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Make the Diagnosis: Malnourishment, Adult

Prior Probability

The prior probability for adult malnutrition has a broad range. Among hospitalized medical or surgical patients, the prevalence is 10% to 40%. The prevalence among healthy patients, by definition, will be much lower.

Population for Whom Adult Malnutrition Should Be Considered

  • Disorders, conditions, or treatments affecting appetite

  • Malignancy

  • Psychiatric illness

  • Gastrointestinal tract illness

  • Conditions requiring a change to a suboptimal solid diet (eg, liquid diets, tube diets)

  • Disorders affecting metabolism

  • Elderly patients

  • Patients with unintentional weight loss of more than 5%, a major category of individuals for whom additional testing is warranted

Identifying the Malnourished Adult

Determine whether the patient has lost weight, the amount of weight loss, and his or her appetite to get a malnutrition score (Table 28-7).

Table 28-7.Detecting the Likelihood of Adult Malnutrition

Reference Standard Tests

  • Expert evaluation (dietitian or physician trained in nutritional care and assessment) using a combination of historical features, anthropometry, weight change, and biochemical measures.

  • SGA by a trained clinician for identifying patients at risk of complications related to malnutrition.

Original Article: Is This Adult Patient Malnourished?

Clinical Scenarios

Case 1

Ten days before being treated, a 65-year-old man experienced a Wallenberg stroke involving the lateral medulla, which left him with difficulty swallowing. Since then, he had been treated with intravenous fluids, as attempts at eating led to mild aspiration with pneumonia. In that period, he lost 6% of his usual body weight and was continuing to lose weight. He felt weak and was able to ambulate only with difficulty because of his stroke-related ataxia and generalized weakness. On physical examination, there was an obvious squared-off appearance to his shoulders from subcutaneous tissue and muscle wasting. There was no edema.

Case 2

A 63-year-old man was admitted to the hospital for gastric resection of an obstructing gastric carcinoma. He was well until 6 weeks before admission, when he began to notice the rapid onset of early satiety. This progressed to the point where he began to vomit virtually all food and fluids. He had lost 15% of his body weight and was continuing to lose weight. He was ambulatory but felt weak and was no longer able to carry on his usual daily activities because of this weakness. On ...

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