Determination of Nutrition Risk and Status in Critically Ill Patients: What Are Our Considerations?

Abstract

The stress catabolism state predisposes critically ill patients to a high risk of malnutrition. This, coupled with inadequate or delayed nutrition provision, will lead to further deterioration of nutrition status. Preexisting malnutrition and iatrogenic underfeeding are associated with increased risk of adverse complications. Therefore, accurate detection of patients who are malnourished and/or with high nutrition risk is important for timely and optimal nutrition intervention. Various tools have been developed for nutrition screening and assessment for hospitalized patients, but not all are studied or validated in critically ill populations. In this review article, we consider the pathophysiology of malnutrition in critical illness and the currently available literature to develop recommendations for nutrition screening and assessment. We suggest the use of the (modified) Nutrition Risk in the Critically Ill (mNUTRIC) for nutrition risk screening and the subjective global assessment (SGA) together with other criteria relevant to the critically ill patients, such as gastrointestinal function, risk of aspiration, determination of sarcopenia and frailty, and risk of refeeding syndrome for nutrition assessment. Further research is needed to identify suitable nutrition monitoring indicators to determine the response to the provision of nutrition.

Modified NUTRIC score and outcomes in critically ill patients: A meta-analysis

“…Inflammation seems to play an important role in the pathogenesis of malnutrition in ICU patients [2]. The second stage of critical illness is characterized by loss of body cell mass [3]. In addition, ICU patients are likely to suffer from malnutrition before admission to ICU due to chronic illness or cancer [2].…”

“…Malnutrition is associated with increased patient mortality and morbidity, including prolonged ICU stay, decreased immunity, increased rate of hospitalacquired infection, poor wound healing, and muscle wasting (leading to decreased ventilatory drive) [4]. Therefore, malnutrition is considered among the main causes of increased health care costs [3].…”

“…Early identification of patients who are at high risk of malnutrition is essential to start appropriate and prompt treatment [2], which may improve patients' outcomes [7]. Unfortunately, there is no unified standard protocol for screening of malnutrition, resulting in variations in practice across ICUs [3]. Most nutritional screening tools are not suitable in ICU settings because of the difficulty to obtain some parameters, such as accurate history of dietary intake and weight loss [3].…”

“…Unfortunately, there is no unified standard protocol for screening of malnutrition, resulting in variations in practice across ICUs [3]. Most nutritional screening tools are not suitable in ICU settings because of the difficulty to obtain some parameters, such as accurate history of dietary intake and weight loss [3].…”

Reconsidering Nutritional Support in Critically Ill Patients

“…High-NUTRIC scores have been associated with higher short-term mortality in a variety of settings, [18][19][20][21][22][23] and provision of adequate nutritional support among those with high NUTRIC scores appear to be associated with improved 28-day survival. 24,25 Notably, similar to the difficulty in assessing frailty amongst critically ill patients where functional status before an ICU admission is an important contributor, premorbid nutritional status (e.g., recent food intake and weight change) is a significant factor to consider and not accounted for in NUTRIC.…”