Consensus Statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition)
Abstract
The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment and further ensure the provision of high‐quality, cost‐effective nutrition care.
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Despite 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 [13]
Physical withering is still a key component of several criteria to diagnose malnutrition.
“For example, physical withering is still a key component of several criteria to diagnose malnutrition (13), and the loss of both muscle and adipose tissue mass has recently been identified in diagnostic criteria (18).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [13]
By incorporating inflammatory status and measures of muscle mass and function, the AND/ASPEN consensus statement represents a significant step forward in the development of a universal framework for the diagnosis of malnutrition.
“By incorporating inflammatory status and measures of muscle mass and function, the AND/ASPEN consensus statement represents a significant step forward in the development of a universal framework for the diagnosis of malnutrition.”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [13]
The six characteristics put forward by AND/ASPEN include insufficient energy intake, weight loss, loss of subcutaneous fat, localized or generalized fluid accumulation that may mask weight loss, loss of muscle mass, and diminished functional status as measured by hand grip strength.
“The six characteristics put forward include insufficient energy intake, weight loss, loss of subcutaneous fat, localized or generalized fluid accumulation that may mask weight loss, loss of muscle mass, and diminished functional status as measured by hand grip strength (Table 2).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [13]
Once inflammation status is determined, the clinician can diagnose malnutrition if two or more out of six total characteristics are present.
“Once inflammation status is determined, the clinician can diagnose malnutrition if two or more out of six total characteristics are present.”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [13]
In 2012, the Academy of Nutrition and Dietetics collaborated with ASPEN to recommend a standardized set of diagnostic characteristics to be used to identify and document adult malnutrition in the clinical setting.
“In 2012 (Figure 1), the Academy of Nutrition and Dietetics collaborated with ASPEN to recommend a standardized set of diagnostic characteristics to be used to identify and document adult malnutrition in the clinical setting (13).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [13]
Measurable numerical guidelines are only put forth for energy intake and weight loss in the AND/ASPEN criteria, leaving loss of body fat or muscle mass, fluid accumulation, and reduced grip strength up to the clinician's interpretation of whether to rate as 'mild,' or 'moderate to severe'.
“However, measurable numerical guidelines are only put forth for energy intake and weight loss, leaving loss of body fat or muscle mass, fluid accumulation, and reduced grip strength up to the clinician’s interpretation of whether to rate as “mild,” or “moderate to severe.””
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [13]
These publications provide evidence that GLIM has good concurrent criterion validity when compared with established models SGA, MNA-SF, and AAIM.
“These publications provide evidence that GLIM has good concurrent criterion validity when compared with established models—ie, Subjective Global Assessment (SGA), 9 Mini Nutritional Assessment‐Short Form (MNA‐SF), 10 and the Academy of Nutrition and Dietetics and ASPEN Indicators to Diagnose Malnutrition (AAIM). 11”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [11]
The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition recommend the use of handgrip strength to document impaired physical function, depending on the patient's circumstances.
“The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition recommend the use of HGS to document impaired physical function, depending on the patient's circumstances [112].”
From The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review (2026) · cites this paper as [112]
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- Authors
- White, J. V., Guenter, P., Jensen, G., Malone, A., Schofield, M., Academy Malnutrition Work Group, A.S.P.E.N. Malnutrition Task Force, & and the A.S.P.E.N. Board of Directors
- Affiliations
- University of Tennessee at Knoxville (US)
- Pennsylvania State University (US)
- Mount Carmel Health (US)
- Academy of Nutrition and Dietetics (US)
- Corresponding author
- White, Jane V.
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2012-04-24
- Volume
- 36
- Issue
- 3
- Pages
- 275-283
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- OpenAlex
- W2101880068
- Cited by
- 1,284
- References
- 3
- Citations by year
- 2026: 66 · 2025: 101 · 2024: 97 · 2023: 125 · 2022: 120 · 2021: 125 · 2020: 109 · 2019: 98 · 2018: 91 · 2017: 69 · 2016: 74 · 2015: 79 · 2014: 56 · 2013: 60 · 2012: 11
- FWCI
- 61.84
- Type
- journal article
- Language
- en
- Update notices
- correction (2017-03-23)
- Open access
- closed
- Licence
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Society for Parenteral and Enteral Nutrition
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- adult malnutrition, malnutrition diagnosis, diagnostic criteria, diagnostic terminology, inflammation
- MeSH terms
- Adult, Energy Intake, Edema, Humans, Inflammation, Muscular Atrophy, Terminology as Topic, Weight Loss, Hand Strength, Clinical Laboratory Techniques, Diagnostic Techniques and Procedures, Malnutrition, Subcutaneous Fat
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