From the Guidelines
Failure to thrive in adults is a condition characterized by unintentional weight loss of 5% or more within 6-12 months, along with decreased physical and cognitive functioning, malnutrition, and a decline in ability to perform daily activities, and is typically defined as a BMI of less than 18.5 or a weight loss of 5% in the previous 2 months, as stated in the ESPEN-ESPghan-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis 1. The definition of failure to thrive (FTT) in adults is not explicitly stated in the provided evidence, but based on the guidelines for nutrition care for infants, children, and adults with cystic fibrosis, it can be inferred that FTT in adults is characterized by a BMI of less than 18.5 or a weight loss of 5% in the previous 2 months. Some key points to consider when defining FTT in adults include:
- Unintentional weight loss of 5% or more within 6-12 months
- Decreased physical and cognitive functioning
- Malnutrition
- Decline in ability to perform daily activities
- BMI of less than 18.5
- Weight loss of 5% in the previous 2 months It is essential to note that the definition of FTT in adults may vary depending on the specific population and context, and a comprehensive geriatric assessment is typically recommended to evaluate all potential contributing factors and develop an appropriate treatment plan. The management of FTT in adults involves identifying and treating underlying causes, nutritional support, physical therapy to maintain function, and addressing psychosocial needs, as stated in the example answer. Early intervention is crucial as FTT can lead to increased hospitalization, institutionalization, and mortality if left untreated. Some of the evidence provided, such as the guidelines for the management of home parenteral support in adult chronic intestinal failure patients 1, and the international network on oesophageal atresia (INOEA) consensus guidelines on the transition of patients with oesophageal atresia-tracheoesophageal fistula 1, may not be directly related to the definition of FTT in adults, but they highlight the importance of nutritional support and management of underlying conditions in preventing and treating FTT. The scoping review of nutrition issues and management strategies in individuals with skeletal dysplasia 1 provides some insight into the nutritional challenges faced by individuals with skeletal dysplasia, including high rates of underweight or "failure to thrive", and highlights the need for tailored nutrition and weight management advice to address these challenges. However, the most recent and highest quality study on the definition of FTT in adults is the ESPEN-ESPghan-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis 1, which provides a clear definition of FTT in adults and highlights the importance of nutritional support and management of underlying conditions in preventing and treating FTT.
From the Research
Definition of Failure to Thrive (FTT) in Adults
- Failure to thrive (FTT) in adults, particularly in the elderly, refers to a state of decline that is multifactorial and may be caused by chronic concurrent diseases and functional impairments 2, 3.
- This condition is characterized by a gradual decline in physical and/or cognitive function, often accompanied by weight loss and social withdrawal 4.
- FTT is not solely defined by a specific set of criteria but rather encompasses a range of symptoms and conditions that contribute to a decline in an individual's overall health and well-being.
Key Characteristics and Syndromes
- Four syndromes are commonly associated with FTT in adults: impaired physical functioning, malnutrition, depression, and cognitive impairment 2, 3.
- These syndromes can interact with each other and contribute to the decline in an individual's health and functional status.
- Weight loss, decreased appetite, poor nutrition, and inactivity are also common manifestations of FTT in adults 3.
Diagnosis and Evaluation
- The diagnosis of FTT in adults involves a comprehensive evaluation of physical and psychologic health, functional ability, socioenvironmental factors, and nutrition 3.
- Laboratory and radiologic evaluations may be limited initially but can include a complete blood count, chemistry panel, thyroid-stimulating hormone level, urinalysis, and other studies as appropriate for the individual patient 3.
- A medication review is also essential to ensure that side effects or drug interactions are not contributing to FTT 3.