New adult malnutrition strategies could improve diagnosis and treatment

A new consensus statement on adult malnutrition suggests classifying patients in three categories related to the cause of malnutrition, according to an international committee of nutrition researchers. This approach could lead to improved diagnosis and treatment of malnutrition.

"Depending upon the criteria that are used, up to 50 percent of patients in hospitals or skilled nursing facilities have been estimated to be malnourished," said Gordon Jensen, professor and head of nutritional sciences, Penn State.

Even though malnutrition has a far-reaching impact, widespread confusion exists in the clinical community on how to best identify it. Malnourished patients are frequently not identified as such, and those not affected are sometimes thought to be malnourished.

Part of this confusion is caused by the human body's inflammatory response -- the way the body fights disease, injury, and infection. Forms of malnutrition related to injury or disease often lead to loss of muscle and diminished function.

"We're taking a new starting point that we can all agree on, and one that is based on our modern understanding of malnutrition and inflammation," said Jensen. Because there are no universally accepted definitions for many of the terms used to describe the different types of malnutrition, Jensen and his co-authors propose replacing existing terminology with a simplified strategy for diagnosing malnutrition.

Advocated by an international group of nutrition researchers, the statement appeared in both Clinical Nutrition and the Journal of Parenteral and Enteral Nutrition, and has already been formally endorsed by both the European Society for Parenteral and Enteral Nutrition and the American Society for Parenteral and Enteral Nutrition.

In the new diagnosis strategy, each person affected by malnutrition falls into one or more of three categories: starvation related, chronic disease related, or acute disease/injury related. This simple approach is expected to lead to improved diagnosis and treatment.

The international consensus committee is now working on supporting diagnostic criteria.

The guideline committee that wrote the consensus paper includes researchers from Canada, the United States, Brazil, New Zealand, Denmark, South Africa, Mexico, Australia, Paraguay, and the United Kingdom.