Undernutrition is a disturbing reality which affects nearly 2 million people in France alone. It unfortunately affects all ages, although the elderly are particularly affected. Muscle wasting, associated with undernutrition, leads to mechanical and immunological complications that compromise the overall health of those affected. In this article, Alcimed discusses the limitations of current diagnostic solutions and explores potential avenues to enhance the diagnosis and treatment of undernutrition in patients with chronic diseases.
Patients with chronic diseases, such as renal failure or cancer, are at an increased risk of undernutrition. However, the lack of management of undernutrition can compromise the effectiveness of treatment and sometimes the survival of patients. Indeed, a chronic illness can lead to loss of appetite, and certain treatments can exacerbate undernutrition. According to data from the French Society of Clinical Nutrition & Metabolism, nearly 40% of cancer patients suffer from undernutrition1https://francais.medscape.com/voirarticle/3606963. In the case of chronic diseases such as renal failure, a study has shown that undernutrition is a determining factor in patient mortality2https://www.em-consulte.com/article/74458/denutrition-et-insuffisance-renale-chronique. It is estimated that between 5% and 25% of cancer patients die from the consequences of undernutrition rather than their disease3https://www.sfncm.org/images/stories/communique_presse/DP_Cancer_Denutrition.pdf.
The most common method for diagnosing undernutrition involves weighing patients and then checking weight and BMI (Body Mass Index) criteria to confirm undernutrition. A decrease in muscle mass, also known as muscle atrophy or muscle wasting, is also a sign of undernutrition and can sometimes occur before weight loss, highlighting the importance of other indicators beyond weight loss.
Monitoring muscle atrophy remains a challenge. Currently, there are several methods for diagnosing muscle atrophy, such as grip tests, walking tests, or bioimpedance analysis to measure the resistance of biological tissues to low-voltage current. However, these tests are limited in terms of precision and early detection, with the diagnosis often made once symptoms are established.
Some emerging methods could improve diagnostics in the coming years. For example, the use of lumbar scanners allows for a more reliable, precise, and early estimation of muscle mass. However, in addition to being costly, measuring muscle mass on a scanner is time-consuming, and this method is currently reserved for research. Automated image analysis, using artificial intelligence, offers a promising perspective to speed up the measurement process and expand the use of this method. However, advances in diagnostic research alone are likely not sufficient to treat and prevent undernutrition.
More accurate and earlier diagnosis of undernutrition paves the way for actions such as nutritional support and the implementation of tailored physical activity to rebuild muscle loss. However, a lack of awareness among patients and healthcare personnel limits the impact of these measures.
To address this issue, initiatives such as the French National Undernutrition Awareness Week have been launched. In 2022, this awareness week brought together 2,000 participants for 15,000 actions throughout the week4https://www.luttecontreladenutrition.fr/semaine-denutrition-2023/. During the 2023 edition, which took place from November 7th to 14th, impactful messages addressed to the general public, such as “If you lose more than 3kg, talk to your doctor!”, were widely disseminated to emphasize the importance of not downplaying signs of weight loss. The Undernutrition Combat Collective, the organizer of the event, also provides resources to facilitate patient care.
The treatment of undernutrition often involves dietary rebalancing and the implementation of physical activity to counteract muscle loss. In severe cases, hospitalization and the initiation of artificial nutrition may be necessary.
The use of nutritional supplements can also be a beneficial initiative. Indeed, numerous companies are innovating in this field, offering products with better taste and easier integration into daily diets, such as Nutrisens’ G-Nutrition bread or supplements from the young start-up La Picorée.
Advancements are not limited to products but also extend to organizational processes. New patient pathways are emerging, establishing regular consultations with dietitians for individuals with chronic diseases. This systematic approach promotes comprehensive care.
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Undernutrition, although multifactorial and sometimes challenging to detect, is increasingly being addressed in the medical field, particularly in the context of chronic diseases. The consequences of undernutrition are better understood, and there is a gradual shift in perspective on this public health issue. By investing in awareness and the development of innovative solutions, we are paving the way for a future where the diagnosis and treatment of undernutrition will become the norm, significantly improving the care of patients with chronic diseases.
Alcimed closely monitors innovations in this area, and we can assist you in exploring uncharted territories regarding undernutrition detection, treatment, and prevention. Feel free to contact our team!
About the author,
Clémence, Consultant in Alcimed’s Innovation and Public Policy team in France
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