Medical Nutrition


According to Dr. Lance Levy, a Toronto paediatrician specializing in swallowing and eating disorders, says people with eating difficulties can fear gagging or choking so much that they allow themselves to become malnourished or dehydrated, even when food is readily available. But it isn't just disabled children who risk malnutrition. Some older people who have arthritis or tremors would rather deny hunger than be embarrassed by spilled food or rattling a tea cup.

Those who are confined to a bed or wheelchair may have very low energy needs, but if they are eating fewer than 1,800 calories a day, it's likely their diet will be deficient in some vitamins. Moreover, there are elderly people who are just too tired, depressed, or ill to shop, prepare meals, or eat regularly. Disease complications also contribute to malnutrition.

Dry mouth (xerostomia) - a consequence of anticholinergic medications, irradiation treatments, glandular infections, and some systemic diseases make it difficult to taste, masticate and swallow food. And the salivary enzymes needed to begin carbohydrate digestion are lacking.


Requirements for protein, vitamins, and minerals essential for healing increase after the onset of a severe infectious disease. Yet by then many patients have become trapped in a devastating cycle of lost appetite, decreased vigour, irritability, and apathy about meals. Without adequate nutrition, their immunological response declines, thereby contributing to more illness or disability.

The cycle can be reversed, however, dietitians say. Five to 10 days of improved diet will often restore verve and vitality. Patients begin to look forward to meals; their eating improves and they have more energy for activities. Because individual eating and nutritional problems are unique, rehab and community care professionals need to be creative when devising solutions to improve mealtime.


Weight loss of more than two pounds a week on a continuing basis, or of 10 per cent of body weight in six months, is an indication that the person is losing essential body tissues, not fat.


Patients with limited mobility and energy expenditure have a high risk for weight gain becoming obese may exacerbate their problems. Where weight loss would be beneficial, set realistic, achievable goals.

Although a normally active person can lose a couple of pounds of fat a week, this rate may be impossible for a person who cannot exercise. For some, weight maintenance may be the healthiest strategy. To reduce calories without changing the volume of food, try the new lower fat or light cheeses, yogurts, salad dressings and ice creams. These foods provide the same level of protein, vitamins and minerals as their full fat counterparts, but are often significantly lower in calories, because fat is energy dense.


There are many types and brands of dietary supplements on the market, but they are not interchangeable. Some are specially formulated to be energy dense; others are high in fibre, lactose free, or low in osmolarity. Some liquid supplements are particularly useful for adding calories between meals. And over-the-counter products are useful as replacements for a solid meal without adding calories.

For education updates on nutritional supplements and Enteral nutrition see pages 10 to 15 in this section.

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