Diagnostic criteria for malnutrition – An ESPEN Consensus Statement
Open accessAbstract
Objective To provide a consensus-based minimum set of criteria for the diagnosis of malnutrition to be applied independent of clinical setting and aetiology, and to unify international terminology.Method The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a group of clinical scientists to perform a modified Delphi process, encompassing e-mail communications, face-to-face meetings, in group questionnaires and ballots, as well as a ballot for the ESPEN membership.Result First, ESPEN recommends that subjects at risk of malnutrition are identified by validated screening tools, and should be assessed and treated accordingly. Risk of malnutrition should have its own ICD Code. Second, a unanimous consensus was reached to advocate two options for the diagnosis of malnutrition. Option one requires body mass index (BMI, kg/m(2)) <18.5 to define malnutrition. Option two requires the combined finding of unintentional weight loss (mandatory) and at least one of either reduced BMI or a low fat free mass index (FFMI). Weight loss could be either >10% of habitual weight indefinite of time, or >5% over 3 months. Reduced BMI is <20 or <22 kg/m(2) in subjects younger and older than 70 years, respectively. Low FFMI is <15 and <17 kg/m(2) in females and males, respectively. About 12% of ESPEN members participated in a ballot; >75% agreed; i.e. indicated ≥7 on a 10-graded scale of acceptance, to this definition.Conclusion In individuals identified by screening as at risk of malnutrition, the diagnosis of malnutrition should be based on either a low BMI (<18.5 kg/m(2)), or on the combined finding of weight loss together with either reduced BMI (age-specific) or a low FFMI using sex-specific cut-offs.
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Patients with chronic diseases and hypoalbuminemia lose fat-free mass despite adequate food intake.
“Further, patients with chronic diseases and hypoalbuminemia lose fat‐free mass, considered to be an essential indicator of the undernourished state, despite adequate food intake.2, 3”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [2]
The Introduction links malnutrition to decreased fat-free mass, and §3.3 describes inflammation as a cause of catabolism and reduced albumin levels. But the paper does not say that patients with chronic disease and hypoalbuminemia lose fat-free mass despite adequate food intake; it also cautions in §3.3 that albumin is not sufficiently specific for diagnosing malnutrition. The indexed passages provide no page numbers. (LLM, conf=0.84)
Experimental — accuracy not yet measuredESPEN appointed an international expert group in 2015 to reach consensus on generally applicable diagnostic criteria for malnutrition, independent of etiologic mechanisms and applicable to patients from all clinical settings.
“In 2015 (Figure 1), ESPEN appointed an international expert group to reach a consensus on a set of generally applicable diagnostic criteria for the diagnosis of malnutrition, independent of etiologic mechanisms and applicable to patients from all clinical settings (14).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [14]
The Introduction and §1.1 say ESPEN appointed a consensus group to develop generally applicable malnutrition criteria independent of etiology and usable for all patients in all clinical settings. Section 2.1 describes the group as international, but places the initiative’s launch in late 2012 and its outline in January 2013; it does not support the claim that ESPEN appointed the group in 2015. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDespite global attempts to define malnutrition, such as consensus statements issued by ASPEN/AND and ESPEN, there is still no single unambiguous, objective, universally acknowledged consensus definition.
“Despite global attempts to define malnutrition, such as consensus statements issued by the American Society for Parenteral and Enteral Nutrition (ASPEN)/The Academy of Nutrition and Dietetics (AND) (13), the European Society of Clinical Nutrition and Metabolism (ESPEN) (14), we still lack a single unambiguous, objective, universally acknowledged consensus definition.”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [14]
The ESPEN consensus provided numerical cut-offs for each indicator, enabling uniform diagnosis across clinical settings.
“Importantly, the consensus provided numerical cut-offs for each indicator, enabling uniform diagnosis across clinical settings.”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [14]
ESPEN provides two alternatives for malnutrition diagnosis: diagnosis solely based on BMI, or unintentional weight loss together with either reduced BMI or low FFMI using sex-specific cut-offs.
“The group furthermore provides two alternatives for the diagnosis of malnutrition based on the use of these variables: (1) diagnosis solely based on a BMI, or (2) the combined finding of unintentional weight loss together with either reduced BMI or a low FFMI using sex-specific cut-offs.”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [14]
If at risk, the ESPEN committee recommends assessing weight loss, BMI, and free fat mass index (FFMI) as variables reflecting nutritional status most accurately.
“If found to be at risk, the committee recommends the assessment of three variables considered to reflect nutritional status most accurately, namely weight loss, BMI, and free fat mass index (FFMI) (Table 2).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [14]
The ESPEN consensus group determined that inflammation should be regarded as an etiologic factor rather than a diagnostic feature of malnutrition.
“Regarding inflammation, the consensus group determined that it should be regarded as an etiologic factor rather than a diagnostic feature of malnutrition.”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [14]
ESPEN guidelines recommend screening patients at risk of malnutrition with any validated screening tool.
“The guidelines recommend that patients at risk of malnutrition be screened by any validated screening tool.”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [14]
Frailty is well defined and can be diagnosed by clinical observations or by complementary examinations.
“Frailty has been suggested as the burden of comorbid disease, is well defined [15] and can be diagnosed by clinical observations or by complementary examinations [16].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [16]
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- Authors
- Cederholm, T., Bosaeus, I., Barazzoni, R., Bauer, J., Van Gossum, A., Klek, S., Muscaritoli, M., Nyulasi, I., Ockenga, J., Schneider, S. M., de van der Schueren, M. A. E., & Singer, P.
- Affiliations
- Uppsala University (SE)
- Sahlgrenska University Hospital (SE)
- University of Trieste (IT)
- Carl von Ossietzky Universität Oldenburg (DE)
- Sapienza University of Rome (IT)
- Monash University (AU)
- Klinikum Bremen-Mitte (DE)
- Centre Hospitalier Universitaire de Nice (FR)
- Tel Aviv University (IL)
- Corresponding author
- Cederholm, T.
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 34
- Issue
- 3
- Pages
- 335-340
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2083797416
- Cited by
- 1,755
- References
- 21
- Citations by year
- 2026: 112 · 2025: 167 · 2024: 166 · 2023: 170 · 2022: 215 · 2021: 192 · 2020: 194 · 2019: 158 · 2018: 152 · 2017: 123 · 2016: 89 · 2015: 15
- FWCI
- 93.07
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc-nd)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- European Society for Clinical Nutrition and Metabolism
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- malnutrition, diagnostic criteria, body mass index, unintentional weight loss, fat-free mass index, malnutrition screening
- MeSH terms
- Adipose Tissue, Body Composition, Delphi Technique, Europe, Female, Humans, Male, Surveys and Questionnaires, Risk Factors, Societies, Scientific, Weight Loss, Body Mass Index, Consensus, Malnutrition, Nutritional Sciences
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