Definitions

Malnutrition 

An acute, subacute or chronic state of nutrition, in which a combination of varying degrees of overnutrition or undernutrition with or without inflammatory activity have led to a change in body composition and diminished function.(adapted from Soeters PB, Schols AM. Advances in understanding and assessing malnutrition) Soeters PB, Schols AM. Advances in understanding and assessing malnutrition. Curr Opin Clin Nutr Metab Care 2009; 12(5):487–494. 

The 3 etiology-based nutrition diagnoses in adults in clinical practice settings are:

• "Starvation-related malnutrition": chronic starvation without inflammation (e.g., anorexia nervosa)
• "Chronic disease-related malnutrition": inflammation is chronic and of mild to moderate degree (e.g., organ failure, pancreatic cancer, rheumatoid arthritis or sarcopenic obesity)
• "Acute disease or injury-related malnutrition": inflammation is acute and of severe degree (e.g., major infection, burns, trauma or closed head injury)

 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 J Parenter Enteral Nutr. 2010;34(2):156-159. 

 

Adult Definitions

• Nutritionally-at-risk Adults – From Definition of Terms - 2015
• Adults should be considered at risk if they have any of the following:
• Involuntary loss of 10% or more of usual body weight within 6 months, or involuntary loss of greater than or 5% or more of usual body weight in 1 month.
• Involuntary loss or gain of 10 pounds within 6 months.
• Body mass index less than 18.5 kg/m2 or greater than 25 kg/m2.
• Chronic disease.
• Increased metabolic requirements.
• Altered diets or diet schedules. 
• Inadequate nutrition intake, including not receiving food or nutrition products for greater than 7 days.

White JV, Guenter P, et al. Consensus Statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Under-nutrition). JPEN J Parent Ent Nutr. 2012; 36:275-283.

Pediatric Definitions 

Nutritionally-at-Risk Neonates
Neonates should be considered at nutrition risk per the following:

High risk

• Preterm <28 weeks at birth
• Extremely low birth weight < 1000 g
• Infant establishing feeds after episode of NEC or GI perforation
• Infants with severe congenital GI malformations e.g. gastroschisis

Moderate risk

• Preterm 28th – 31st weeks, otherwise well
• IUGR (weight <9th centile) 
• Very low birth weight 1000 – 1500 g
• Illness or congenital anomaly which may compromise feeding

Johnson MJ, Pearson F, Emm A, Moyses HE, Leaf AA. Developing a new screening tool for nutritional risk in neonatal intensive care. Acta Paediatricia 2015;104:e90-e93.

 

ASPEN Definition of Terms-2015

• Low birth weight (<2500 g) even in the absence of gastrointestinal, pulmonary, or cardiac disorders. Institute of Medicine. Anthropometric risk criteria. WIC Nutrition Risk Criteria: A Scientific Assessment. National Academies Press. 1996:67-148. Accessed November 10, 2009.
• Birth weight greater than 2 standard deviations below the mean (approximately the 3rd percentile) for gestational age on fetal weight curves. 
• Acute weight loss of 10% or more.

Nutritionally-at-Risk Children

• Children should be considered at nutrition risk if they have any of the following:
• A weight for length or weight for height or sex less than the 10th percentile or greater than the 95th percentile.31
• Body mass index for age or sex less than 5th percentile or greater than the 85th percentile. Centers for Disease Control. Use and interpretation of the CDC growth charts. Accessed November 6, 2009.
• Increased metabolic requirements. 
• Impaired ability to ingest or tolerate oral feedings. 
• Documented inadequate provision of or tolerance of nutrients. 
• Inadequate weight gain or a significant decrease in usual growth percentile.

From Definition of Terms, Style, and Conventions Used in ASPEN Board of Directors - Approved Documents, May 2015. [note: definition of terms will be updated as they are approved by the ASPEN Board of Directors]

Mehta NM, et al Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions JPEN J Parenter Enteral Nutr. July 2013; (37)4:460-481

Becker P, Carney LN, et al. Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Indicators Recommended for the Identification and Documentation of Pediatric Malnutrition (Undernutrition). Nutr Clin Pract. 2014;30:147-161.