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'''Malnutrition''' is a lack of or imbalance in vitamins, minerals or other nutrients.<ref name="WHO-factsheet">{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/malnutrition | title = Fact sheets - Malnutrition|last = | first = | authorlink = | date = | website = [[World Health Organization]]|language=en|archive-url=|archive-date=|url-status=|access-date=2022-03-03}}</ref> Types of malnutrition include: ; undernutrition : when not enough essential nutrients are consumed or they are excreted more quickly rapidly than they can be replaced ; micronutrient-related malnutrition : deficiency in specific nutrients, for example [[iron]] or [[Vitamin B12 deficiency|vitamin B12]] ; overnutrition : people consume too much, the wrong things, don't exercise enough, or take too many dietary vitamins or [[:Category:Supplements|other nutrients]]<ref name="hopkins">{{Cite web|url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/malnutrition | title = Malnutrition|last = | first = | authorlink = | date = | website = Hopkins Medicine|language=en|archive-url=|archive-date=|url-status=|access-date=2022-03-03}}</ref><ref name="CDC">{{Cite web|url=https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm | title = Poor Nutrition|last = | first = | authorlink = | date = 2021-01-12 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2022-03-03}}</ref> ==Signs and symptoms== *unexpected [[weight loss]] β clothes, dentures, or jewellery may become loose *[[Tired all the time|tiredness]] [[fatigue]], and lethargy, which may include sleepiness *[[Depression]], [[anxiety]], or mood changea *[[anorexia (appetite loss)|loss of appetite]], medically known as the symptom anorexia (which is different to the eating disorder anorexia nervosa) *loss of interest in food and/or drinks *[[paresis|loss of muscle strength]]Β or [[muscle atrophy|muscle wasting]] *[[Dizziness]] *stunted growth (in children)<ref name="WHO-factsheet" /><ref name="BDA">{{Cite web|url=https://www.bda.uk.com/resource/malnutrition.html | title = Malnutrition|last = | first = | authorlink = | date = | website = British Dietetic Association|archive-url=|archive-date=|url-status=|access-date=2022-03-03}}</ref><ref name="NHS">{{Cite web|url=https://www.nhs.uk/conditions/malnutrition/symptoms/ | title = Malnutrition β Symptoms|last = National Health Service | first = | authorlink = National Health Service | date = 2017-10-23 | website = National Health Service|language=en|archive-url=|archive-date=|url-status=|access-date=2022-03-03}}</ref><ref name="Medline" /> Further complications caused by malnutrition include: * increased risk of illness * increased [[Susceptibility to viruses|risk of infections]] * slower wound healing * increased risk of falls * lower [[quality of life]] * reduced independence * reduced ability to carry out [[activities of daily life]]<ref name="BDA" /> ==Possible causes and risk factors== *Lack of food including starvation *Poverty *overnutrition risk is increased by being [[obesity|more than 20% overweight]] or having a diet [[Ketogenic diet|high in fat]] and [[sodium|salt]] *[[Anorexia and eating disorders|Eating disorders]] *Disease-related malnutrition - due to reduced dietary intake, malabsorption, inability to eat, increased nutrient losses or increased energy expenditure caused by certain diseases ::Examples of illnesses that can cause malnutrition include [[diarrhea]], and cancer.<ref name="WHO-factsheet" /><ref name="hopkins" /><ref name="CDC" /><ref name="Medline">{{Cite web|url=https://medlineplus.gov/ency/article/000404.htm | title = Malnutrition|last = | first = | authorlink = |website=MedlinePlus Medical Encyclopedia|language=en|archive-url=|archive-date=|url-status=|access-date=2022-03-03}}</ref><ref name="PMC4951875">{{Cite journal | title = The Neuroinflammatory Etiopathology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | date = 2017 | url=https://www.frontiersin.org/articles/10.3389/fphys.2017.00088|journal=Frontiers in Physiology|volume=8|last = Glassford | first = Julian A. G. |doi=10.3389/fphys.2017.00088|pmc=PMC5314655|pmid=28261110|issn=1664-042X}}</ref> ==Treatment== *A [[healthy, balanced diet]] helps prevent malnutrition *[[Tube feeding|Tube feeding or IV nutrition]], for instance when a patient is unable to eat enough or for diseases like [[irritable bowel disease]] or burns that are known to cause malabsorption or increase nutrition requirements<ref name="hopkins" /><ref name="dietary-guidelines">{{Cite web|url=https://www.dietaryguidelines.gov/resources/consumer-resources | title = Consumer Resources|last = | first = | authorlink = | date = | website = Dietary Guidelines for Americans 2020-2025|archive-url=|archive-date=|url-status=|access-date=2022-03-03}}</ref> ==ME/CFS== [[Severe_and_very_severe_ME#verysevere|Very severe ME]] can cause malnutrition, for example patients who are physically unable to eat enough due to extreme exhaustion and [[post-exertional malaise]], [[:Category:Digestive signs and symptoms|gastrointestinal symptoms of ME/CFS]], or [[food intolerance]]s.<ref name="Baxter2021" /> === Diet and nutritional deficiencies === ME/CFS cannot be diagnosed until medical tests have been carried out to rule out certain nutritional deficiencies, including [[iron]], [[vitamin B12]], and [[vitamin D]], but these can occur after diagnosis.<ref name="niceng206">{{Cite web|url=https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last = NICE Guideline Development Group|first = | authorlink = |publisher=[[National Institute for Health and Care Excellence]] | date = 2021-10-29}}</ref><ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10= Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf}}</ref><ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 =Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 =Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 =Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref> Nutritional deficiencies identified in people with ME/CFS include: * Lack of dietary fibre in 95% * unhealthy fat intake in 70% * inadequate fruit and vegetable intake in 70% * low intake of [[calcium]], [[iodine]], [[selenium]] and [[vitamin D]] was common * [[Vitamin D deficiency|low vitamin D]] levels in 60% of those not taking supplements was found in one study * low circulating levels of vitamin E were found in CFS patients, but only in lower quality studies<ref name="Jones2017" /><ref name="Joustra2017" /> *Deficiencies that have been found in some studies but not others include various [[B vitamin]]s, [[vitamin C]], [[magnesium]], [[sodium]], [[zinc]], [[L-tryptophan]], [[carnitine]], [[coenzyme Q10]], and [[essential fatty acid]]s.<ref name="Werbach2000">{{Cite journal | date = 2000|url=https://www.researchgate.net/profile/Mel-Werbach/publication/12548254_Nutritional_strategies_for_treating_chronic_fatigue_syndrome/links/59ea9d3eaca272cddddb8318/Nutritional-strategies-for-treating-chronic-fatigue-syndrome.pdf | title=Nutritional Strategies for Treating Chronic Fatigue Syndrome|journal=Alternative Medicine Review|first = Melvyn R. | last = Werbach|language=en|volume=5|issue=2 | pages = 93-108|quote=|via=}}</ref> A review by Jones and Probst stated that "unhealthy dietary intake [was] not significantly associated with fatigue severity or functional impairment" in chronic fatigue syndrome patients, and found that avoiding [[Dairy-free diet|dairy]] or [[Gluten-free diet|grains]] was common, and was usually not based on a diagnosed allergy or intolerance.<ref name="Jones2017" /> {{See also|Nutritional deficiencies in ME/CFS}} ==Notable articles== *2021, Life-Threatening Malnutrition in Very Severe ME/CFS<ref name="Baxter2021">{{Cite journal|last = Baxter | first = Helen | authorlink = | last2 = Speight | first2 = Nigel | authorlink2 = Nigel Speight | last3 = Weir | first3 = William | authorlink3 = William Weir | date = Apr 2021 | title = Life-Threatening Malnutrition in Very Severe ME/CFS|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213|journal=Healthcare|language=en|volume=9|issue=4 | pages = 459|doi=10.3390/healthcare9040459|pmc=PMC8070213|pmid=33919671|access-date=|quote=|via=}}</ref> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070213 (Full text)] *2017, Role of dietary modification in alleviating chronic fatigue syndrome symptoms: A systematic review<ref name="Jones2017">{{Cite journal | title = Role of dietary modification in alleviating chronic fatigue syndrome symptoms: a systematic review | date = 2017-06-14|url=https://doi.org/10.1111/1753-6405.12670|journal=Australian and New Zealand Journal of Public Health|volume=41|issue=4 | pages = 338β344 | last = Jones | first = Kathryn | last2 = Probst | first2 = Yasmine|doi=10.1111/1753-6405.12670|issn=1326-0200}}</ref> - [https://www.researchgate.net/publication/317623951_Role_of_dietary_modification_in_alleviating_chronic_fatigue_syndrome_symptoms_A_systematic_review/fulltext/595f87d10f7e9b8194e5bb13/Role-of-dietary-modification-in-alleviating-chronic-fatigue-syndrome-symptoms-A-systematic-review.pdf (Full text)] *2017, Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis<ref name="Joustra2017">{{Cite journal | title = Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis | date = 2017-04-28|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176631|journal=PLOS ONE|volume=12|issue=4| pages = e0176631 | last = Joustra | first = Monica L. | last2 = Minovic | first2 = Isidor | last3 = Janssens | first3 = Karin A.M. | last4 = Bakker | first4 = Stephan J.L. | last5 = Rosmalen | first5 = Judith G.M. | language=en|doi=10.1371/journal.pone.0176631|pmc=PMC5409455|pmid=28453534|issn=1932-6203}}</ref> - [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176631 (Full text)] *2005, Nutrient intake is unrelated to nutrient status in patients with chronic fatigue syndrome<ref name="Rayman2005">{{Cite journal | title = Nutrient intake is unrelated to nutrient status in patients with chronic fatigue syndrome | date = 2005-01-01|url=https://doi.org/10.1080/13590840600681751|journal=Journal of Nutritional & Environmental Medicine|volume=15|issue=4|pages=177β189 | last = Jenkins | first = Michael | last2 = Rayman | first2 = Margaret|doi=10.1080/13590840600681751|issn=1359-0847}}</ref> - [https://www.tandfonline.com/doi/abs/10.1080/13590840600681751 (Full text)] ==See also== *[[Healthy, balanced diet]] *[[Dr Lapp's supplement recommendations]] *[[Nutritional deficiencies in ME/CFS]] *[[Anorexia (appetite loss)]] *[[Severe and very severe ME]] *[[Gastroparesis]] *[[Cyclic vomiting syndrome]] ==Learn more== *[https://www.bda.uk.com/resource/malnutrition.html Malnutrition] - British Dietetic Association *[https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm Poor Nutrition] - CDC *[https://www.nhs.uk/conditions/malnutrition/symptoms/ Malnutrition - Symptoms] - NHS *[https://www.dietaryguidelines.gov/resources/consumer-resources Dietary Guidelines for Americans 2020β2025] - MyPlate and Consumer Resources *[https://www.who.int/news-room/fact-sheets/detail/malnutrition Malnutrition] - World Health Organization fact sheet ==References== {{reflist}} [[Category:Potential comorbidities]] [[Category:Nutritional deficiencies]]
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