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      Morphofunctional assessment of patient's nutritional status: a global approach Translated title: Evaluación morfofuncional del estado nutricional de los pacientes: un nuevo enfoque

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          Abstract

          Abstract Disease-related malnutrition represents an imbalance between the intake and the requirements of energy and nutrients. It produces a series of metabolic and functional changes in the body. There are multiple limitations in the classic parameters for nutrition assessment including body mass index, weight loss, food intake, or standard laboratory parameters such as albumin or lymphocytes. We can establish some points of interest in this new approach to nutrition focused on the assessment of nutritional status by evaluating changes in composition and function using parameters such as PhA and other electrical measurements of bioimpedance, dynamometry, functional tests, muscle ultrasound, or laboratory parameters such as CRP/prealbumin. Each of these parameters has a number of uses and limitations that should be understood when evaluating its ability to diagnose malnutrition as related to disease, its concordance with other tests, and its prognostic value. Emerging nutritional parameters for future use should be sensitive, specific, and interrelated to allow a better understanding of each patient's status at different time points during their disease.

          Translated abstract

          Resumen La malnutrición relacionada con la enfermedad representa un disbalance entre el aporte y los requerimientos de energía y nutrientes, que produce una serie de cambios metabólicos y funcionales a nivel corporal. Existen múltiples limitaciones de los parámetros clásicos de valoración nutricional, como el índice de masa corporal, la pérdida de peso, la ingesta o los parámetros analíticos clásicos, como es el caso de la albúmina o los linfocitos. Sugerimos un nuevo enfoque de la nutrición clínica centrado en la valoración del estado nutricional del paciente evaluando los cambios de composición y función con nuevos parámetros como el ángulo de fase y otras medidas eléctricas de la bioimpedanciometría, la ecografía nutricional©, los nuevos parámetros analíticos como el cociente PCR/prealbúmina, la dinamometría o los test funcionales. Cada uno de estos parámetros tiene una serie de utilidades y limitaciones que es importante conocer a la hora de evaluar su capacidad de diagnosticar la desnutrición relacionada con la enfermedad, la concordancia con otros tests y su valor pronóstico. La nueva visión global de la nutrición clínica debería integrar diferentes aspectos de composición y función del organismo para poder establecer un diagnóstico más preciso de la situación nutricional y un plan terapéutico individualizado. Los parámetros nutricionales emergentes deben ser sensibles y específicos, y estar relacionados entre sí, de forma que permitan un mejor conocimiento de la situación particular de cada paciente en los diferentes momentos evolutivos de su proceso patológico.

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          Most cited references52

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          Bioelectrical impedance analysis--part I: review of principles and methods.

          U KYLE (2004)
          The use of bioelectrical impedance analysis (BIA) is widespread both in healthy subjects and patients, but suffers from a lack of standardized method and quality control procedures. BIA allows the determination of the fat-free mass (FFM) and total body water (TBW) in subjects without significant fluid and electrolyte abnormalities, when using appropriate population, age or pathology-specific BIA equations and established procedures. Published BIA equations validated against a reference method in a sufficiently large number of subjects are presented and ranked according to the standard error of the estimate. The determination of changes in body cell mass (BCM), extra cellular (ECW) and intra cellular water (ICW) requires further research using a valid model that guarantees that ECW changes do not corrupt the ICW. The use of segmental-BIA, multifrequency BIA, or bioelectrical spectroscopy in altered hydration states also requires further research. ESPEN guidelines for the clinical use of BIA measurements are described in a paper to appear soon in Clinical Nutrition.
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            Diagnostic criteria for malnutrition - An ESPEN Consensus Statement.

            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.
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              GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community *

              Summary Rationale This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. Methods In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face‐to‐face meetings, telephone conferences, and e‐mail communications. Results A two‐step approach for the malnutrition diagnosis was selected, i.e., first screening to identify “at risk” status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology‐related diagnosis categories. Conclusion A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re‐considered every 3–5 years.
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                Author and article information

                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                June 2021
                : 38
                : 3
                : 592-600
                Affiliations
                [4] Baracaldo orgnameHospital Universitario Cruces orgdiv1Division of Endocrinology and Nutrition Spain
                [2] Málaga Andalucía orgnameUniversidad de Málaga orgdiv1Faculty of Medicine orgdiv2PhD Program in Biomedicine. Translational Research and new Health Technologies Spain
                [3] Málaga orgnameFIMABIS orgdiv1Hospital Clínico Virgen de la Victoria orgdiv2Division of Endocrinology and Nutrition Spain
                [5] Ferrol orgnameComplejo Hospitalario de Ferrol orgdiv1Division of Endocrinology and Nutrition Spain
                [1] Málaga orgnameHospital Quirónsalud orgdiv1Hospital Clínico Virgen de la Victoria orgdiv2Division of Endocrinology and Nutrition Spain
                Article
                S0212-16112021000300592 S0212-1611(21)03800300592
                10.20960/nh.03378
                33749304
                d4cace18-ee99-4119-b0f9-85e9eeac33c5

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 03 October 2020
                : 27 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 52, Pages: 9
                Product

                SciELO Spain

                Categories
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                Functional tests,Malnutrición relacionada con la enfermedad,Composición corporal,Ángulo de fase,Fuerza muscular,Ultrasonografía,Test funcionales,Disease-related malnutrition,Body composition,Phase angle,Muscle strength,Ultrasonography

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