Malnutrition: diagnosis, screening and consequences

In his work entitled Nutrition Clinique Pratique, Stéphane Schneider examines malnutrition. The book gives us the opportunity to issue a reminder of the key issues relating to the condition.

Overview

■  Malnutrition is defined as a deficiency in energy, protein or any other macro or micronutrient that affects bodily functions and/or body composition and worsens conditions. Muscles are the part of the body most affected by malnutrition.

Consequences of malnutrition 

■ Increase in morbidity and mortality rates of chronic and acute diseases
■ Increase in the likelihood of:
– infection, particularly hospital-acquired and pulmonary
– osteopenia/osteoporosis
– dependence, falling and handicap
– bedsores and thromboembolic disorders
– fractures
– hypothermia
■ Delays cure
■ Reduces efficiency of treatments
■ Increases length of convalescence, number of prescriptions and hospital costs
■ Affects quality of life, well-being and social relations

According to Stratton et al

■ The condition can be caused by a lack of appropriate intake and/or an increase in loss and/or and increase in requirements. It is associated with certain chronic diseases.

Three types of malnutrition :

– Malnutrition in conjunction with an inflammatory disease is defined as cachexia

– Malnutrition in conjunction with a non-inflammatory disease (e.g. increase in loss or increased requirements)

– Non disease-related malnutrition (insufficient intake)

Principal chronic diseases associated with malnutrition 

Disease/Age	Consequences of
Cancers	39%
AIDS	5 à 10%
Kidney disease	25% (kidney disease) à 70% (dialysis)
Respiratory disease	20 à 70%
Chronic pancreatitis	67%
Chronic liver conditions	30%
IBD	15%
Neuromuscular disorders	15-55%
Neurological disorders with difficulty swallowing	100% Swallowing difficulties as a result of a stroke
Patients aged 70-80, at home	3-5%
Patients aged over 80	10%
Patients in care, aged over 60	20-30%

According to Stratton et al

■ A combination of symptoms indicate malnutrition

Symptoms to watch out for

■ Memory loss and lack of concentration

■ Mid-day asthenia

■ Loss of physical ability

■ Apathy

■ Digestive symptoms: anorexia, dysphagia and odynophagia, slow digestion, dyspepsia, diarrhoea and/or constipation

■ A number of concording clinical, biological and MNA or NRI elements lead to a diagnosis of malnutrition.

Malnutrition is diagnosed in the presence of one or more of the following criteria: 

Malnutrition	Severe Malnutrition
<70 years BMI: 16-18.5 Loss of over 5% body weight over 1 month or loss of over 10% body weight over 6 months Albumin level <30g/l Prealbumin level <0.11g/l	<70 years BMI <16 Loss of over 10% body weight over 1 month or loss of over 15% body weight over 6 months Albumin level <20g/l Prealbumin level <0.05g/l
>70 years BMI: 18-21 Albumin level <35g/l MNA <17 or MNA-SF <8	>70 years BMI <18 Albumin level <30g/l

Criteria issued by HAS, the French health authority