Study Supports Use of New Malnutrition Definition in Older Post-Acute Rehab Patients

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A study has confirmed that a new definition of malnutrition helps to detect the condition in deconditioned, older post-acute patients. The researchers also noted a significant link between malnutrition and sarcopenia. In the study from the Centre Fòrum-Hospital del Mar in Barcelona, Dolores Sanchez-Rodríguez, MD, PhD, and colleagues investigated an expanded use of the European Society of Clinical Nutrition and Metabolism (ESPEN) consensus definition of malnutrition. The society developed the diagnostic definition of malnutrition to fill a definition gap that “has been problematic for researchers, clinicians, and policy makers for many years” (Clin Nutr 2017;36:1339–1344). The ESPEN definition has been applied to a variety of groups, but not to the deconditioned, post-acute older population. In their 8-month study, the researchers reached out to 102 consecutive inpatients in a post-acute geriatric rehabilitation unit. They focused on 88 who agreed to take part in the study and met various criteria: they were admitted after suffering functional loss due to a nondisabling disease, were 70 or older, and had previously been ambulatory before hospitalization but were now bedbound. The average age of the participants was 85 years, and 62% were women. They stayed an average of 15 days in acute care followed by an average of 15 days in the post-acute care unit. The researchers found that, after they had screened them with the Mini Nutritional Assessment-Short Form tool, all the patients were at risk for malnutrition. The researchers then screened the patients for malnutrition using the ESPEN definition. A total of 17 patients (19%) fit the ESPEN malnutrition criteria. Fifteen had unintentional weight loss and a low fat-free body mass index (BMI) of less than 15 kg/m2 (women) or less than 17 kg/m2 (men). Seven had unintentional weight loss and a low BMI of less than 20 kg/m2 (<70 years) or less than 22 kg/m2 (≥70 years). Four had a BMI of less than 18.5 kg/m2. Most of the patients met two or more of these criteria. The study authors were unable to link biochemical markers to malnutrition, so they did not recommend the use of markers to detect malnutrition in the post-acute population. The researchers also evaluated sarcopenia in these patients with criteria from the European Working Group on Sarcopenia in Older People (EWGSOP). “These conditions share a pathogenesis and clinical effects, and a relationship between them has been proposed,” the study authors wrote. A total of 17 patients met the criteria for sarcopenia, including 13 who were defined as having malnutrition by the ESPEN criteria. Only four of the 17 who met the ESPEN malnutrition criteria did not meet the definition of having sarcopenia. Randy Dotinga is a freelance writer based in San Diego.