September is Spotlight on Malnutrition Month

Malnutrition is defined as inadequate nutrition (over or undernutrition) and it is prevalent in our communities. As nutrition professionals, it is our responsibility to identify when patients/clients are malnourished or at risk for malnutrition. Proper nutrition can reduce length of stay in the hospital setting, improve quality of life, and reduce the risk for nutrition related diseases like diabetes and cardiovascular disease.

In the hospital setting, screening tools like MUST (Malnutrition Universal Screening Tool) are widely used to identify if patients are at nutritional risk. Sample criteria may include: involuntary weight loss, difficulty chewing/swallowing, decreased appetite, inadequate oral intake, and changes in taste/smell. Any of these would be a red flag for dietitians to take a closer look at what a patient is eating and how the patient is feeling.

The nutrition care process includes assessment, diagnosis, intervention, and monitoring/evaluation. Nutrition focused physical exam (NFPE) is part of nutrition assessment and helps a dietitian assess if patients code for malnutrition. During NFPE, a dietitian will assess if a patient has any muscle wasting, fat wasting, or signs of nutrient deficiencies. It is a head to toe exam.

Loss of fat or muscle mass in these areas may be a sign of malnutrition. Loss of lean body mass is especially concerning as it correlates with poor prognosis and decreased strength.

Assessment of fat status:

  • Orbital fat pads (underneath the eyes)
  • Upper arm (skin/fat surrounding the triceps)
  • Ribs
  • Iliac crest (surrounding the hip bones)

Assessment of muscle status:

  • Temples
  • Collar bone
  • Shoulders
  • Interosseous muscle of the hand
  • Thigh/knee
  • Calf

It is important to also take a look at the fingernails, oral cavity, eyes, hair, and skin as many micronutrient deficiencies result in changes to these areas. An example might be spoon shaped nails (koilonychia) with iron deficiency anemia.

Debunking malnutrition myths:

  • “Only people who are underweight can be malnourished”- Anyone can be malnourished if they don’t receive an adequate amount of macro and micronutrients. Even overweight patients can be malnourished. Patients may not look malnourished, which is why it is important to ask probing questions and perform a nutrition focused physical exam
  • “I eat so much! How can I be malnourished?” – Even if a patient eats adequately, he/she may still be malnourished. A person’s body may be less efficient at absorbing and utilizing nutrients, so even though he/she may consume an adequate amount of food, his/her needs may be increased due to his/her condition. The individual might also not be eating nutrient dense foods.

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