Adult Starvation and Disease-Related Malnutrition: A Proposal for Etiology-Based Diagnosis in the Clinical Practice Setting From the International Consensus Guideline Committee

• Published in: JPEN. Journal of parenteral and enteral nutrition 2010-03, Vol.34 (2), p.156-159
• Main Authors: Jensen, Gordon L., Mirtallo, Jay, Compher, Charlene, Dhaliwal, Rupinder, Forbes, Alastair, Grijalba, Rafael Figueredo, Hardy, Gil, Kondrup, Jens, Labadarios, Demetre, Nyulasi, Ibolya, Castillo Pineda, Juan Carlos, Waitzberg, Dan
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chronic Disease; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Humans; Inflammation - complications; Intensive care medicine; Malnutrition - diagnosis; Malnutrition - etiology; Medical sciences; Starvation - complications; Starvation - diagnosis; Terminology as Topic; Wounds and Injuries - complications
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607110361910

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.