title: Unsatisfactory knowledge and use of terminology regarding malnutrition, starvation, cachexia and sarcopenia among dietitians.
abstract: Clinical signs of malnutrition, starvation, cachexia and sarcopenia overlap, as they all imply muscle wasting to a various extent. However, the underlying mechanisms differ fundamentally and therefore distinction between these phenomena has therapeutic and prognostic implications. We aimed to determine whether dietitians in selected European countries have 'sufficient knowledge' regarding malnutrition, starvation, cachexia and sarcopenia, and use these terms in their daily clinical work.
  
  
  
  An anonymous online survey was performed among dietitians in Belgium, the Netherlands, Norway and Sweden. 'Sufficient knowledge' was defined as having mentioned at least two of the three common domains of malnutrition according to ESPEN definition of malnutrition (2011): 'nutritional balance', 'body composition' and 'functionality and clinical outcome', and a correct answer to three cases on starvation, cachexia and sarcopenia. Chi-square test was used to analyse differences in experience, work place and number of malnourished patients treated between dietitians with 'sufficient knowledge' vs. 'less sufficient knowledge'.
  
  
  
  712/7186 responded to the questionnaire, of which data of 369 dietitians were included in the analysis (5%). The term 'malnutrition' is being used in clinical practice by 88% of the respondents. Starvation, cachexia and sarcopenia is being used by 3%, 30% and 12% respectively. The cases on starvation, cachexia and sarcopenia were correctly identified by 58%, 43% and 74% respectively. 13% of the respondents had 'sufficient knowledge'. 31% of the respondents identified all cases correctly. The proportion of respondents with 'sufficient knowledge' was significantly higher in those working in a hospital or in municipality (16%, P < 0.041), as compared to those working in other settings (7%).
  
  
  
  The results of our survey among dietitians in four European countries show that the percentage of dietitians with 'sufficient knowledge' regarding malnutrition, starvation, cachexia and sarcopenia is unsatisfactory (13%). The terms starvation, cachexia and sarcopenia are not often used by dietitians in daily clinical work. As only one-third (31%) of dietitians identified all cases correctly, the results of this study seem to indicate that nutrition-related disorders are suboptimally recognized in clinical practice, which might have a negative impact on nutritional treatment. The results of our study require confirmation in a larger sample of dietitians.
authors.affiliation: Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Eyssoniusplein 18, 9714 CE Groningen, The Netherlands. Electronic address: l.ter.beek@pl.hanze.nl.
authors.forename: Lies
authors.initials: L
authors.lastname: Ter Beek
authors.affiliation: University Colleges Leuven-Limburg, Faculty of Health and Social Work, Centre of Expertise Healthy Living, Herestraat 49, 3000 Leuven, Belgium; KU Leuven, Department of Clinical and Experimental Medicine, Leuven, Belgium. Electronic address: erika.vanhauwaert@ucll.be.
authors.forename: Erika
authors.initials: E
authors.lastname: Vanhauwaert
authors.affiliation: Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, PO Box 459, SE-405 30 Göteborg, Sweden. Electronic address: frode.slinde@nutrition.gu.se.
authors.forename: Frode
authors.initials: F
authors.lastname: Slinde
authors.affiliation: Department of Nutrition and Dietetics, Karolinska University Hospital, Solna, S-171 76 Stockholm, Sweden. Electronic address: ylva.orrevall@karolinska.se.
authors.forename: Ylva
authors.initials: Y
authors.lastname: Orrevall
authors.affiliation: Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1046 Blindern, 0317 Oslo, Norway. Electronic address: christine.henriksen@medisin.uio.no.
authors.forename: Christine
authors.initials: C
authors.lastname: Henriksen
authors.affiliation: Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, PO Box 459, SE-405 30 Göteborg, Sweden. Electronic address: madelene.johansson@outlook.com.
authors.forename: Madelene
authors.initials: M
authors.lastname: Johansson
authors.affiliation: University Colleges Leuven-Limburg, Faculty of Health and Social Work, Centre of Expertise Healthy Living, Herestraat 49, 3000 Leuven, Belgium. Electronic address: carine.vereecken@ucll.be.
authors.forename: Carine
authors.initials: C
authors.lastname: Vereecken
authors.affiliation: Food and Meal Science, Kristianstad University, Elmetorpsvägen 15, 291 88 Kristianstad, Sweden. Electronic address: elisabet.rothenberg@hkr.se.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Rothenberg
authors.affiliation: Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Eyssoniusplein 18, 9714 CE Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, HPC BB 70, PO Box 30.001, 9700 RB Groningen, The Netherlands. Electronic address: ha.jager@pl.hanze.nl.
authors.forename: Harriët
authors.initials: H
authors.lastname: Jager-Wittenaar
mesh_terms: D000328:Adult; D001823:Body Composition; D002100:Cachexia / Q000175:diagnosis* / Q000178:diet therapy; D002983:Clinical Competence; D003710:Demography; D003937:Diagnosis, Differential; D005060:Europe; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis* / Q000178:diet therapy; D008875:Middle Aged; D015596:Nutrition Assessment; D064686:Nutritionists; D055948:Sarcopenia / Q000175:diagnosis* / Q000178:diet therapy; D013217:Starvation / Q000175:diagnosis* / Q000178:diet therapy; D011795:Surveys and Questionnaires; D009626:Terminology as Topic
keywords: Cachexia; Dietitian; Malnutrition; Nutrition disorder; Sarcopenia; Starvation