From the Guidelines
Severe protein calorie malnutrition is defined as a condition characterized by a weight loss of more than 10% within the past 6 months, or more than 20% beyond 6 months, a body mass index (BMI) of less than 18.5 if under 70 years old, or less than 20 if 70 years or older, and a severe deficit in muscle mass, according to the ESPEN GLIM recommendations. This condition can be identified using phenotype criteria, such as weight loss, BMI, and muscle mass, as well as etiologic criteria, including food intake, malabsorption, or gastrointestinal symptoms 1. The severity of malnutrition can be graded into two stages: Stage 1 (moderate malnutrition) and Stage 2 (severe malnutrition), with Stage 2 requiring a more significant weight loss, lower BMI, and more severe muscle mass deficit.
Key Characteristics of Severe Protein Calorie Malnutrition
- Weight loss of more than 10% within the past 6 months, or more than 20% beyond 6 months
- BMI of less than 18.5 if under 70 years old, or less than 20 if 70 years or older
- Severe deficit in muscle mass
- Food intake of less than 50% of energy requirements for more than 1 week, or severe malabsorption or gastrointestinal symptoms
Diagnosis and Assessment
The diagnosis of severe protein calorie malnutrition can be made using a combination of clinical assessment, laboratory tests, and nutritional evaluation, including the use of validated assessment methods such as dual-energy absorptiometry or bioelectrical impedance analysis 1.
Treatment and Management
Treatment of severe protein calorie malnutrition requires a comprehensive approach, including nutritional rehabilitation, micronutrient supplementation, and management of underlying medical conditions, with the goal of improving morbidity, mortality, and quality of life outcomes 1.
From the Research
Definition of Severe Protein Calorie Malnutrition
Severe protein calorie malnutrition can be defined as a condition characterized by a significant loss of muscle mass and body weight, often associated with edema 2. It is a type of malnutrition that results from a deficient intake or uptake of protein and energy, leading to physiologic alterations such as inflammation, loss in fat-free mass, and/or decreased response to medical treatment 3.
Characteristics of Severe Protein Calorie Malnutrition
The characteristics of severe protein calorie malnutrition may include:
- Obvious significant muscle wasting and loss of subcutaneous fat
- Nutritional intake of less than 50% of recommended intake for 2 weeks or more
- Bedridden or significantly reduced functional capacity
- Weight loss of more than 2% in 1 week, 5% in 1 month, or 7.5% in 3 months 4
- Edema 2
Diagnosis and Treatment
Severe protein calorie malnutrition can be diagnosed through a combination of clinical assessment, laboratory tests, and nutritional evaluation 3, 5. Treatment typically involves provision of additional calories and protein through oral nutritional supplements, enteral tube feedings, or parenteral nutrition 3. The goal of treatment is to restore nutritional balance, promote weight gain, and improve overall health outcomes.
Special Considerations
In certain populations, such as older adults with chronic kidney disease, the diagnosis and treatment of severe protein calorie malnutrition may require special consideration 6. For example, the need to restrict protein intake to slow disease progression must be balanced against the need to maintain adequate nutrition to prevent malnutrition. Individualized assessment and monitoring are essential to guide decision-making and ensure optimal outcomes.