expenditure. Disease-related malnutrition arises due to reduced dietary intake, malabsorption, increased nutrient losses or altered metabolic demands. Rapid decompensation occurs with insults such as infection and trauma. Therefore, a collaboration between the Department of Health and stakeholders with an interest and expertise in nutritional care has published the Nutrition Action Plan which sets out key priorities 15 including: raising awareness ensuring access to guidance promoting screening and training clarifying standards. The prevalence of malnutrition increases by at least twofold in the elderly and those with chronic disease, and threefold in individuals living in institutional care.
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The term malnutrition has no universally accepted definition. This may occur following only a short period of starvation. Delayed wound healing is also well described in malnourished surgical patients. They raise our blood pressure, quicken our heart beat and tense the muscles: our body is now fully prepared for fight or flight. But the causes must be set in the larger context of employers paying Chinese workers a fraction of the regular wage rate and the desperate situation of Chinese Canadian workers after the completion of the Canadian Pacific Railroad. Some 30,000 people are declared unfit for work due to stress or being overworked each year. In examining both tragedies and accomplishments in the past, we are usually interested in the questions of how and why. The total must score is a better predictor of outcome than scores from the individual components. These questions start the search for causes: what were the actions, beliefs, and circumstances that led to these consequences? People have motivations and reasons for taking action (or for sitting it out but causes go beyond these. Importantly, unbalanced or sudden excessive increases in energy intake also put malnourished patients at risk of decompensation and refeeding syndrome.