Micronutrient Deficiencies in Medical and Surgical Inpatients

Abstract

Inpatients are threatened by global malnutrition, but also by specific micronutrient (i.e., trace element and vitamins) deficiencies that frequently are overseen in the differential diagnosis of major organ dysfunctions. Some of them are related to specific geographic risks (iodine, iron, selenium, zinc, vitamin A), while others are pathology related, and finally many are associated with specific feeding patterns, including low dose enteral feeding. Among the pathologies in which laboratory blood investigations should include a micronutrient outwork, anemia is in the front line, followed by obesity with bariatric surgery, chronic liver disease, kidney disease, inflammatory bowel disease, cardiomyopathies and heart failure. The micronutrients at the highest risk are iron, zinc, thiamine, vitamin B12 and vitamin C. Admission to hospital has been linked with an additional risk of malnutrition—feeding below 1500 kcal/day was frequent and has been associated with a structural additional risk of insufficient micronutrient intake to cover basal needs. Although not evidence based, systematic administration of liberal thiamine doses upon admission, and daily complementation of inpatients’ food and enteral feeding solutions with multi-micronutrient tablets might be considered.

Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up

“…Micronutrient deficiencies and borderline status are more common than generally acknowledged [31]. The most important acute deficiency being thiamine level [31]. The above is confirmed by Bilgen et al who claims that inpatients dietary assessment and proper nutritional interventions may decrease readmission rate in patients with HF and improve their quality of life [32].…”

“…All in all, there is no doubt nutritional status assessment is essential in HF patient management. Micronutrient deficiencies and borderline status are more common than generally acknowledged [31]. The most important acute deficiency being thiamine level [31].…”

Nutrition and Micronutrient Therapy in Critical Illness Should Be Individualized

“…They are likely to be increased owing to the impact of the condition (losses due to drains and exudates), the presence of oxidative stress that challenges the endogenous defenses, and the treatments that may induce additional losses, particularly with the use of continuous renal replacement therapy 49 and diuretics. 50 In the Lausanne burn center, the observations of the major-burn patients experiencing severe infectious complications and important losses of lean body mass led, in the late 1980s, to balance studies of Cu, Se, and Zn. 51,52 These 3 elements were chosen because of their implication in antioxidant chain system, wound healing, and immune defenses.…”

Molecular Mechanism of Functional Ingredients in Barley to Combat Human Chronic Diseases

“…Diabetes in 11 production regions of polished rice with high glycemic index (GI ≥ 70) caused the biggest reduction in health-adjusted life expectancy at birth in 21 regions in 187 countries from 1990 to 2013 [3]. The micronutrients deficiencies at the highest risk are Fe, Zn, and vitamins (V B1 , V B2 , V B12 , and V C ) [4]. The outbreak of human chronic disease is due to taste pursuit that changes a healthy diet, i.e., the ancients switched from brown rice (GI ≤ 55, high K and high micronutrients) and barley (GI ≤ 25) or its grass flour (K/Na ≥ 10) as staple foods to modern polished rice (GI ≥ 87) and wheat white flour (GI ≥ 86) with low and low micronutrients as staple foods [3,5].…”