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For the chapter in the Wells Handbook, please go to Chapter 59. Nutrition Evaluation and Support.



  • image Malnutrition encompasses both overnutrition (obesity) and undernutrition.

  • image Nutrition screening is distinct from assessment; it should be designed to quickly and consistently identify those with preexisting malnutrition or those at risk for malnutrition.

  • image A comprehensive nutrition assessment is required to formulate a nutrition care plan for an individual found to be nutritionally-at-risk for nutrition-related poor outcomes.

  • image A nutrition-focused physical examination and medical, surgical, and dietary history are essential components of a comprehensive nutrition assessment.

  • image Evaluation of anthropometric measurements (weight, height, and head circumference) should be based on published standards.

  • image Laboratory assessment of visceral proteins and other nutrition-related parameters must be interpreted in the context of physical findings, medical and surgical history, including acute and chronic inflammation, and clinical status.

  • image Micronutrient or macronutrient deficiencies or toxicities or risk factors for these deficiencies or toxicities can be identified by a comprehensive nutrition assessment.

  • image Evidence-based patient-specific goals should be established considering the patient’s clinical condition and the need for maintenance or repletion in adults or continued growth and development in children.

  • image Validated predictive equations are most often used to determine energy requirements; however, if available, indirect calorimetry is the most accurate bedside method to determine energy requirements.

  • image Drug–nutrient interactions can affect nutrition status and the response to and adverse effects seen with drug therapy.

Nutrition care is a vital component of quality patient care and nutrition screening and assessment are integral parts of the nutrition care process. No single clinical or laboratory parameter is an absolute indicator of nutrition status, so information from a number of them must be collected and analyzed. This chapter reviews the tools most commonly used for accurate, relevant, and cost-effective nutrition screening and assessment, including various methods used to determine patient-specific macro- and micronutrient requirements and potential drug–nutrient interactions.


image Malnutrition is a consequence of nutrient imbalance. In general, deficiency states can be categorized as those involving protein and calories or single nutrients such as individual vitamins or trace elements. Starvation-associated malnutrition, marasmus, results from prolonged inadequate intake, absorption, or utilization of protein and energy. It occurs in patients with an inadequate food supply, anorexia nervosa, major depression, and malabsorption syndromes (Fig. 141-1). Somatic protein (skeletal muscle) and adipose tissue (subcutaneous fat) wasting occurs, but visceral protein (albumin [ALB] and transferrin [TFN]) production is usually preserved. Weight loss may exceed 10% of usual body weight (UBW; typical weight). Patients with starvation-associated malnutrition commonly have a prototypical wasted appearance.1,2 Kwashiorkor, a form of starvation-associated malnutrition develops as a consequence of inadequate protein intake and is usually seen in areas where there is famine or limited food supply. In the United States, kwashiorkor has been seen in children and ...

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