title: Diagnostic criteria for malnutrition - An ESPEN Consensus Statement.
abstract: OBJECTIVE
  To provide a consensus-based minimum set of criteria for the diagnosis of malnutrition to be applied independent of clinical setting and aetiology, and to unify international terminology.
  
  
  METHODS
  The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a group of clinical scientists to perform a modified Delphi process, encompassing e-mail communications, face-to-face meetings, in group questionnaires and ballots, as well as a ballot for the ESPEN membership.
  
  
  RESULTS
  First, ESPEN recommends that subjects at risk of malnutrition are identified by validated screening tools, and should be assessed and treated accordingly. Risk of malnutrition should have its own ICD Code. Second, a unanimous consensus was reached to advocate two options for the diagnosis of malnutrition. Option one requires body mass index (BMI, kg/m(2)) <18.5 to define malnutrition. Option two requires the combined finding of unintentional weight loss (mandatory) and at least one of either reduced BMI or a low fat free mass index (FFMI). Weight loss could be either >10% of habitual weight indefinite of time, or >5% over 3 months. Reduced BMI is <20 or <22 kg/m(2) in subjects younger and older than 70 years, respectively. Low FFMI is <15 and <17 kg/m(2) in females and males, respectively. About 12% of ESPEN members participated in a ballot; >75% agreed; i.e. indicated ≥7 on a 10-graded scale of acceptance, to this definition.
  
  
  CONCLUSIONS
  In individuals identified by screening as at risk of malnutrition, the diagnosis of malnutrition should be based on either a low BMI (<18.5 kg/m(2)), or on the combined finding of weight loss together with either reduced BMI (age-specific) or a low FFMI using sex-specific cut-offs.
authors: Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden. Electronic address: tommy.cederholm@pubcare.uu.se.
authors: T
authors: T
authors: Cederholm
authors: Clinical Nutrition Unit, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden.
authors: I
authors: I
authors: Bosaeus
authors: Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
authors: R
authors: R
authors: Barazzoni
authors: Department of Geriatric Medicine, Carl von Ossietzky Universität, Oldenburg, Germany.
authors: J
authors: J
authors: Bauer
authors: Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium.
authors: A
authors: A
authors: Van Gossum
authors: General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland.
authors: S
authors: S
authors: Klek
authors: Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
authors: M
authors: M
authors: Muscaritoli
authors: Department of Nutrition and Dietetics and Department of Medicine, Monash University Central Clinical School, Prahran, Australia.
authors: I
authors: I
authors: Nyulasi
authors: Department of Gastroenterology, Hepatology, Endocrinology, and Nutrition, Klinikum Bremen Mitte, Bremen, Germany.
authors: J
authors: J
authors: Ockenga
authors: Department of Gastroenterology and Clinical Nutrition, University Hospital and University of Nice Sophia-Antipolis, Nice, France.
authors: S M
authors: SM
authors: Schneider
authors: Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors: M A E
authors: MA
authors: de van der Schueren
authors: Department of General Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100, Israel.
authors: P
authors: P
authors: Singer
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism; D001823:Body Composition; D015992:Body Mass Index; D032921:Consensus; D003697:Delphi Technique; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D052756:Nutritional Sciences / Q000592:standards*; D012307:Risk Factors; D012958:Societies, Scientific; D011795:Surveys and Questionnaires; D015431:Weight Loss
keywords: Body composition; Consensus; Definition; Delphi; Malnutrition; Nutritional assessment