Malnutrition Awareness Week was just a few weeks ago and the spotlight was once again on malnutrition. Are we any better at diagnosing and treating it? In 2012, the Academy of Nutrition and Dietetics and the American Society of Parenteral and Enteral Nutrition published a consensus statement concerning the characteristics recommended to identify malnutrition. For years RDs had been using serum albumin and prealbumin as markers for nutritional status. We now know that those acute-phase proteins are better markers of the severity of inflammation and not nutritional status. What do we use instead?
Recognizing there was and still is no single, universally accepted approach to the diagnosis and documentation of adult malnutrition, in 2009 ASPEN and their European counterpart ESPEN, began developing criteria to use.
The consensus statement, using the work of ASPEN, recommended 6 characteristics to diagnose malnutrition:
• Insufficient energy intake
• Weight loss
• Loss of muscle mass
• Loss of subcutaneous fat
• Localized or generalized fluid accumulations that masks weight loss
• Diminished functional status as measured by hand grip strength
The 6 characteristics of adult malnutrition are etiology based…meaning that not all malnutrition is due to the same root cause. Malnutrition may be related to starvation due to environmental or social issues, or related to mild to severe inflammation from chronic or acute disease. Three of the six characteristics require hands on physical assessment. Clinical skill is a necessary part of diagnosing malnutrition.
With that background, there are a number of questions that I have. Here goes:
• Where do you think we are as a profession and as individuals in our ability to accurately define, diagnose and document malnutrition?
• How did Malnutrition Awareness Week impact your clinical practice?
• What have you found to be helpful in advancing your practice in these areas?
- Establishing nutrition preventions before malnutrition develops
- Better detecting malnutrition as a nutrition diagnosis
- Setting up effective nutrition interventions
• What do you think are the next steps to drive home the message of malnutrition to our colleagues?
Share your ideas and success stories so as a profession, we can be in the forefront of this issue and be viewed by other professions as the experts we are.