Assessment of nutritional status. The clinician's perspective

The prevalence of malnourished patients in the hospital continues to hover around 50%. As more ambulatory and day care medical and surgical facilities open, those actually admitted to the nation's acute care hospitals will be sicker, and thus a higher percentage will be malnourished. There is currently a plethora of tools designed to assess nutritional status within the spectrum of a broad range of costs and sensitivity. At the very least, upon admission to an acute care hospital, patients should undergo a nutritional screening consisting of weight history, recent dietary habits, and serum albumin concentration. An accurate assessment of the degree of malnutrition should rely on the expertise of a dietician trained to use the techniques of global nutritional assessment in conjunction with anthropometries. Clinical laboratories need to enlarge their services to encompass more direct measures of body composition (e.g., BIA) and dynamic assessment of muscle function (e.g., WOB). Subsequent serial measurements of nutritional status have limited sensitivity and specificity but may be useful in selected patients with a high severity of illness score (i.e., APACHE) and prolonged LOS. Attention should be directed to ensuring that nutrient intakes correspond to estimated needs.