(13) Poor appetite
During some illnesses (eg, some cancers,
chronic obstructive pulmonary disease, Parkinson’s disease) and after
surgery, the effort of eating a normal meal can be overwhelming. Patients
who are ill might have no appetite for “meat and two vegetables”,
but they can often manage soup, soft rolls, desserts made with milk, breakfast
cereals or small sandwiches. Fried and fatty foods can be particularly
unwelcome. Although most dietary problems in the UK result from dietary
surplus, poor appetite for prolonged periods can make it difficult to
obtain sufficient energy and nutrients. There are a number of dietary
measures that can help to improve this situation.
- Eat smaller meals at more frequent intervals.
Consuming a small meal, snack or energy-providing drink can substantially
increase energy and nutrient intake.
- Encourage the use of foods that are concentrated
sources of energy (eg, full-cream milk, custard, milk puddings, eggs,
cheese, meat).
- Make ordinary foods more energy- or nutrient-dense
(eg, adding milk or cream to soups, butter to vegetables and extra sugar,
jam or honey to desserts).
- Increase consumption of energy and nutrient-providing
drinks (eg, milk, fruit juice, Build-up, Complan) rather than tea and
coffee.
- Drink minimal amounts of fluid with meals so
that the stomach is not filled too quickly.
- Have a glass of wine or other aperitif before
a meal might help to stimulate the appetite.
- Consume foods that are enjoyed. Although the
above suggestions will help to improve nutritional status, there is
no point in trying to get people to eat foods that they do not fancy.
- If these measures do not help, the patient might
benefit from a ready-to-drink sip feed (eg, Ensure, Fortisip). These
products are ACBS-prescribable (Advisory Committe on Borderline Substances).
Many are nutritionally complete and can, if necessary, be used as the
sole source of nutrition or they can be used to supplement the diet.
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This series of “dietary advice tips” is intended
to be a reminder of the main points to be made by pharmacists when giving
nutritional information to the public. The conditions included in the
series are those where diet is a well recognised risk factor, those in
which diet contributes to the management of the condition, and others
for which patients may welcome sound dietary advice.
Written by Dr Pamela Mason (a pharmacist with a postgraduate qualification
in nutrition)
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