"...all doctors should be able to diagnose and treat nutritional deficiencies."
Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002
This page has been printed from the www.stewartnutrition.co.uk web site.
Rapid Unintentional Weight Loss
Unintentional and rapid weight loss can result in nutritional deficiencies developing within weeks and occasionally days. Some deficiencies may influence the person’s appetite, energy level and resistance to infection and as a result may further delay the person’s recovery.
Those with this problem should already have received medical assessment and ideally input from an experienced dietitian or nutritional therapist.
Assessment of Those with Rapid Unintentional Weight Loss
Assessment should include determining the possible cause(s) and:
- The degree of weight loss (percentage of body weight lost) and the degree of undernutrition (Body Mass Index <20.0 kg/m2) to calculate the risk of deficiencies developing, see report here.
- The presence of Common Nutritional Deficiencies that are most likely to develop and adversely affect appetite or energy level
- The need for nutrition support by use of:
Dietary Treatment with selected drinks and foods
Protein-energy supplements in the form of milk or soya-based drinks and
Nutritional Supplements
Common Nutritional Deficiencies and their Early Features
| Nutrient | Early Features of Deficiency |
| Vitamin B1 – Thiamine | Fatigue, nausea, loss of appetite, muscle pain on exercise, confusion, unsteadiness and difficulties with eye movements |
| Potassium | Fatigue, weakness and palpitations |
| Magnesium | Fatigue, weakness and muscle cramps |
| Anaemia | Fatigue, weakness, shortness of breath, cold intolerance and palpitations |
| Iron | Fatigue, poor or distorted appetite, sore tongue, cracking at the corners of the mouth, mouth ulcers |
| Zinc | Poor appetite, poor vision in the dark, delayed wound healing and poor immune function |
| Vitamin C | Fatigue, easy bruising, poor wound healing, poor resistance to infection and anaemia |
Dietary Advice for Those with Rapid Weight Loss
The most pressing need is for energy, then protein, especially if there is a significant loss of muscle, and then many essential nutrients particularly vitamin B.
Foods need to be chosen because they are nutritious, widely available, easy to prepare and some may need to be suitable for those with swallowing difficulties.
Foods and Drinks Suitable For Those with Rapid Weight Loss
| Foods | Main Nutrients Provided |
| Fruit juices – diluted if necessary | Energy, potassium and vitamin C |
| Stewed Bramley cooking apples and sugar | Energy, vitamin C, potassium |
| Home made vegetable soup | Energy, potassium, magnesium and vitamin B |
| Prepared soup | As above and sodium salt |
| White bread | Energy, protein, iron, vitamins B1 and B3 |
| Banana | Energy, potassium and magnesium |
| Tea with milk and sugar | Energy and a few nutrients |
| Scrambled egg | Energy, protein, vitamin B and iron |
| Spinach with egg and cheese | Energy, protein, vitamins B12, folate, B2, B3, iron, magnesium and calcium |
| Rice pudding | Energy, vitamin A and B2, calcium and protein |
| Cheddar cheese | Energy, calcium, vitamin B and zinc |
| Baked fish | Energy, protein, vitamin B12 |
| Tinned sardines | Energy, protein, vitamin B12, zinc calcium and n-3 EFAs |
| Mashed or jacket potatoes | Energy, potassium, magnesium, vitamin C and B |
| Chocolate | Energy, potassium, magnesium and iron |
| Shepherd’s pie or other minced meat dishes | Energy, protein, iron, zinc, vitamins B and C |
| Fish pie (fish, milk, egg, cheese and potato) | Energy, protein, calcium, vitamins A, B and C |
If necessary the person may require a fortified drink such as Build-up or Complan which are available from a local chemist.
Nutritional Supplements for Those with Weight Loss
Often the most pressing need is for vitamins B and C. Just such a recommendation was made for the ill and convalescing elderly in 1974 by an editorial in the British Medical Journal Old People’s Nutrition (BMJ 1974 February 9; 1(5901): 212-213) which stated:
“Many would agree that iron, vitamin C, vitamin D and the B-complex vitamins should be given for three to four weeks to elderly patients recovering from a severe illness of any type and the administration of vitamin C before an elective surgical procedure might also be considered”.
Suitable supplements might include:
- Sanatogen Berocca: half of one effervescent tablet twice, three or even four times per day for at least 10 days (from chemists and some supermarkets).
- A vitamin B and C tablet providing approximately 10 mg of the B vitamins and at least 100 mg of vitamin C (from health food shops).
- An A-to-Z multivitamin: one per day with an additional vitamin B supplement providing at least 10 mg per tablet (available from numerous outlets). They should be taken at separate times of the day.
For those with significant weight loss >10% of body weight it is better to give small amounts of a nutritional supplement three to four times per day during the convalescent period than giving a large supplement once per day.
It is prudent to check with the patient’s medical advisor that any nutritional supplements are suitable and are not contraindicated.
