Disease Related Malnutrition case study: Mary's story

It was tricky for her to put weight on through food alone, but with the help of oral nutritional supplements, Mary started to rebuild muscle mass and got back to a healthy weight. 

Your kidneys are essential for your wellbeing. These bean-shaped organs remove waste products from the body. They balance the fluids in your body and control blood pressure. They make the active form of vitamin D, essential for healthy bones and teeth, and regulate red blood cells, which carry oxygen around your body.

Many diseases can damage the kidneys, including diabetes and, in Mary’s case, dangerously high blood pressure (hypertension). The damage causes the kidneys to gradually stop working. Doctors call this Chronic Kidney Disease (CKD), which often leaves people feeling tired. CKD can also weaken bones, damage nerves and, as Mary found, lead to muscle wasting and unintentional weight loss.

Mary, a 62-year-old former school teacher, has only about a seventh of her normal kidney function. Because of a process called protein-energy wasting (PEW) associated with kidney disease, Mary had lost protein - the building blocks of much of the body - and fat. Both are important energy sources.

During an appointment with her consultant, Mary complained that she’d lost 5kg over the past 3 months – that’s about a tenth of her body weight. She constantly felt tired and had “no appetite”. The team asked Mary to see a dietitian.  

Mary told the dietitian that she avoided protein-rich foods, because they tasted metallic to her. Her fatigue and weakness made cooking and going to the supermarket difficult, and she often skipped breakfast. For dinner, Mary usually microwaved ready meals, home-delivered by the local supermarket. Because of the metallic taste she usually finished only a quarter of the meat, so she wasn’t getting enough protein or energy to meet her needs. Mary was underweight and had lost a significant amount of muscle mass.

The dietitian suggested one high-protein oral nutritional supplement daily and a modular, single-nutrient oral nutritional supplement three times a day to boost her energy and protein intake. The dietitian also explained to Mary how to fortify her food to increase her intake, for example by adding cheese or butter to dishes, or adding cream or condensed milk to puddings. 

Three months later, Mary is now in the healthy range for body mass and she has gained muscle. She’s getting out more, eating fewer ready meals, has more energy and a better appetite. She looks forward to the improvement continuing.