What is Disease-Related Malnutrition?
Too Often Overlooked, Undetected and Untreated
Disease-related malnutrition has been a concern for a long time. In 400 BC, Hippocrates noted that: ”in all maladies, those who are well nourished do best. It is bad to be very thin and wasted.”1 Already then, the relationship between malnutrition and disease was apparent.
Clinical Definition of Disease-Related Malnutrition
Malnutrition can be defined as “a state of nutrition in which a deficiency, excess or imbalance of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form (body shape, size, and composition) and function, and clinical outcome”.2 The term malnutrition includes both over-nutrition (overweight and obesity) as well as under-nutrition. However, in the context of the “United for clinical nutrition” initiative, the term refers to malnutrition caused by disease-related factors, such as malabsorption or increased nutrient demands. The International Consensus Guideline Committee, including members of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and the European Society for Clinical Nutrition and Metabolism (ESPEN), categorized disease-related malnutrition for adults in the clinical setting as follows:3
- Chronic disease-related malnutrition: when inflammation is chronic and of mild to moderate degree, e.g. rheumatoid arthritis, organ failure, chronic diseases in older patients, sarcopenic obesity
- Acute disease or injury-related malnutrition: when inflammation is acute and of severe degree such as in cases of sepsis, burns or trauma
Disease-Related Malnutrition: Overlooked, Undetected and Untreated
Disease-related malnutrition is not confined to underweight patients, it is also affecting normal weight, overweight and obese patients. It can impact all age groups, most commonly older people.4
Disease-related malnutrition is frequently overlooked, undetected and untreated. If left unaddressed, the consequences can be serious, leading to a marked decline in physical and psychological health and function.2
- 1. Elia M, Austin P, Stratton RJ. Indications for nutritional support. In: Sobotka L, editor. Basics in Clinical Nutrition. Prague: Galen 2011:223-231.
- 2. a. b. Stratton R, Green C, Elia M. Disease-related malnutrition: an evidence based approach to treatment. Wallingford: CABI Publishing 2003.
- 3. Jensen GL, Mirtallo J, Compher C et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN 2010;34(2):156-159.
- 4. Pirlich M, Schutz T, Norman K et al. The German hospital malnutrition study. Clin Nutr 2006;25(4):563-572.