteropathy), Wandering and other dementia related factors and malabsorption.

Morley JE has enumerated the major causes of malnutrition as lack of food, paranoia, emotional factors (like depression), inappropriate dieting, anorexia, problem with feeding (tremors, dementia, functional impairment, and dysphagia), Enteral problems (e.g., gluten enteropathy), Wandering and other dementia related factors and malabsorption.<ref>Morley JE. Editorial: Defining Undernutrition (Malnutrition) in Older Persons. J Nutr Health Aging. 2018;22(3):308-310. doi: 10.1007/s12603-017-0991-3. PMID: 29484342.</ref>

Old age persons are at high risk of developing protein-energy malnutrition. It affects health, cognitive and physical functions as well as quality of life. Study concludes that increasing age, unmarried/separated/divorced status, difficulties walking 100 m, climbing stairs and hospitalization, cognitive impairment or receiving social support are the major predictors of malnutrition.  

Old age persons are at high risk of developing protein-energy malnutrition. It affects health, cognitive and physical functions as well as quality of life. Study concludes that increasing age, unmarried/separated/divorced status, difficulties walking 100 m, climbing stairs and hospitalization, cognitive impairment or receiving social support are the major predictors of malnutrition.<ref>Corish CA, Bardon LA. Malnutrition in older adults: screening and determinants. Proc Nutr Soc. 2019 Aug;78(3):372-379. doi: 10.1017/S0029665118002628. Epub 2018 Dec 3. PMID: 30501651.</ref>

Shetty P has validated scoring systems such as MUST, which indicates patients at risk of malnutrition. BMI less than 18.5 kg/m2 is a sign of undernutrition. Laboratory investigations like hemoglobin or packed cell volume (indicators of anemia, hydration), blood urea (indicating hydration and  protein intake), C-reactive protein and ESR (inflammatory pathology), total lymphocyte count (for immune function) are also suggested to aid early diagnosis.Donini LM et al developed and validated a screening tool for the easy detection and reporting of both undernutrition and over-nutrition, two types of malnutrition. A systematic review to evaluate malnutrition biomarkers among older adults, concluded that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults.

Shetty P has validated scoring systems such as MUST, which indicates patients at risk of malnutrition. BMI less than 18.5 kg/m2 is a sign of undernutrition. Laboratory investigations like hemoglobin or packed cell volume (indicators of anemia, hydration), blood urea (indicating hydration and  protein intake), C-reactive protein and ESR (inflammatory pathology), total lymphocyte count (for immune function) are also suggested to aid early diagnosis.<ref>Shetty, P. (2006). Malnutrition and undernutrition. Medicine, 34(12), 524–529. https://doi.org/10.1053/j.mpmed.2006.09.014</ref>Donini LM et al developed and validated a screening tool for the easy detection and reporting of both undernutrition and over-nutrition, two types of malnutrition.<ref>Donini LM, Ricciardi, L. M., Neri, B., Lenzi, A., & Marchesini, G. (2014). Risk of malnutrition (over and under-nutrition): Validation of the JaNuS screening tool. Clinical Nutrition, 33(6), 1087–1094. https://doi.org/10.1016/j.clnu.2013.12.001</ref> A systematic review to evaluate malnutrition biomarkers among older adults, concluded that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults.<ref>Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of blood biomarkers associated with risk of malnutrition in older adults: A Systematic Review and Meta-Analysis. Nutrients. 2017 Aug 3;9(8):829. doi: 10.3390/nu9080829. PMID: 28771192; PMCID: PMC5579622</ref>

   

   

'''Consequences''' : Malnutrition in adults is greatly associated with risk of sarcopenia, frailty, falls, dependence in activities, respiratory muscle wasting, effects musculoskeletal system,  experience metabolic changes in cellular electrolytes including calcium accumulation, reduced resistance to infection, poor functioning of excretory systems, longer hospital stay, poor response to other medical conditions. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength and it is strictly correlated with physical disability, poor quality of life and death.Cachexia is a multifactorial syndrome with involuntary progressive weight loss as a result of reduction of skeletal muscle mass with or without depletion of adipose tissue.Frailty is a common clinical syndrome in older adults and is associated with poor health outcomes including falls, disability, hospitalization, decline in functions of various physiological systems and mortality.

'''Consequences''' : Malnutrition in adults is greatly associated with risk of sarcopenia, frailty, falls, dependence in activities, respiratory muscle wasting, effects musculoskeletal system,  experience metabolic changes in cellular electrolytes including calcium accumulation, reduced resistance to infection, poor functioning of excretory systems, longer hospital stay, poor response to other medical conditions. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength and it is strictly correlated with physical disability, poor quality of life and death.Cachexia is a multifactorial syndrome with involuntary progressive weight loss as a result of reduction of skeletal muscle mass with or without depletion of adipose tissue.Frailty is a common clinical syndrome in older adults and is associated with poor health outcomes including falls, disability, hospitalization, decline in functions of various physiological systems and mortality.