The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics

Abstract

Malnutrition in adult hospitalized patients has been a significant issue for almost 40 years. Changes in 2007 to the diagnosis related groups reimbursement methodology, as outlined by the Center for Medicare and Medicaid Services, provided an impetus to improve the diagnosis and documentation of malnutrition in adult patients. Being able to accurately assess, diagnose, and document malnutrition has been challenged by the lack of a standard malnutrition definition. In 2012 a workgroup of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition published a consensus paper outlining characteristics for the diagnosis of adult hospital malnutrition. Using the etiology approach for defining malnutrition as outlined by Jensen and colleagues, 6 general characteristics are outlined with specific thresholds to delineate severe and nonsevere malnutrition. The purpose of this article is to provide practical strategies for criteria implementation and to describe one institution's experience in implementing a broad-based "malnutrition program" within its healthcare system.

ThedaCare Nutrition Risk Screen Improves the Identification of Non–Intensive Care Unit Patients at Risk for Malnutrition Compared With the Nutrition Risk Screen 2002

“…Interestingly, Kyle et al found similar sensitivity, specificity, and agreement for the NRS 2002 as confirmed using the Subjective Global Assessment when compared with the results that we report for the NRS 2002 . Current guidelines for the nutrition assessment as part of the nutrition care process use the 6 malnutrition clinical characteristics developed by AND/ASPEN . Given these similar results, the current study contributes to the evidence base that the nutrition assessment and NFPE, which employs the 6 malnutrition clinical characteristics outlined by AND/ASPEN, produces similar results as a nutrition assessment tool when compared with the Subjective Global Assessment.…”

Malnutrition: laboratory markers vs nutritional assessment

“…Moreover, they were found to have higher rates of readmission or require ongoing services such as home healthcare following discharge [11]. Hence, due to the recognition of the importance of the impact of malnutrition on economic burden, the Centers for Medicare and Medicaid Services (CMS) have implemented a change in their reimbursement rates according to its severity [5]. …”

Nutrition Assessment of the Intensive Care Unit Patient

“…Inspection and palpation of muscles and skinfolds can yield important information about muscle and fat stores. 26,27 Edema and ascites are associated with alterations in total body water, protein synthesis and transport, or hypoalbuminemia and should be noted if present. An evaluation for signs and symptoms of micronutrient and mineral deficiencies should be made (see Table 2 50 TOPICS IN CLINICAL NUTRITION/JANUARY-MARCH 2015 for examples).…”

“…Requirement calculations should be done using estimated dry weight in edematous patients. 26 Accurate determination of dry weight is difficult in the ICU setting. Weight of retained fluid is estimated to be 2.2 kg for minimal ascites, 6 kg for moderate ascites and 14 kg for severe ascites.…”

“…A standardized set of diagnostic criteria was proposed by the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (ASPEN) to support these definitions. 25,26 Criteria include assessment of energy intake, interpretation of weight loss, and physical findings such as body fat loss, muscle loss, fluid accumulation/ edema, and reduced muscle function. See Table 1 for clinical characteristics of acute disease or injury-related malnutrition.…”