A review by McKinlay discusses this very important topic of disease related malnutrition. The cost is enormous both in hospital and long term care facilities. There is aslo much malnutrition in the population at large especially the elderly.
Recognising this is a real clinical requirement both generally and specifically for each new patient.
The body mass index BMI ( weight in kg divided by Height squared in meters squared ) is a good measure. Less than 18 is associated with severe muscle and function impairment.
The British Association of Parenteral and Enteral Nutrition ( BAPA ) suggest the Malnutrition Universal Screening Test
1. The measurement of height and weight and calculation of the BMI. This will identify patients with a BMI below 20 as well as those who are obese. It is surprising that doctors have traditionally accepted the importance of measuring weight but not of correlating it against height. BMI is simply the logical extension of the most basic clinical parameter and arguably should’ be a routine part of good clinical practice. The Malnutrition Universal Screening Tool also supplies a range of surrogate measures for height, although surrogate measures for weight are more problematic, particularly in the acutely ill where oedema and injuries may make any measurement difficult.
2. The patient is then asked about unintentional weight loss of 5 or 10% over the preceding three to six months.
3. Finally, patients are asked whether they have eaten anything over the past five days.
A score greater than two indicates a significant risk of malnutrition.
McKinlay. 2008. Malnutrition : the spectre at the feast. J R. College Physicians Edinburgh vol 38 317-21
- Martin Eastwood