Malnutrition Unrecognized and Untreated

  • M. VandewoudeEmail author
  • S. Perkisas
Part of the Practical Issues in Geriatrics book series (PIG)


Malnutrition is common across varying patient populations, particularly older adults, and sarcopenia prevalence increases with advancing age. Chronic diseases, acute inflammation, and important comorbidities make the situation more complex. When these changes are translated into nutritional concepts, it is clear that in the older patient there is a strong overlap of starvation, sarcopenia, and cachexia. The final result is a complex metabolic state resulting in a therapy resistant malnutrition-sarcopenia syndrome. This condition is associated with substantial adverse outcomes affecting both the patient and the health care system, including increased morbidity, mortality, rehospitalization rates, and health care costs. Clinicians are urged to screen, assess, and treat this condition currently so as to adequately address the full spectrum of patients’ nutritional issues. By examining all aspects, clinicians can more fully assess their patients’ clinical and nutritional status and can tailor targeted therapies to meet their needs and improve outcomes.


Malnutrition Geriatrics Nutritional assessment Screening Sarcopenia 


  1. 1.
    Morley JE, Vellas B, van Kan GA et al (2013) Frailty consensus: a call to action. J Am Med Dir Assoc 14:392–397CrossRefGoogle Scholar
  2. 2.
    Vandewoude MFJ, Geerts CAM, Paridaens KMJ, D’Hooghe HM (2008) A screening tool for activating liaison geriatrics in general hospitals: the “variable indicative of placement risk” (VIP). Eur J Geriatr 10:120–126Google Scholar
  3. 3.
    Hoeck S, Vandewoude M, Geerts J et al (2007) Déceler la fragilité des Belges de plus de 65 ans vivant à domicile, à l’aide de deux instruments de dépistage. Neuron 12:237–242Google Scholar
  4. 4.
    Van Gossum A, Van Wijngaarden J, Hofstede J et al (2017) Malnutrition is highly prevalent in Belgian nursing home residents and community dwelling older adults, especially in those with depression and dementia. Clin Nutr 36:S67CrossRefGoogle Scholar
  5. 5.
    Vandewoude MFJ, van Wijngaarden JP, De Maesschalck L, Luiking YC, Van Gossum A (2018) The prevalence and health burden of malnutrition in Belgian older people in the community or residing in nursing homes: results of the NutriAction II study. Aging Clin Exp Res.
  6. 6.
    Van Wijngaarden J, Van Gossum A, Rudka T et al (2017) Malnutrition is underestimated by health care professionals in older adults. Clin Nutr 36:S66–S67CrossRefGoogle Scholar
  7. 7.
    Vandewoude M, Van Gossum A (2013) Nutritional screening strategy in nonagenarians: the value of the MNA-SF (mini nutritional assessment short form) in NutriAction. J Nutr Health Aging 17:310–314CrossRefGoogle Scholar
  8. 8.
    Jensen GL, Mirtallo J, Compher C et al (2010) Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. Clin Nutr 29:151–153CrossRefGoogle Scholar
  9. 9.
    Rosenberg I (1989) Summary comments. Am J Clin Nutr 50:1231–1233CrossRefGoogle Scholar
  10. 10.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423CrossRefGoogle Scholar
  11. 11.
    Perkisas S, De Cock A, Verhoeven V, Vandewoude M (2016) Physiological and architectural changes in the ageing muscle and their relation to strength and function in sarcopenia. Eur Geriatr Med 7:201–206. CrossRefGoogle Scholar
  12. 12.
    Evans WJ, Morley JE, Argiles J et al (2008) Cachexia: a new definition. Clin Nutr 27:793–799CrossRefGoogle Scholar
  13. 13.
    Vandewoude MF, Alish CJ, Sauer AC et al (2012) Malnutrition-sarcopenia syndrome: is this the future of nutrition screening and assessment for older adults? J Aging Res 2012:651570CrossRefGoogle Scholar
  14. 14.
    Vandewoude M, Hoeck S, Geerts J et al (2008) Mobility and frailty in community-dwelling older people: the effect of weight loss. J Nutr Health Aging 12:573Google Scholar
  15. 15.
    Flegal KM, Graubard BI, Williamson DF et al (2005) Excess deaths associated with underweight, overweight, and obesity. JAMA 293:1861–1867CrossRefGoogle Scholar
  16. 16.
    Reuben DB (2007) Quality indicators for the care of undernutrition in vulnerable elders. J Am Geriatr Soc 55(Suppl 2):S438–S442CrossRefGoogle Scholar
  17. 17.
    Henderson S, Moore N, Lee E et al (2008) Do the malnutrition universal screening tool (MUST) and Birmingham nutrition risk (BNR) score predict mortality in older hospitalised patients? BMC Geriatr 8:26CrossRefGoogle Scholar
  18. 18.
    Kondrup J, Rasmussen HH, Hamberg O et al (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22:321–336CrossRefGoogle Scholar
  19. 19.
    Kruizenga HM, Seidell JC, de Vet HC et al (2005) Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr 24:75–82CrossRefGoogle Scholar
  20. 20.
    Neelemaat F, Kruizenga HM, de Vet HC et al (2008) Screening malnutrition in hospital outpatients. Can the SNAQ malnutrition screening tool also be applied to this population? Clin Nutr 27:439–446CrossRefGoogle Scholar
  21. 21.
    Guigoz Y, Vellas B, Garry P (1994) Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol 4:15–59Google Scholar
  22. 22.
    Jeejeebhoy KN, Detsky AS, Baker JP (1990) Assessment of nutritional status. JPEN J Parenter Enteral Nutr 14:193S–196SCrossRefGoogle Scholar
  23. 23.
    Detsky AS, McLaughlin JR, Baker JP et al (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 11:8–13CrossRefGoogle Scholar
  24. 24.
    Ottery FD (1994) Rethinking nutritional support of the cancer patient: the new field of nutritional oncology. Semin Oncol 21:770–778PubMedGoogle Scholar
  25. 25.
    Ottery F (2000) Patient-generated subjective global assessment. In: PD MC, Polisena CG (eds) The clinical guide to oncology nutrition. American Dietetic Association, Chicago, IL, pp 11–23Google Scholar
  26. 26.
    Ritz P, Prod’Homme F, Berger V et al (2007) Nutritional risk score is not sensitive enough to predict weight loss in diseased elderly subjects. J Nutr Health Aging 11:389–392PubMedGoogle Scholar
  27. 27.
    Van Hoeyweghen RJ, De Leeuw IH, Vandewoude MF (1992) Creatinine arm index as alternative for creatinine height index. Am J Clin Nutr 56:611–615CrossRefGoogle Scholar
  28. 28.
    Baumgartner RN, Wayne SJ, Waters DL et al (2004) Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 12:1995–2004CrossRefGoogle Scholar
  29. 29.
    Prado CM, Lieffers JR, McCargar LJ et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635CrossRefGoogle Scholar
  30. 30.
    Vandewoude M, Bautmans I (2012) Sarcopenia: is it preventable? In: Cruz-Jentoft A, Morley J (eds) Sarcopenia. Wiley/Blackwell, West Sussex, pp 324–337CrossRefGoogle Scholar
  31. 31.
    Correia MI, Hegazi RA, Higashiguchi T et al (2014) Evidence-based recommendations for addressing malnutrition in health care: an updated strategy from the feedM.E. Global Study Group. J Am Med Dir Assoc 15:544–550CrossRefGoogle Scholar
  32. 32.
    Trevino-Aguirre E, Lopez-Teros T, Gutierrez-Robledo L et al (2014) Availability and use of dual energy X-ray absorptiometry (DXA) and bio-impedance analysis (BIA) for the evaluation of sarcopenia by Belgian and Latin American geriatricians. J Cachexia Sarcopenia Muscle 5:79–81CrossRefGoogle Scholar
  33. 33.
    McClave SA, Martindale RG, Vanek VW et al (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 33:277–316CrossRefGoogle Scholar
  34. 34.
    Volpi E, Rasmussen BB (2000) Nutrition and muscle protein metabolism in the elderly. Diabetes Nutr Metab 13:99–107PubMedGoogle Scholar
  35. 35.
    Volpi E, Kobayashi H, Sheffield-Moore M et al (2003) Essential amino acids are primarily responsible for the amino acid stimulation of muscle protein anabolism in healthy elderly adults. Am J Clin Nutr 78:250–258CrossRefGoogle Scholar
  36. 36.
    Zanchi NE, Nicastro H, Lancha AH Jr (2008) Potential antiproteolytic effects of L-leucine: observations of in vitro and in vivo studies. Nutr Metab (Lond) 5:20CrossRefGoogle Scholar
  37. 37.
    Campbell WW, Crim MC, Dallal GE et al (1994) Increased protein requirements in elderly people: new data and retrospective reassessments. Am J Clin Nutr 60:501–509CrossRefGoogle Scholar
  38. 38.
    Symons TB, Sheffield-Moore M, Wolfe RR et al (2009) A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc 109:1582–1586CrossRefGoogle Scholar
  39. 39.
    Bauer J, Biolo G, Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. JAm Med Dir Assoc 14:542–559CrossRefGoogle Scholar
  40. 40.
    Deutz NE, Bauer JM, Barazzoni R et al (2014) Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 33:929–936CrossRefGoogle Scholar
  41. 41.
    Dawson-Hughes B (2008) Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr 88:537S–540SCrossRefGoogle Scholar
  42. 42.
    Robinson SM, Reginster JY, Rizzoli R et al (2018) Does nutrition play a role in the prevention and management of sarcopenia? Clin Nutr 37(4):1121–1132CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University Department Geriatrics, Ziekenhuisnetwerk Antwerpen (ZNA)University of AntwerpAntwerpenBelgium

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