The Use of Liquid Diet As An Alternative In

The Treatment of Malnutrition and Deficiency Diseases

by

Napatchanan Supattaraniyapong
Saovarat Pomtong

Submitted to
Mahidol University International Demonstration School
April 2023
 Literature Review Research Paper

The Use of Liquid Diet As An Alternative In The Treatment of

Malnutrition and Deficiency Diseases

Napatchanan Supattaraniyapong, Saovarat Pomtong

Mahidol University International Demonstration School, Nakhon Pathom, Thailand

__________________________________________________________________

Abstract

Liquid diet has been widely used in the medical field to aid in the preparation of tests or
procedures that require an empty stomach, the recovery of the gastrointestinal system as well as
assisting in weight loss. However, the use of liquid diet in the treatment of malnutrition and
deficiency diseases has not been brought up even until now. The specific purpose of this study is to
review past studies on the topic of liquid diet as well as malnutrition and deficiency diseases, to
bring about new measures to support the maintenance of a healthy diet and aid in body recovery.
Utilization of liquid diet involves the various steps of food processing to obtain an
accessible liquid state. It can be used in different ways to help supply the human body with
necessary nutrients by adjusting the levels of components in that particular diet. Additionally, many
researches have shown that one of the most common deficiency diseases observed worldwide is
iron deficiency, which is most frequent in older age. Thus, liquid diet can be utilized as a
supplement to maintain an appropriate level of iron in order to treat or prevent aggravation.

Keywords: Liquid diet ᐧ Malnutrition ᐧ Deficiency disease ᐧ Nutrients

 1. Introduction

1a. Malnutrition and Deficiency Diseases

The term ‘malnutrition’ has no universally accepted definition. It is used to describe

deficiency, excess or imbalance of nutrient intake, resulting in a measurable adverse effect on the
body composition, function and clinical outcome. Occasionally, we get more nutrients than we
actually need, and sometimes less than that from the food we eat daily. Malnutrition occurs
frequently, however, it is an underrecognized and undertreated problem faced by many. They can
come in two types: overnutrition and undernutrition, however, ‘malnutrition’ is often used
synonymously with ‘undernutrition’ in this article.
Malnutrition is both a cause and a consequence of diseases that exist in the community
often due to situations of poverty, social isolation and substance misuse. Biological factors such
as mental illnesses and disabilities also play a major role in the cause of various deficiency
diseases. These deficiencies are also often barely noticeable, which makes it difficult for many to
identify the disease or notice the symptoms. However, in most cases, deficiency diseases are able
to be treated by simply eating enough food that contain the nutrients that the patient is lacking.
According to the World Health Organization, the most common micronutrient
undernutrition is iron deficiency. The prevalence of iron deficiency increased during an interval
of 12 years(2006 - 2018). Iron is one of the important minerals that our body needs. Iron plays a
major role in synthesizing heme or haem, one of the components that make up hemoglobin
which is necessary to bind oxygen to the bloodstream. With less amount of iron, our body will be
unable to produce enough hemoglobin, which would later lead to health problems like anemia if
left untreated. The only way to treat iron deficiency is to get enough iron from food consumed.
This is simply because the human body is unable to synthesize iron. An example of the food that
contains iron are lean meat, seafood, and poultry. However, the amount of iron that our body
needs actually depends on each person. Children need a higher amount of iron because they need
it for their growth and development.
 1b. Liquid Diet

The term ‘food’ can be described as a substance that all living organisms need in order to
stay alive. Food consists essentially of proteins, carbohydrates, fat and other nutrients that are
used in the body of an organism to sustain growth and vital processes to furnish energy. Food can
be divided into two main categories which are solid and liquid food.
Solid food is any solid substance that is used as a source of nourishment. It is something
that we see and need in our everyday lives. However, liquid food on the other hand might not
sound familiar to many people. Just like solid food, the word liquid food can be used to describe
edibles that come in the form of a liquid or semi-liquids. Liquid food is often used by many
groups of people as supplements to fulfill what the body needs, rather than replacing a solid food
meal. This is because although liquid food provides energy in the form of calories, the human
body does not detect them the same way as it would detect solid food, these calories are then
considered as empty calories. When people consume solid food, the calories they obtain are
naturally compensated as the body does not assimilate 12% of it. Instead, the human spends the
12% calories in the process of breaking down and absorbing leftover calories and nutrients.
This category of food, liquid food, can be further classified into two main types: clear
liquid diet and full liquid diet. Clear liquid diet is a diet consisting of exclusively clear liquids,
which can include water, broth and some juices without fiber or pulp. Similar to a clear liquid
diet, a full liquid diet is also a diet that is made up only of fluids or foods that turn to liquid when
at normal room temperature. However, a full liquid diet covers a much wider range of food such
as dairy products such as milk and cream and can include a more concentrated or denser liquid.
Compared to each other, full liquid diets have more calories, protein and nutrients than clear
liquid diets, however, both can be used to help meet the daily calorie and protein requirements of
the body.
Malnutrition and Deficiency Disease

The term ‘malnutrition’ refers to deficiencies, excesses or imbalances in a person’s intake

of energy and/or nutrients. It pertains to two broad categories of conditions. One is
‘undernutrition’, which is the insufficiency of nutrients. And the other is ‘overnutrition’, which is
caused due to excessive intake of nutrients. The environment, lifestyle and resources are some of
the factors that cause the imbalance in levels of nutrient consumption, which leads to
malnutrition. Malnutrition can be the beginning of the occurrence of many other medical
conditions and diseases which can be life threatening if left untreated. Both the types -
undernutrition and overnutrition - have a negative effect on the human body, however, many
researches have shown that undernutrition has a greater impact than overnutrition, and is one of
the problems that has been gradually increasing throughout the world.
Despite all the developments in our world, malnutrition is a condition that many countries
still face unfortunately due to situations of poverty. Many families are unable to afford or access
enough nutritious food due to the high cost, while unhealthy foods high in fat, sugar and salt are
cheaper and more readily available. This leads to a rapid rise in the number of children and
adults who are overweight and obese all over the world. However, social status and the
availability of nutritious food are not the only causes of malnutrition. In many countries,
malnutrition is also often caused by long-term health conditions which lead to lack of appetite,
disrupted digestion and the body’s increased demand for energy. Reduction in appetite sensation
is a result of changes in cytokines, glucocorticoids, insulin and other hormones. This condition
may also be experienced by people with intestinal failure and those undergoing abdominal
surgical procedures, which can also cause malabsorption and increase risk for weight loss.
Malnutrition affects the function and recovery of the organ systems mainly including the
muscular system, cardio-respiratory system, gastrointestinal system, lymphatic system and the
nervous system. One of the most obvious signs of malnutrition is weight loss due to depletion of
fat and muscle mass. Muscle function declines before changes in muscle mass occur, suggesting
that altered nutrient intake has an important impact independent of the effects on muscle mass.
Similarly, improvements in muscle function with nutrition support occur more rapidly than can
be accounted for by replacement of muscle mass alone. Not only does normal muscles get
depleted, malnutrition may also lead to the reduction in cardiac muscles resulting in decreased
cardiac output which has a corresponding impact on renal function. If dietary intake is
insufficient to meet requirements over a long period of time, the body draws on functional
reserves in tissues such as muscle, adipose tissue and bone leading to changes in body
composition. And with time, there are direct consequences for tissue function, leading to loss of
functional capacity and a weak, but stable metabolic state. In addition, adequate nutrition is
important for preserving the gastrointestinal function. Malnutrition results in changes in
pancreatic exocrine function, intestinal blood flow, villous architecture and intestinal
permeability. The colon eventually loses the ability to absorb water and electrolytes, and the
secretion of ions and fluid occurs in the small and large intestine, which can cause diarrhea
leading to death in severely malnourished patients.
Malnutrition affects people all over the world. Observational studies have shown that 462
million individuals are underweight and around 1.9 billion are overweight. An estimated 41
million children under the age of 5 years are overweight, while 159 million have problems
relating to growth and development, and 50 million are emaciated. In addition, 528 million or
29% of women of reproductive age around the world are affected by anemia. Malnutrition
increases one’s susceptibility to and severity of infections, and is thus a major component of
illness and death from disease. It is the direct cause of about 300,000 deaths per year and is
indirectly responsible for about half of all deaths in young children.

Iron Deficiency

Iron is an essential mineral that is needed by the human body to produce red blood cells,
which are required for a healthy immune system, mental function, muscle strength and energy.
Its main role is in the production of hemoglobin, a protein present in red blood cells that allows it
to carry oxygen received from the lungs to various parts of the body, as well as myoglobin, a
protein that provides oxygen to muscles. The amount of iron needed by the body varies for each
person, depending on their age, sex and diet routine. It is recommended that infants take 11 mg
of iron, teenage boys take 11 mg while girls take 15 mg, and adult men take 8 mg while adult
women take 18 mg. It can be observed that women need more iron than men as large amounts of
red blood cells are lost during their menstruation. Additionally, during pregnancy, the volume of
blood in the body increases, which requires an increased demand of iron to make healthy red
blood cells to supply oxygen to the whole body as well as to the developing baby.

In the short term, getting too little iron does not cause obvious symptoms. The body[ is
able to use stored iron from muscles, liver, spleen and bone marrow. However, when levels of
iron stored in the human body becomes low, there is an increased risk of illness and infection
resulting from the body’s weak immune system. The main use of iron in the body is in the
production of a protein, hemoglobin, which is required in red blood cells to aid in transportation
of oxygen. So, if the body lacks iron, the red blood cells will become smaller in size due to the
inability to produce necessary proteins and the body will be unable to transport oxygen from
lungs to the tissues for respiration, leading to low energy production rate. Low levels of iron not
only affects the process of transportation of oxygen, but also decreases the conversion of certain
hormones. This process requires an enzyme called thyroid peroxidase, which relies heavily on
iron. Without sufficient iron, the whole process slows down and the body ends up with less
active thyroid hormones. This may lead to the deterioration of iron deficiency even as low
thyroid activity causes a decrease in stomach acid production rate, leading to less absorption of
nutrients in the stomach and the cycle continues.
Iron deficiency is the most common and widespread nutritional disorder in the world,
affecting 22.8% of the population globally. The prevalence was highest among children under
five years of age, affecting 39.7% of the whole group. This high prevalence in children is a result
of various reasons, commonly the lack of iron in diet. While in adults, especially women, iron
deficiency arises from an unbalanced diet, chronic blood loss, pregnancy, vigorous exercise and
the inability to absorb nutrients efficiently. Normally, the healthy body absorbs around 18% of
the available iron from a typical diet and about 10% from a vegetarian diet. However, the rate of
absorption of iron also depends on the amount of iron already stored in various organs of the
body including the liver, spleen, bone marrow and many more. If the stored iron levels are high,
the human body absorbs less iron from the food consumed. And conversely, low iron stores
increases the ability to absorb iron. Iron stores in the body can vary from time to time and in
different age and sex. This depends on the body’s need for iron during that specific time. For
instance, women go through a period of blood loss from the menstrual cycle resulting in a
decreased number of red blood cells and an increased need for iron to produce more healthy
blood cells.

Liquid Diet

Food is one of the basic necessities of every life on earth. The term ‘food’ is any
nourishing substance that contains nutrients that are essential for growth and development,
repair, and maintenance of an organism’s body and for the regulation of vital processes. Nutrients
are classified into five major categories: carbohydrates, proteins, minerals, fats and vitamins. In
these six categories of nutrients, minerals and vitamins could be categorized further as
micronutrients as they are required by the body in very small amounts as compared to other types
of nutrients such as carbohydrates and proteins. Most foods contain all or most nutrient groups in
different amounts.
Similar to how nutrients can be grouped into different types, food can also be divided into
solid and liquid, depending on their state. Solid food is what we are familiar with everyday in our
lives, including common food such as meat, fruits, cereal, and much more. But when speaking of
liquid food, many might have a hard time imagining what that type of food might be. The term
‘liquid food’ or ‘liquid diet’ is used to label a type of food that is made up only of fluids or
semi-solids. There are two types of liquid diet: clear liquid diet and full liquid diet. These two
may sound similar and are both composed of a liquid base, however, a full liquid diet is much
less constrictive and can consist of items like cream, honey, custard and many more types of food
that have high density and are more viscous. While a clear liquid diet limits the options to only
clear, transparent liquids and in some cases non-thickened liquids.
Liquid diet is used by many groups of people, varying from medical professionals to
athletes and to large groups of elderly. The most common use of liquid diet is in the medical
field, right before a medical test or procedure, or before certain kinds of surgery. Having a lower
calorie content, liquid diet is used by doctors to regulate the body mass of a patient, which
reduces the liver size, and intra-abdominal fat, as well as the operating time and recovery time.
Expecting similar outcomes, liquid food is also used by athletes and many groups of people as a
tool to reduce weight and as supplements to lead a healthy lifestyle. However, misuse of liquid
diet may lead to complications such as the development of malnutrition. Liquid diet provides
calories at a decently low level, however, this applies to the nutritional values too. Calories
provided by a liquid diet are often referred to as empty calories due to the lack of nutrients.
However, the amount of nutrients available in a liquid diet can be regulated by the user,
depending on the ingredients used. Liquid food could be considered as one alternative in the
treatment of malnutrition and deficiency diseases. Suppose a liquid food schedule was to be
made for the treatment of iron deficiency, fruits and vegetables high in iron such as beetroot,
spinach and prune could be processed and filtered into a liquid form, appropriate for use. In
severe cases where very high levels of nutrients are needed, liquid diet can be used along with
ferrous sulfate to boost the availability of iron in the diet.
Conclusion
Food plays an important role in every human’s life, providing the body with nutrients and
energy. However, large parts of the globe suffer from medical complications that arose from the
deteriorating economic conditions in particular areas, which leads to poverty and hunger. And
finally, this affects the human body directly, causing various types of malnutrition and deficiency
diseases. Research shows that iron deficiency disease is the most prevalent type of deficiency
disease, affecting 22.8% of the world population and 39.7% in children under five years of age.
If malnutrition and deficiency diseases are left untreated, it may cause the body to weaken and
shut itself down eventually.
The use of liquid diet as an alternative in the treatment of these diseases could be taken
into effect, considering the various benefits. Liquid diet is a type of diet that is easily accessible
by all groups or people no matter the age or sex. Furthermore, levels of nutrients available in
liquid food could be modified according to the body’s needs. However, cautions have to be taken
to prevent any forms of misapplications that could lead to deterioration in the body’s health. To
conclude, new measures should be brought about as an alternative to the treatment of
malnutrition and deficiency diseases such as the application of liquid food.
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