2.1. Malnutrition Screening and Diagnosis

Question 1

15-80% of which studied populations are diagnosed with malnutrition? Which of these groups is at the highest risk of malnutrition?

Answer 1

• Community (15%)
• Hospitals (50%)
• Long-term care (80%) ******

Question 2

Studies done by the Canadian Malnutrition Task Force found that 51% of patients in hospitals for longer than 7 days were malnourished; 14% of which considered to be severely so.

What was theorized to be a cause of this occurence?

Answer 2

The lack of availability of good quality foods in hospitals.

Question 3

What screening tool for malnutrition is:

• sensitive, specific, reliable, valid
• and simple, practical, rapid, and intuitive?

Answer 3

None. There is no tool described above that exists

Question 4

What are the elements of screening for malnutrition currently in place?

Answer 4

1. Current condition?
   BMI first, then MAMC or calf circumference
   - If BMI is 18.5-20 kg/m²; RISK
   -If BMI <18.5 kg/m²; LOWERED LEAN MASS
2. Stable condition? Involuntary weight loss
   * *-** Severe = >5% in 1 month or 10-15% in 6 months
   - Moderate = >5% in 3 months
3. Will condition deteriorate? Lower food intake
   * *-** Estimated or measured
4. Impact of disease on deterioration?

Question 5

Examples of screening questionnaires

Answer 5

Question 6

Some screening tools include the NRI (Nutrition Risk Index), the MUST (Malnutrition Universal Screening Tool), the SNAQ (Short nutritional Assessment Questionnaire), and the MNA (Mini Nutritional Assessment).

Which of these is specific to older patients?

Answer 6

The MNA.

Question 7

The GLIM criteria for the diagnosis of malnutrition is a consensus report from the global clinical nutrition community. What is the process of the GLIM report?

Answer 7

1. Risk screening: validated screening tools
2. Diagnostic assessment: phenotypic and etiologic
3. Diagnosis: @ least 1 phenotypic AND 1 etiologic
4. Severity grading: based on cutoffs and phenotypic criterion

Question 8

What functional assessment can be used as a supportive measure for determining strength?

Answer 8

Hand-grip test

Question 9

Which stage of the GLIM severity grading does the following criteria apply to?

• 5-10% BW lost within 6 months, or 10-20% beyond 6 months
• BMI of <20 if under 70 y.o., or BMI of <22 if over 70 y.o.
• Mild to moderate reduced muscle mass

How many of the above phenotypic criteria need to be present in order to meet this grade level?

Answer 9

• Stage 1: Moderate malnutrition
• Only 1 criterion necessary

Question 10

Which stage of the GLIM severity grading does the following criteria apply to?

• >10% BW lost within 6 months; or >20% beyond 6 months
• <18.5 BMI if <70 y.o., <20 BMI if >70 y.o.
• Severe reduced muscle mass

How many of the above criteria need to be present in order to meet this grade of severity?

Answer 10

• Stage 2: Severe Malnutrition
• Only 1 criterion needs to be present

Question 11

If inflammation is not present when a nutrition risk is identified, what is the likely etiologic definition of malnutrition?

Answer 11

Starvation-related malnutrition: pure chronic starvation, anorexia nervosa

Question 12

If inflammation is present in mild to moderate levels after a nutrition risk is identified, what is the etiologic definition of malnutrition?

Answer 12

Chronic disease-related malnutrition: organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity

Question 13

If a marked inflammatory response is present after a nutrition risk is identified, what is the etiology-based definition of malnutrition?

Answer 13

Acute disease- or injury-related malnutrition: major infection, burns, trauma, closed head injury