Adult Starvation and Disease‐Related Malnutrition

Abstract

Background & Aims: Multiple definitions for malnutrition syndromes are found in the literature resulting in confusion. Recent evidence suggests that varying degrees of acute or chronic inflammation are key contributing factors in the pathophysiology of malnutrition that is associated with disease or injury. Methods: An International Guideline Committee was constituted to develop a consensus approach to defining malnutrition syndromes for adults in the clinical setting. Consensus was achieved through a series of meetings held at the A.S.P.E.N. and ESPEN Congresses. Results: It was agreed that an etiology‐based approach that incorporates a current understanding of inflammatory response would be most appropriate. The Committee proposes the following nomenclature for nutrition diagnosis in adults in the clinical practice setting. “Starvation‐related malnutrition”, when there is chronic starvation without inflammation, “chronic disease‐related malnutrition”, when inflammation is chronic and of mild to moderate degree, and “acute disease or injury‐related malnutrition”, when inflammation is acute and of severe degree. Conclusions: This commentary is intended to present a simple etiology‐based construct for the diagnosis of adult malnutrition in the clinical setting. Development of associated laboratory, functional, food intake, and body weight criteria and their application to routine clinical practice will require validation.

Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine?

“…This may result from a lack of clarity regarding the relationship between malnutrition risk versus diagnosed malnutrition, or from the lack of a gold standard for the diagnosis of PEM, either in hip fracture or more broadly (Hoekstra et al 2011;Elia and Stratton 2012). The International Statistical Classification of Diseases and Related Health Problems (National Centre for Classification in Health 1998) and a consensus statement defining characteristics for the identification and classification of malnutrition recently released by the Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) provide 2 well-recognised criteria for the purposes of diagnosing malnutrition (Jensen et al 2010;White et al 2012). The former of these considers subjective criteria in line with those proposed by Detsky et al (1987) or a BMI of <18.5 kg·m -2 , whilst the latter includes a combination of intake, anthropometric, fluid status, and functional measures to define malnutrition in the context of starvation, chronic disease, acute disease, or injury (White et al 2012).…”

Intensive Medical Nutrition Therapy: Methods to Improve Nutrition Provision in the Critical Care Setting

“…32,33 Critical illness promotes an acute inflammatory response, resulting in rapid lean body mass depletion and acute disease or injury related malnutrition. 34 To date, a nutritional status classification system that recognizes the role of inflammation is essential, yet nonexistent. Further research endeavors should incorporate markers and degrees of inflammation, in conjunction with laboratory, food intake, functional status, and weight histories.…”

Dilated Cardiomyopathy Induced by Chronic Starvation and Selenium Deficiency

“…We report a rare case of dilated cardiomyopathy caused by severe malnutrition combined with selenium deficiency in a teenager. The malnutrition seen in this patient can be more accurately defined as “disease or injury related malnutrition” and is commonly seen in the setting of major infection, burns, or trauma [2]. …”