Perspectives in Practice: Updates on Diagnosing Malnutrition in Adults in Clinical Settings

The diagnosis of malnutrition in adults in clinical settings is challenging. The prevalence rates vary depending on the malnutrition risk screen and diagnostic criteria used. The key role of inflammation in the development and progression of malnutrition has been recognized as a potential cause of the condition in patients with disease or injury. Inadequate food intake or inability to absorb nutrients at adequate levels also may contribute. Although most approaches in common use to diagnose malnutrition agree on the core variables to evaluate, differing cut points can result in varied diagnostic results. The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) Indicators of Malnutrition (AAIM) and the Global Leadership Initiative on Malnutrition (GLIM) share some phenotypic variables (weight loss, low muscle mass), but AAIM also includes loss of fat mass, edema, and handgrip strength, whereas GLIM adds low body mass index (BMI). The 2 approaches differ somewhat on the timing and percentages of weight loss, giving a risk of rejection of insurance claims for severe malnutrition. Documentation in the claim of the variables that are included in both AAIM and GLIM, with evidence of a nutrition treatment plan that is equivalent in intensity to the malnutrition diagnosis, including frequent dietitian follow-up, may help to avoid claims rejections.