A new systematic assessment of malnutrition, created by researchers at Penn State, will aid dietitians and other health care providers in diagnosis and treatment.
Up to 50 percent of patients in hospitals and nursing facilities are estimated to be malnourished, according to Gordon Jensen, professor and head of nutritional sciences, Penn State. Although malnutrition is widespread, confusion exists in the clinical community on how to best make this diagnose. Malnourished patients are frequently not identified as such, and those not affected are sometimes thought to be malnourished.
"Our systematic assessment is a new approach created for health care professionals to enable them to appropriately diagnosis and treat malnutrition in patients," said Jensen.
Supported by the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition, the new approach to diagnosis describes syndromes of malnutrition in the context of starvation, chronic disease and/or acute disease or injury.
"While it may be obvious that a person suffering from starvation -- as a result of an eating disorder or depression, for example -- is malnourished, it may be less obvious that a person suffering from a chronic disease, such as diabetes or rheumatoid arthritis, or from an acute disease or injury, such as major trauma from an auto accident or a serious blood-borne infection, is malnourished," said Jensen.
According to Jensen, patients with chronic or acute disease or injury may suffer from malnutrition as a result of their bodies' natural and sometimes exaggerated inflammatory responses to disease or injury, which can trigger a loss of appetite, abnormal metabolism and muscle breakdown.
"Inflammation is an important underlying factor that increases risk for malnutrition," he said. "Those patients with chronic disease tend to have inflammation that is chronic and of mild to moderate degree, while those with acute disease or injury tend to have inflammation that is acute and of severe degree."
That is why, in addition to providing health care workers with instructions for determining if a patient is suffering from malnutrition in the context of starvation, chronic disease and/or acute disease or injury, the assessment also suggests that health care workers evaluate patients' inflammatory status. This new approach can help guide practitioners in discerning appropriate nutrition interventions and anticipated outcomes.
The assessment appears in the May issue of the Journal of Parenteral and Enteral Nutrition. A companion paper that more thoroughly describes the necessity for the new assessment is in the May issues of both the Journal of Parenteral and Enteral Nutrition and the Journal of the Academy of Nutrition and Dietetics.
"The new assessment is part of a national effort to educate and implement the use of a more systematic and thorough approach to diagnosing malnutrition," said Jensen. "Our hope is that it will help ensure high-quality, cost-effective care for people suffering from malnutrition."
The researchers look forward to testing the effectiveness of the new approach to assessment and diagnosis in health care systems throughout the United States.
Other authors on the assessment paper include Pao Ying Hsiao and Dara Wheeler, graduate students in nutritional sciences, Penn State. Authors on the companion paper also include Jane White, Department of Family Medicine, University of Tennessee; Peggi Guenter, American Society for Parenteral and Enteral Nutrition; Ainsley Malone, Mt. Carmel West Hospital; and Marsha Schofield, Academy of Nutrition and Dietetics.
Consensus 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). Jane V. White, Peggi Guenter, Gordon Jensen, etal.. JPEN J Parenter Enteral Nutr, May 2012; vol. 36, 3: pp. 275-283.
Journal of the Academy of Nutrition and Dietetics Vol. 112, Issue 5, Pages 730-738 doi:10.1016/j.jand.2012.03.012
Penn State University