Since there are no universally recognized diagnostic criteria for malnutrition, the diagnosis is not always straightforward.
There are several sets of criteria currently in use for the diagnosis of malnutrition.[1][2] The Global Leadership Initiative on Malnutrition (GLIM) criteria include unintentional weight loss, low BMI, reduced muscle mass, decreased intake or absorption of food, and inflammation.[3] The American Society for Parenteral and Enteral Nutrition (ASPEN) criteria are insufficient energy intake, weight loss, loss of subcutaneous fat, loss of muscle mass, accumulation of general fluid, and decreased functional status (assessed by grip strength).[4] The European Society for Clinical Nutrition and Metabolism (ESPEN) criteria for a malnutrition diagnosis are either a BMI less than 18.5 or an unintentional weight loss paired with either a low BMI or a low fat-free-mass index (FFMI).[5] There are many similarities between these diagnostic tools. BMI is often used as a starting point because it is easily determined and provides quick information. Other gauges of body composition, like a DEXA scan or CT scan, might be more accurate but require equipment and financial resources.
The current malnutrition diagnostic criteria do not include the overweight and obesity (overnutrition) or micronutrient types of malnutrition. However, overweight and obesity are commonly diagnosed according to BMI, although it’s not always accurate, e.g., in the case of athletes. A BMI between 25 and 29.9 is considered overweight, and a BMI of 30 or higher is considered obese. Measuring the waist circumference can also be an indicator of the distribution of excess adipose (fat) tissue.[6]
Micronutrient malnutrition can occur in both undernutrition and overnutrition. Blood tests for micronutrient deficiencies are ordered based on symptoms, physical examination findings, and diagnosis. For example, testing for a vitamin B12 deficiency would be helpful in someone who is using medication for stomach ulcers and experiencing numbness in the feet and hands (peripheral neuropathy).[7]
References
- ^Hegazi R, Miller A, Sauer AEvolution of the diagnosis of malnutrition in adults: a primer for clinicians.Front Nutr.(2024)
- ^Elia MDefining, Recognizing, and Reporting Malnutrition.Int J Low Extrem Wounds.(2017 Dec)
- ^Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren MAE, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Van Gossum A, Compher C, GLIM Core Leadership Committee, GLIM Working GroupGLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community.Clin Nutr.(2019 Feb)
- ^White JV, Guenter P, Jensen G, Malone A, Schofield M, Academy Malnutrition Work Group, A.S.P.E.N. Malnutrition Task Force, A.S.P.E.N. Board of DirectorsConsensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition).JPEN J Parenter Enteral Nutr.(2012 May)
- ^Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM, de van der Schueren MA, Singer PDiagnostic criteria for malnutrition - An ESPEN Consensus Statement.Clin Nutr.(2015 Jun)
- ^Orzano AJ, Scott JGDiagnosis and treatment of obesity in adults: an applied evidence-based review.J Am Board Fam Pract.(2004 Sep-Oct)
- ^Berger MM, Shenkin A, Schweinlin A, Amrein K, Augsburger M, Biesalski HK, Bischoff SC, Casaer MP, Gundogan K, Lepp HL, de Man AME, Muscogiuri G, Pietka M, Pironi L, Rezzi S, Cuerda CESPEN micronutrient guideline.Clin Nutr.(2022-Jun)