Patient Populations at Nutritional Risk

Most healthy people have adequate amounts of nutrients stored for three to five days post-operatively as long as fluid intake remains sufficient.  There are some groups of people who cannot tolerate even this short episode of inadequate nutrition.  Patients with poor nutritional status prior to surgery such as chronic alcoholics and other substance abusers, people on very restrictive diets, patients undergoing chemotherapy or radiation therapy need to maintain a steady supply of nutrients.  This is also true of patients with diseases of the gastrointestinal tract, such as Crohn's disease, medically compromised patients, and the diabetic patient.  The medically compromised may include patients with chronic cardiovascular disease or heart failure, end stage liver or kidney disease, and chronic pulmonary disease.  Nutrient requirements increase due to blood loss, increased catabolism, tissue regeneration, and maintenance of the immune response.  Populations most at risk for poor nutrition are those with unexplained weight loss and the elderly.  In addition, there are many other patients at high risk for marginal nutrient intakes; see Table 1 for more details.^4,33,40

Unexplained weight loss, regardless of body size, represents a catabolic state during which both fat mass and lean body mass are lost.  This often occurs as a result of acute conditions, such as cancer, and chronic disease, such as poorly controlled diabetes, as well as secondarily to some medical regimens such as chemotherapy.  These people are at high risk for problems with healing following dental procedures.

The elderly are often at nutritional risk due to a number of factors including: physiologic changes, the presence of multiple chronic diseases, polypharmacy, and psychosocial issues.  Physiological changes include a decreased ability to absorb nutrients, such as vitamin B12, as well as more advanced periodontal disease, atrophy of saliva glands, alterations in taste, and dysregulation of the immune response.  One study found as many as six diseases among one group of elderly.³⁶  Findings suggest that 30% of all prescriptions are bought by the elderly along with 40% of all over-the-counter medications.³⁶  Medications such as prednisone increase the need for protein, calcium, vitamin D, and folate.  Diuretics like hydrochlorothiazide and Lasix increase the need for potassium, magnesium, and calcium.  Psychosocial issues such as depression and isolation also lead to poor nutrient intakes and increased rates of alcoholism among elderly.

Click Here To Navigate Within Article >> Abstract Introduction Nutrition in Periodontal Health Integrity of the Oral Mucosa Nutrient Effects on Collagen Healing and Maintenance Maintenance of Calcified Tissues Maintenance of the Host Immune Response Patient Populations at Nutritional Risk Dietary Recommendations References About the Authors
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Citation Number: Vol. 2, No. 2, Page 042