Changes

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>

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.<ref>Santilli V, Bernetti A, Mangone M, Paoloni M. Clinical definition of sarcopenia. Clin Cases Miner Bone Metab. 2014;11(3):177-180</ref>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.<ref>Vanhoutte G, van de Wiel M, Wouters K, et al. Cachexia in cancer: what is in the definition?. BMJ Open Gastroenterol. 2016;3(1):e000097. Published 2016 Oct 18. doi:10.1136/bmjgast-2016-000097</ref>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.<ref>Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1-15. doi:10.1016/j.cger.2010.08.009</ref>

'''Treatment strategies-'''  

'''Treatment strategies-'''  

Provide dietary solutions considering Guts changes of the elderly.  

Provide dietary solutions considering Guts changes of the elderly.<ref>Rémond D, Shahar DR, Gille D, et al. Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget. 2015;6(16):13858-13898. doi:10.18632/oncotarget.4030</ref>

Manipulation in energy / nutritive density of food.

Manipulation in energy / nutritive density of food.<ref>Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, Kiesswetter E, Maggio M, Raynaud-Simon A, Sieber CC, Sobotka L, van Asselt D, Wirth R, Bischoff SC. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019 Feb;38(1):10-47. doi: 10.1016/j.clnu.2018.05.024. Epub 2018 Jun 18. PMID: 30005900.</ref>

Changes in hedonic pattern (taste, flavor, appearance) of foods.

Changes in hedonic pattern (taste, flavor, appearance) of foods.

Provide feeding assistance.

Provide feeding assistance.

Give motivation for physical activities.

Give motivation for physical activities.<ref>Hébuterne X, Bermon S, Schneider SM. Ageing and muscle: the effects of malnutrition, re-nutrition, and physical exercise. Curr Opin Clin Nutr Metab Care. 2001 Jul;4(4):295-300. doi: 10.1097/00075197-200107000-00009. PMID: 11458024.</ref>

Adopt interdisciplinary approach like inclusion of Yoga techniques to improve mental health.

Adopt interdisciplinary approach like inclusion of Yoga techniques to improve mental health.<ref>Baldwin C, Kimber KL, Gibbs M, Weekes CE. Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults. Cochrane Database Syst Rev. 2016;12(12):CD009840. Published 2016 Dec 20. doi:10.1002/14651858.CD009840.pub2.</ref>

'''Ama-'''  

'''Ama-'''  

Ama is an important principle to understand the etiopathogenesis of all disorders and to decide the treatment modalities. Agni is the digestive and metabolic fire which is responsible for any transformation in body. Transformation of food material predominantly takes place at the level of gastrointestinal track (grahani-seat of jathragni) and at the level of tissues (dhatvagni-abodes of dhatus). Dysfunction of agni results into undigested or partly digested intermediator product called as ama. Ama act as toxic element and form the basis for many pathological conditions. It can be considered raw, uncooked, unripe, immature, undigested or incompletely oxidized / metabolized or similar to a poisonous substance that disrupts body physiology. Accumulation of metabolic waste (mala) may takes place at various levels in body physiology. The amalgamation of aggravated doshas with metabolic waste results in ama formation, which is considered the initial stage of disease formation. Origin of ama is mainly considered from gastrointestinal track (amashaya). Agni functions at different levels; hence, ama can be formed at different levels at different body sites. Forms of agni - jatharagni, bhutagni and dhatvagni functions at different level hence any impairment at the corresponding level leads to ama formation.

Ama is an important principle to understand the etiopathogenesis of all disorders and to decide the treatment modalities. Agni is the digestive and metabolic fire which is responsible for any transformation in body. Transformation of food material predominantly takes place at the level of gastrointestinal track (grahani-seat of jathragni) and at the level of tissues (dhatvagni-abodes of dhatus). Dysfunction of agni results into undigested or partly digested intermediator product called as ama. Ama act as toxic element and form the basis for many pathological conditions. It can be considered raw, uncooked, unripe, immature, undigested or incompletely oxidized / metabolized or similar to a poisonous substance that disrupts body physiology. Accumulation of metabolic waste (mala) may takes place at various levels in body physiology. The amalgamation of aggravated doshas with metabolic waste results in ama formation, which is considered the initial stage of disease formation. Origin of ama is mainly considered from gastrointestinal track (amashaya). Agni functions at different levels; hence, ama can be formed at different levels at different body sites. Forms of agni - jatharagni, bhutagni and dhatvagni functions at different level hence any impairment at the corresponding level leads to ama formation.

Digestion process starts from mouth where mechanical and chemical digestion of food takes place. Thinking, smelling and seeing food secrets saliva, helps in digestion. Component of saliva like water, mucus, electrolytes and enzymes has a unique function. Starch breakdown starts here due to the enzyme in saliva called salivary amylase. Mucus lubricates the food and helps in the formation of bolus in mouth. Small food particles are dissolved by saliva and it makes dry food moist enough to swallow comfortably. If person is not following dietary codes, eating hurriedly without proper mastication, disturbed mental health while taking food will affect this cephalic phase of digestion. It will lead to ama formation due to improper digestion process in mouth. Mastication of food is subjected to condition of teeth.  Studies have attempted to find a correlation between tooth loss and nutrition. Deteriorated dental health affects mechanical digestion process and leads to nutritional deficiency . Another study observed that modifying the mastication rate alters the glycemic index of rice. Its glycemic index classification shows impact of digestion process on the final outcome of food.

Digestion process starts from mouth where mechanical and chemical digestion of food takes place. Thinking, smelling and seeing food secrets saliva, helps in digestion. Component of saliva like water, mucus, electrolytes and enzymes has a unique function. Starch breakdown starts here due to the enzyme in saliva called salivary amylase. Mucus lubricates the food and helps in the formation of bolus in mouth. Small food particles are dissolved by saliva and it makes dry food moist enough to swallow comfortably. If person is not following dietary codes, eating hurriedly without proper mastication, disturbed mental health while taking food will affect this cephalic phase of digestion. It will lead to ama formation due to improper digestion process in mouth. Mastication of food is subjected to condition of teeth.  Studies have attempted to find a correlation between tooth loss and nutrition. Deteriorated dental health affects mechanical digestion process and leads to nutritional deficiency.<ref>Najeeb S, Zafar MS, Khurshid Z, Zohaib S, Almas K. The role of nutrition in periodontal health: An Update. Nutrients. 2016 Aug 30;8(9):530. doi: 10.3390/nu8090530. PMID: 27589794; PMCID: PMC5037517. </ref> Another study observed that modifying the mastication rate alters the glycemic index of rice. Its glycemic index classification shows impact of digestion process on the final outcome of food.<ref>Ranawana, V., Leow, M. K.-S., & Henry, C. J. K. (2014). Mastication effects on the glycemic index: impact on variability and practical implications. European Journal of Clinical Nutrition, 68(1), 137–139. https://doi.org/10.1038/ejcn.2013.231</ref>

Health of a person is essentially dependents on healthy gut. Mucosal integrity is more important for proper absorption of nutrient from villi. The intestines also play an essential role in protecting the body from harmful bacteria and toxins. If mucosal integrity is hampered it results into leaky gut syndrome. It affects the lining of intestinal mucosa leading to bacteria and other toxins to pass into the bloodstream. It also leads to the imbalance of gut microbiome .  

Health of a person is essentially dependents on healthy gut. Mucosal integrity is more important for proper absorption of nutrient from villi. The intestines also play an essential role in protecting the body from harmful bacteria and toxins. If mucosal integrity is hampered it results into leaky gut syndrome. It affects the lining of intestinal mucosa leading to bacteria and other toxins to pass into the bloodstream. It also leads to the imbalance of gut microbiome.<ref>Gerwyn Morris, Michael Berk, André F. Carvalho, Javier R. Caso, Yolanda Sanz and Michael Maes, “The Role of Microbiota and Intestinal Permeability in the Pathophysiology of Autoimmune and Neuroimmune Processes with an Emphasis on Inflammatory Bowel Disease Type 1 Diabetes and Chronic Fatigue Syndrome”, Current Pharmaceutical Design (2016) 22: 6058. https://doi.org/10.2174/1381612822666160914182822</ref>

This gut leakage and dysbiosis leads to gut inflammation, also disrupt an immune homeostasis. It causes systemic immune activation, neurological disturbances and auto immune diseases. All these predisposing conditions cause ama formation which triggers many complex pathological conditions, act as route cause for many diseases.

This gut leakage and dysbiosis leads to gut inflammation, also disrupt an immune homeostasis. It causes systemic immune activation, neurological disturbances and auto immune diseases. All these predisposing conditions cause ama formation which triggers many complex pathological conditions, act as route cause for many diseases.<ref>Sharma H. Leaky Gut Syndrome, Dysbiosis, Ama, Free Radicals, and Natural Antioxidants.AYU. Year : 2009 | Volume:  30 | Issue Number:  2 | Page: 88-105.</ref>

Formation of ama occurs at the level of tissues or cellular level due to impaired metabolism or due to free radical activity. Free radicals are highly reactive atom or molecule which is having one or more unpaired electrons. It always tries to have stability by giving its electron or by acquiring extra electron form adjacent molecules. After providing the electron adjacent molecule becomes unstable and acts as a free radical, a chain reaction sets in to damage many molecules. A higher concentration of free radicals causes damage to the cellular structure like DNA, protein, lipid, and other cell parts. It causes disturbance in homeostasis of body leading to disease condition .

Formation of ama occurs at the level of tissues or cellular level due to impaired metabolism or due to free radical activity. Free radicals are highly reactive atom or molecule which is having one or more unpaired electrons. It always tries to have stability by giving its electron or by acquiring extra electron form adjacent molecules. After providing the electron adjacent molecule becomes unstable and acts as a free radical, a chain reaction sets in to damage many molecules. A higher concentration of free radicals causes damage to the cellular structure like DNA, protein, lipid, and other cell parts. It causes disturbance in homeostasis of body leading to disease condition.<ref>Sharma GN, Gupta G, Sharma P. A Comprehensive Review of Free Radicals, Antioxidants, and Their Relationship with Human Ailments. Crit Rev Eukaryot Gene Expr. 2018;28(2):139-154. doi:10.1615/CritRevEukaryotGeneExpr.2018022258</ref>

Ama formation occurs due to the accumulation of toxic or intermediatory product of metabolism in the body termed as mala. These intermediatory products are formed due to defect in the metabolism of protein, carbohydrate or lipid. Excessive uric acid is formed due to improper metabolism of protein which is hazardous to body tissue and joint structure. Lactic acid, acetone and ketone bodies are formed due to improper metabolism of carbohydrate and fats. Lack of insulin activity defunct carbohydrate metabolism and leads to formation of intermediatory products in the body. This intermediatory products act as ama and leads to many disease conditions.

Ama formation occurs due to the accumulation of toxic or intermediatory product of metabolism in the body termed as mala. These intermediatory products are formed due to defect in the metabolism of protein, carbohydrate or lipid. Excessive uric acid is formed due to improper metabolism of protein which is hazardous to body tissue and joint structure. Lactic acid, acetone and ketone bodies are formed due to improper metabolism of carbohydrate and fats. Lack of insulin activity defunct carbohydrate metabolism and leads to formation of intermediatory products in the body. This intermediatory products act as ama and leads to many disease conditions.