The role of nutrition in persons with disabilities

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МАТЕРІАЛИ УЧАСНИКІВ КОНФЕРЕНЦІЇ
ISSN 2077-6594. УКРАЇНА. ЗДОРОВ’Я НАЦІЇ. 2020. № 3/1 (61)
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Dostupné na internete: https://www.employment.gov.sk/files/rodina-soc-pomoc/soc-sluzby/narodny-akcny-plan-prechodu-z-
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sociálnej práce. In: Inovácie, plánovanie a kvalita sociálnych služieb v komunite – zborník príspevkov z 1. ročníka
medzinárodnej vedeckej konferencie. Ružomberok: Katolícka Univerzita v Ružomberku, 2011. 265-268 s.
ISBN 978-80-8084-781-4.
DOI 10.24144/2077-6594.3.2.2020.213729
Belovičová M., Popovičová M.
The role of nutrition in persons with disabilities
St. Elizabeth University of Health and Social Sciences, Bratislava, Slovakia
mriab9@gmail.com, maria.popovic911@gmail.com
Nutrition as a part of health care significantly affects
the patient´s healing process and is a necessary condition for
successful treatment and improvement of the patient´s clinical
condition. Natural, enteral and parenteral nutrition have
healing effects and form a unified system of clinical nutrition.
Inpatient care facilities for adults and pediatric wards,
nutritional care is provided, adapted to the nutritional status
and nutritional needs, morphological and functional state of the
digestive tract and the age of the patient [1].
Malnutrition is a condition of poor nuttion, which
includes any deviation from the state of good nutrition: it
occurs as a result of insufficient intake of energy or protein
according to the needs of the body, but also as a consequence
of insufficient intake of vitamins and trace elements.
During the escalation of catabolism, anabolic processes
are bound, the renewall of cells of the immune system, the
epithelium of the digestive tract, is reduced, and bacteria are
translocated through the intestinal wall. Reduced supply of
nutrients increases the intesity of stress metabolism, reduces
the effectiveness of treatment and worsens the course of the
disease [2]. Malnutrition is associated with a higher risk of
complications during the treatment of diseases, poorer woud
healing, an increased incidence of infections, greater
complications of surgery and other therapeutic interventions.
It is associated with longer hospital stays and increased
mortality [3,4].
Malnutrition is a serious global health problem that is
far from being limited to developing countries. In developed
European countiers, up to a third of patients suffer from various
forms of malnutrition. In total, malnutriion affects more than
30 million people i Europe. Insufficient nutrition of the patient
leads to a loss of muscle mass, which prevents effectice
rehabilitation of patients, impairs physical fitness and quality
of life [3]. At the same time, the effectiveness of many times
expensive and costly treatment is impaired, which is closely
related to the extension of hospitalisation and demands for
hospital and outpatient health care. The cost of treating
malnutrition-related health complications in EU countries is
estimated at up to 170 billion Eur.
Malnutrition and disability are both major global
public health problems, both are key human rights concerns,
and both are currently prominent within the global health
agenda. Malnutrition can cause or contribute to an individual’s
physical, sensory, intellectual or mental health disability. They
affect large numbers of often vulnerable individuals, including
children and adults: some one billion people worldwide are
malnourished, and around one billion live with a disability [5].
Both are currently prominent within the global health
agenda: the first ever World Report on Disability was
published jointly in 2011 by WHO and the World Bank cost-
effective interventions for tackling malnutrition have recently
been high; lighted in the 2013 Lancet Nutrition Series and
Scaling-up Nutrition (SUN), launched in 2010, is a major new
movement tackling malnutrition by “uniting people – from
governments, civil society, the United Nations, donors,
businesses and researchers – in a collective effort to improve
nutrition”.
The fields of malnutrition and disability are closely
interrelated with a number of points of convergence. Countries
with high levels of malnutrition and nutrient deficiency also
often report higher rates of disability and developmental delay.
There are several important areas of overlap and influence:
malnutrition can cause or contribute to a variety of different
disabilities; disabilities can cause or contribute to malnutrition.
Maternal malnutrition. Maternal malnutrition can
affect the development of the fetus, cause intra-uterine growth
delay and increase the risk of the infant developing
impairments. Micronutrients often play specific roles in such
occurrences. For example, low maternal folate is associated
with an increased risk of neural tube defects, one of the clearest
examples of a micronutrient specific, often serious and yet
largely preventable disability. A more general combination of
maternal macro and micronutrient malnutrition is associated
with physical and neurological/cognitive disabilities [5].
Child malnutrition. Infants and young children who are
malnourished as defined by underweight (low weight-for-age)
and stunting (low height-for-age) are also more likely to
screen positive for disability. Macronutrient and micronutrient

МАТЕРІАЛИ УЧАСНИКІВ КОНФЕРЕНЦІЇ
ISSN 2077-6594. УКРАЇНА. ЗДОРОВ’Я НАЦІЇ. 2020. № 3/1 (61)
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deficiencie are risk factors for physical, sensory and cognitive
impairment. For example, regarding micronutrient-associated
disability, each year between 250,000 and 500,000 children
become blind as a result of vitamin A deficiency. Several of the
B vitamins are associated with disabling conditions: vitamin B1
(thiamine) deficiency manifests as beri-beri, symptoms of which
include a lower extremity polyneuropathy; vitamin B3 (niacin)
deficiency manifests as pellagra whose neurological effects
include confusion and agitation; vitamin B6 (pyridoxine)
deficiency is a rare but well recognised cause of intractable
epilepsy. Childhood macronutrient malnutrition often manifests
as underweight or wasting and also impairs immune system
function and renders a child more susceptible to infection [5].
Dietitians are responsible for the nutritional
management of individuals who are referred to their care. It is
well recognised that people with disabilities are at risk of
nutritional problems and therefore it is very important that
there is access to dietetic services for this group. In children
with Cerebral Palsy, feeding difficulties have been found to
affect 60-90% of children. Many children with Autism
Spectrum Disorder exhibit selective eating and therefore have
self limiting diets which are unbalanced and problematic.
Equally, children with conditions such as Down’s Syndrome,
Spina Bifida and Muscular Dystrophy experience a range of
nutritional difficulties including undernutrition, eating, drinking
and swallowing (EDS) disorders, constipation, vitamin &
mineral deficiencies, bone problems, overweight/obesity,
among others. A significant number of those presenting with
EDS difficulties go on to require tube feeding [6].
Disabilities placing an individual at particularly
high risk of nutritional deficiency include cerebral palsy,
craniofacial anomalies (cleft lip and/or palate) and the many
genetic syndromes such as Down syndrome and Pierre Robin
sequence which are associated with, for example, oral-motor
feeding and swallowing problems.
A high incidence/prevalence of malnutrition is often
reported in children with disability, and this may result in
poorer health and development, leading to a perpetuating cycle
of sub-optimal nutrition, disability and worsening health status.
Malabsorption of nutrients is also common in children
with certain conditions, including cystic fibrosis. Unless
carefully managed with specially adapted diets (including
pancreatic enzyme supplementation in the case of cystic
fibrosis), both macro- and micronutrient-related malnutrition
can occur. This may lead to increased muscle wasting and loss
of function, and further exacerbate the insufficient intake of
energy and nutrients, now through mechanical causes.
Children with disabilities are also disproportionately
represented in many institutions and orphanages, and these
facilities are often overlooked in food programmes. An
additional concern is the often poor quality of food in
institutions. While of concern to all institutionalised children,
children with disabilities may be at particular risk.
Adult and later-life malnutrition. Malnutrition and
under-nutrition in older adults can also increase the likelihood
of breaking bones, including hip fractures, which can lead to
limited physical mobility; problems with physical mobility
after illness or injury can leave older adults physically unable
to obtain or prepare food for themselves; leading to changes in
eating patterns which can lead to further disability in older
patients.
Assessing nutrition and energy requirements is
challenging because the nutrition and energy requirements
vary depending on the disability diagnosis, the severity of the
disability, mobility status, age, medications, and feeding
problems. When determining energy requirements, registered
dietitian nutritionists may individualize the requirements based
on all of these considerations, as well as monitor the individual
and make changes to the plan of care as needed [7].
Conclusions. Disability is often seen as a specialist
subject and therefore not mainstreamed into education for
practitioners in nutrition, health and child development. Pre-
and in-service training of professionals in health-care, nutrition
and development on the links between disability and nutrition
would increase awareness of the specific nutrition
requirements of children with disabilities, and expand more
inclusive programmes and practice. As nutrition efforts are
scaled up, the needs of children and adults with disabilities
must be integrated to ensure that they are offered the same life-
saving interventions as other children [5].
Nutrition interventions for all children and adults will
also benefit children and adults with disabilities. In order to
ensure effective and inclusive nutrition, special attention
should be paid by nutritionists, health-care and community
service-providers to include children at high risk of becoming
malnourished (such as those with existing disability or chronic
disease) in existing nutrition programmes, as well as adapting
or expanding community-based models of care and reaching
out to institutions in which some children and adults with
disabilities live.
Adults with developmental disabilities and children and
youth with special health care needs have multiple risk factors
requiring nutrition interventions, including growth alterations
(eg, failure to thrive, obesity, or growth retardation), metabolic
disorders, poor feeding skills, drug-nutrient interactions, and
sometimes partial or total dependence on enteral or parenteral
nutrition [7].
Comorbid conditions such as obesity or endocrine
disorders that require nutrition interventions are also more
likely to develop as the population ages. Poor nutrition-related
health habits, limited access to services, and long-term
polypharmacy are considered significant health risk factors and
registered nutrition dietetics technicians are vital in providing
comprehensive care to these individuals [7].
The international community – governments, policy-
makers, multi- and bilateral donors and practitioners – must
ensure political and resource commitment to tackling nutrition
and disability as related issues.
For some children with disabilities as well as for adults
with disabilities, there is also a need for disability-specific
services which target and address their needs and those of their
families or caretakers, including professional special and
community-based rehabilitation services where these are
available [5].
Key words: malnutrition, disabilities, maternal
malnutrition, child malnutrition, adult-and later life malnutrition.