Malnutrition is defined as any nutritional imbalance (and as such includes overnutrition), but in common use it refers to states of nutritional deficiency of calories, protein, or other nutrients necessary for tissue repair and maintenance.
Malnutrition can occur due to inadequate nutrient intake (inadequate access to nutrients or inadequate intake despite availability, as in anorexia nervosa), increased nutritional demands that outstrip intake (infection, cancer, traumatic injury and burns, other etiologies for inflammation), inadequate or impaired bowel absorption and transport, and altered nutrient utilization by the body.
While inadequate nutritional intake is the most common etiology of malnutrition in the developing setting and remains a significant and often underrecognized issue in the elderly, impaired utilization and increased demand due to inflammation are a more common etiology in the developed world.
Regardless of etiology, malnutrition is associated with both increased morbidity and mortality, and its presence is associated with increased frequency and length of hospitalization and higher health care costs.
No single parameter is definitive for adult malnutrition. Consensus guidelines from ASPEN (American Society for Parenteral and Enteral Nutrition) define malnutrition as the presence of 2 of the following 6 findings.
- Insufficient energy intake
- Weight loss
- Loss of muscle mass
- Loss of subcutaneous fat
- Localized or generalized fluid accumulation that may mask weight loss
- Diminished functional status measured by hand-grip strength
E46 – Unspecified protein-calorie malnutrition
T73.0XXA – Starvation, initial encounter
212968006 – Starvation
272588001 – Malnutrition
- Anorexia (anorexia nervosa, drug-induced anorexia)
- Inflammatory bowel disease (see Crohn disease, ulcerative colitis)
- Human immunodeficiency virus (HIV) disease
- Advanced liver disease (eg, liver cirrhosis)
- Congestive heart failure
- Renal failure
- Amyloidosis (AL amyloidosis, AA amyloidosis)
- Pancreatic insufficiency
- Celiac disease
- Diabetes mellitus (type 1 and type 2)
- Microscopic colitis
- Infectious diarrhea (eg, diarrheagenic Escherichia coli)
- Hypothyroidism or hyperthyroidism
- Cystic fibrosis
- Alcohol use disorder
- Intravenous (IV) drug abuse (eg, opioid use disorder)
- Bariatric surgery (eg, resulting in dumping syndrome)
Last Updated: 08/29/2018