Practice Consideration — Protein and Malnutrition
Understanding how protein supports recovery is central to critical thinking in dietetic practice.
Protein is necessary for:
💪 Tissue Repair & Muscle Mass
Essential for growth and repair of tissues, including muscle. In malnourished patients, muscle wasting is common.
🧬 Immune Function
Involved in the production of antibodies and immune cells that defend against infection.
⚖️ Enzymes & Hormones
Required for synthesis of enzymes and hormones that regulate vital body functions.
💧 Fluid Balance
Albumin helps maintain fluid distribution between blood and tissues. Low protein can lead to edema, commonly seen in severe malnutrition.
In protein-energy malnutrition (PEM), protein reserves are depleted, resulting in muscle wasting, weakened immunity, and organ dysfunction. Dietitians must evaluate protein requirements considering factors such as swallowing difficulties, comorbidities (infection, cancer), and injury-related metabolic stress.
The RDA for healthy adults is about 0.8 g/kg body weight/day, but higher amounts are needed in malnourished individuals to restore lean body mass. High biological value (HBV) proteins are preferred where feasible, though accessibility and affordability must be considered.
Goal: Develop a balanced nutrition plan addressing protein, energy, and micronutrient needs to support full recovery.
Dietitian’s Critical Thinking Framework
When assessing a patient with Protein-Energy Malnutrition (PEM), dietitians think systematically about the following:
- Dietary Intake: Assess quality and quantity of protein, focusing on high biological value sources.
- Anthropometry: Review BMI, MUAC, and weight history for trends in muscle loss or fat depletion.
- Biochemical Markers: Evaluate serum pre-albumin, albumin, and related labs for insight into protein status.
- Nutrition-Focused Physical Findings: Identify visible signs—muscle wasting, edema, poor wound healing, and skin/hair changes. Consider gastrointestinal function and absorption capacity.
- Micronutrient Deficiencies: Recognize that PEM frequently coexists with deficiencies that affect healing and immune function.
Tailoring the Nutrition Care Plan
The aim is to restore metabolic stability through targeted nutrition therapy:
- Protein Requirements: Calculated based on severity of malnutrition, activity, and metabolic stress (often exceeding RDA).
- Energy Requirements: Sufficient calories are provided to spare protein for tissue repair rather than energy use.
- Micronutrient Requirements: Support enzyme function, immunity, and tissue recovery.
