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.


■  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