A questionnaire for physical findings of malnutrition when physical exams are not possible

When nutrition assessments must be performed virtually, such as during the coronavirus pandemic, it is difficult to fully assess patients for malnutrition without the ability to perform a nutrition-focused physical exam. Practitioners may ask patients about their physical appearance, but there is currently no validated set of questions whose answers correlate with nutrition-focused physical findings for the diagnosis of malnutrition in such situations. The aim of this study was to evaluate correlations between patients' responses to verbalized questions and physical signs of malnutrition.

Questions related to the physical findings of malnutrition were developed and evaluated for content validity. Thirty patients receiving nutrition assessments at an acute care veterans' hospital were asked the questions prior to a nutrition-focused physical exam. Patients' responses were compared with a diagnosis of malnutrition and physical findings of muscle, fat, fluid accumulation, and handgrip strength.

Four questions significantly correlated with malnutrition: "Does the area around your eyes appear sunken in?" (P = 0.03), "Are you able to see your ribs?" (P = 0.05), "Do you feel you are unusually skinny for you?" (P = 0.001), and "Do you find yourself eating less due to swelling in your belly?" (P = 0.008).

There are relationships between patients' responses to certain verbalized questions and their physical status. Such questions can be used to identify physical signs of malnutrition when nutrition-focused physical exams cannot be performed. Further research is needed to validate these questions in other populations.