Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee.
OBJECTIVE
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 ASPEN 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.
Jensen
Gordon L
GL
Department of Nutritional Sciences, 110 Chandlee Lab, Penn State University, University Park, PA 16802, USA. glj1@psu.edu
Mirtallo
Jay
J
Compher
Charlene
C
Dhaliwal
Rupinder
R
Forbes
Alastair
A
Grijalba
Rafael Figueredo
RF
Hardy
Gil
G
Kondrup
Jens
J
Labadarios
Demetre
D
Nyulasi
Ibolya
I
Castillo Pineda
Juan Carlos
JC
Waitzberg
Dan
D
D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D006801:Humans; D007249:Inflammation / Q000150:complications*; D044342:Malnutrition / Q000175:diagnosis* / Q000209:etiology; D013217:Starvation / Q000150:complications* / Q000175:diagnosis; D009626:Terminology as Topic; D014947:Wounds and Injuries / Q000150:complications