Defining malnutrition: a plea to rethink

Soeters, P., Bozzetti, F., Cynober, L., Forbes, A., Shenkin, A. and Sobotka, L. (2017) Defining malnutrition: a plea to rethink. Clinical Nutrition, 36 (3). 896–901. ISSN 0261-5614

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    Abstract

    In a recent consensus report in Clinical Nutrition the undernourished category of malnutrition was proposed to be defined and diagnosed on the basis of a low BMI or unintentional weight loss combined with low BMI or FFMI with certain cut off points. The definition was endorsed by ESPEN despite recent endorsement of a very different definition. The approach aims to assess whether nutritional intake is sufficient but is imprecise because a low BMI does not always indicate malnutrition and individuals with increasing BMI's may have decreasing FFM's. The pathophysiology of individuals, considered to be malnourished in rich countries and in areas with endemic malnutrition, results predominantly from deficient nutrition combined with infection/inflammation. Both elements jointly determine body composition and function and consequently outcome of disease, trauma or treatment. When following the consensus statement only an imprecise estimate is acquired of nutritional intake without knowing the impact of inflammation. Most importantly, functional abilities are not assessed. Consequently it will remain uncertain how well the individual can overcome stressful events, what the causes are of dysfunction, how to set priorities for treatment and how to predict the effect of nutritional support. We therefore advise to consider the pathophysiology of malnourished individuals leading to inclusion of the following elements in the definition of malnutrition: a disordered nutritional state resulting from a combination of inflammation and a negative nutrient balance, leading to changes in body composition, function and outcome. A precise diagnosis of malnutrition should be based on assessment of these elements

    Item Type: Article
    Uncontrolled Keywords: nutritional assessment,diagnosis,definition,inflammation,undernutrition,malnutrition,functional disability,diagnostic tools for malnutrition
    Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
    University of East Anglia > Faculty of Medicine and Health Sciences > Research Groups > Gastroenterology and Gut Biology
    University of East Anglia > Faculty of Medicine and Health Sciences > Research Groups > Nutrition
    Related URLs:
    Depositing User: Pure Connector
    Date Deposited: 13 Oct 2016 16:00
    Last Modified: 31 Aug 2018 16:31
    URI: https://ueaeprints.uea.ac.uk/id/eprint/60922
    DOI: 10.1016/j.clnu.2016.09.032

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