Table 6.
Organization of Malnutrition Assessment Tool Measurement Parameters According to the Malnutrition Framework
| Measurement Parameters |
||||
|---|---|---|---|---|
| Tool (Assessment) | Scoring Criteria | Nutrient Balance | Nutrition Status | Malnutrition Risk |
|
| ||||
| AND/A.S.P.E.N. | Inflammation | |||
| • Inflammation scoring criteria used to classify malnutrition type (starvation, acute disease/injury, chronic disease) | Laboratory | • Marked negative nitrogen balance | • Low albumin | |
| • Low transferrin | ||||
| • Low prealbumin | ||||
| • High CRP | ||||
| • Malnutrition scoring criteria used to assess malnutrition | • High glucose | |||
| • Low/high WBC count | ||||
| • Diagnosis: ≥2 abnormal criteria | • High neutrophils | |||
| • Low platelets | ||||
| Clinical | • Conditions (diagnoses) | |||
| • Fever | ||||
| • Hypothermia | ||||
| • Infection (urinary, sepsis, wound/incision, pneumonia) | ||||
| • Abscess | ||||
| Malnutrition | ||||
| Weight change | • Weight loss | |||
| Dietary intake | • Inadequate energy intake | |||
| Fat mass | • Reduced subcutaneous fat mass | |||
| Muscle mass | • Reduced muscle mass | |||
| Fluid accumulation | • Edema/ascites | |||
| Functional capacity | • Reduced handgrip strength | |||
| • Reduced function (other tests) | ||||
| GLIM | Phenotypic | |||
| • Phenotypic scoring criteria used to assess severity of malnutrition | Weight change | • Weight loss | ||
| Body mass | • Low BMI | |||
| Muscle mass | • Reduce muscle mass | |||
| • Etiologic scoring criteria used to classify malnutrition type (starvation, acute disease/injury, chronic disease ± inflammation) | • Reduced function (supportive) | |||
| Etiologic | ||||
| Dietary intake | • Inadequate energy intake | • GI symptoms or conditions impairing food assimilation/absorption | ||
| • Diagnosis: ≥1 abnormal phenotypic and etiologic criteria | Inflammation | • Conditions (diagnoses) | ||
| • High CRP (supportive) | ||||
| 7-Point SGA | History | |||
| • Scoring criteria rated on 7-point Likert scale as very mild risk to well nourished (6–7), mild-moderate (3–5), or severely malnourished (1–2). | Weight change | • Weight loss | ||
| Dietary intake | • Inadequate energy and protein intake | |||
| • Reduced diet type (e.g., liquid) | ||||
| GI symptoms | • GI symptoms | |||
| • Diagnosis: Overall rating subjectively determined based on scoring criteria ratings. | • Anorexia | |||
| Functional capacity | • Reduced function (ambulation, activity) | |||
| Disease state | • Conditions (diagnoses) | |||
| • Increased nutrition requirements | ||||
| • Metabolic stress | ||||
| Physical exam | ||||
| Fat mass | • Reduced subcutaneous fat mass | |||
| Muscle mass | • Reduced muscle mass | |||
| Fluid accumulation | • Edema | |||
| MIS | Medical history | |||
| • Scoring criteria rated on 4-point Likert scale as normal (0), mild (1), moderate (2), or severe (3). | Weight change | • Weight loss | ||
| Dietary intake | • Inadequate dietary intake | |||
| • Reduced diet type (e.g., liquid) | ||||
| GI symptoms | • GI symptoms | |||
| • Diagnosis: Rated as the unweighted sum of scoring criteria (0–30); no established cutoff for diagnosis, but proposed cutoff values range from 4 to 10/30.29–33 | • Anorexia | |||
| Functional capacity | • Reduced function (ambulation, fatigue, activity) | |||
| Comorbidity | • Conditions | |||
| • Dialysis vintage | ||||
| Physical exam | ||||
| Fat mass | • Reduced subcutaneous fat mass | |||
| Muscle mass | • Reduced muscle mass | |||
| Body mass | • Low BMI | |||
| Laboratory tests | ||||
| Serum albumin | • Low albumin | |||
| TIBC | • Low TIBC | |||
| ISRNM | Serum chemistry | • Low albumin | ||
| • Diagnosis: Abnormalities in ≥3/4 scoring criteria; optimally on three occasions (2–4 wks apart) | • Low prealbumin | |||
| • Low cholesterol | ||||
| Body mass | • Weight loss | • Low BMI | ||
| • Reduced fat mass | ||||
| Muscle mass | • Muscle loss | • Low creatinine appearance | ||
| Dietary intake | • Inadequate energy and protein intake | |||
AND/A.S.P.E.N., Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition; CRP, C-reactive protein; GLIM, Global Leadership Initiative on Malnutrition; GI, gastrointestinal; ISRNM, International Society of Renal Nutrition and Metabolism; MIS, Malnutrition-Inflammation Score; SGA, Subjective Global Assessment; TIBC, total iron binding capacity.