Deconstructing Disease-Related Malnutrition: A New Assessment Framework for Clinical Practice

Abstract

Protein-energy wasting (PEW) is a key cause of functional impairment and poor health outcomes in people with chronic kidney disease. While PEW can be mitigated with nutrition therapy, it is a complex myriad of disorders with numerous interacting etiologies and corresponding presentations, which make it difficult to diagnose and manage in practice. A variety of scoring rubrics have been developed to facilitate malnutrition assessment. Although these tools have greatly benefited the recognition and treatment of PEW, the typical format of grading specified PEW indicators has the potential to overlook or overstate highly relevant individual-specific factors. This review presents a simple framework for malnutrition assessment that can be used to complement and evaluate conventional assessment tools. Unlike standard tools, which are designed to identify and rate malnutrition risk and severity, the malnutrition framework is conceptual model that organizes PEW assessment into three distinct, but interacting facets of PEW risk: nutrient balance, nutrition status, and malnutrition risk. The new framework encourages critical thinking about PEW risk that may help clinicians plan and interpret assessments to efficiently and effectively manage this condition.

Keywords: Malnutrition; assessment; chronic kidney disease; diagnosis; protein-energy wasting.

Figure 1.

Malnutrition framework, Figure Legend. The malnutrition framework breaks down PEW assessment into three subassessments based on related, but distinct components of PEW pathophysiology: 1) Nutrient Balance, 2) Nutrition Status, and 3) Malnutrition Risk. Figure 1 provides an overview of each subassessment, including the key information gleaned (Questions), types of measurements (Assessment), and clinical utility (Relevance).