Screening and Assessment of Malnutrition

Forty years ago, there were preliminary reports pointing out that malnutrition is not only seen in persons living in poor socioeconomic conditions, but it can also be observed in patients admitted to hospitals or living in the community associated to an underlying disease [1]. Many disorders can cause a deterioration of nutritional status. Neurological diseases can be associated with malnutrition due to decreased appetite and intake, frequent occurrence of dysphagia, and varying degree of hypermetabolism [2]. Although common sense would predict that it is not difficult to characterize malnutrition, it is well known that it is not easy to define it [3]. There is a need of a gold standard that allows clinicians and scientists to achieve a consensus definition of malnutrition. A few years ago, a group of experts in clinical nutrition were invited to answer a questionnaire aimed at identifying the main features of malnutrition. The deficiencies of energy or protein and the decrease in fat-free mass were most often cited to be particularly important in defining malnutrition. From the perspective of elements important in delineating malnutrition, involuntary weight loss, body mass index (BMI), and no nutritional intake were also mentioned. However, opinions on cutoff points regarding these elements differed strongly among experts [4]. A few years later, an international consensus committee established a classification of malnutrition syndromes [5]: