Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider S M, de van der Schueren M A E, Singer P
Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
Clinical Nutrition Unit, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden.
Clin Nutr. 2015 Jun;34(3):335-40. doi: 10.1016/j.clnu.2015.03.001. Epub 2015 Mar 9.
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.
The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a group of clinical scientists to perform a modified Delphi process, encompassing e-mail communications, face-to-face meetings, in group questionnaires and ballots, as well as a ballot for the ESPEN membership.
First, ESPEN recommends that subjects at risk of malnutrition are identified by validated screening tools, and should be assessed and treated accordingly. Risk of malnutrition should have its own ICD Code. Second, a unanimous consensus was reached to advocate two options for the diagnosis of malnutrition. Option one requires body mass index (BMI, kg/m(2)) <18.5 to define malnutrition. Option two requires the combined finding of unintentional weight loss (mandatory) and at least one of either reduced BMI or a low fat free mass index (FFMI). Weight loss could be either >10% of habitual weight indefinite of time, or >5% over 3 months. Reduced BMI is <20 or <22 kg/m(2) in subjects younger and older than 70 years, respectively. Low FFMI is <15 and <17 kg/m(2) in females and males, respectively. About 12% of ESPEN members participated in a ballot; >75% agreed; i.e. indicated ≥7 on a 10-graded scale of acceptance, to this definition.
In individuals identified by screening as at risk of malnutrition, the diagnosis of malnutrition should be based on either a low BMI (<18.5 kg/m(2)), or on the combined finding of weight loss together with either reduced BMI (age-specific) or a low FFMI using sex-specific cut-offs.
提供一套基于共识的营养不良诊断标准的最小集，使其能够独立于临床环境和病因应用，并统一国际术语。
欧洲临床营养与代谢学会（ESPEN）任命了一组临床科学家进行改良的德尔菲法，包括电子邮件沟通、面对面会议、小组问卷和投票，以及面向ESPEN成员的投票。
首先，ESPEN建议通过经过验证的筛查工具识别有营养不良风险的受试者，并应相应地进行评估和治疗。营养不良风险应有其自己的国际疾病分类代码。其次，就倡导两种营养不良诊断选项达成了一致共识。选项一要求体重指数（BMI，kg/m²）<18.5来定义营养不良。选项二要求同时具备非故意体重减轻（必备条件）以及BMI降低或无脂肪体重指数（FFMI）低两者中的至少一项。体重减轻可以是超过习惯体重的10%（不限时间），或者在3个月内超过5%。70岁及以下和70岁以上受试者的BMI降低分别为<20和<22 kg/m²。女性和男性的低FFMI分别为<15和<17 kg/m²。约12%的ESPEN成员参与了投票；超过75%的成员表示同意；即在10分接受度等级量表上给出≥7分，认可这一定义。
在通过筛查确定有营养不良风险的个体中，营养不良的诊断应基于低BMI（<18.5 kg/m²），或基于体重减轻与特定年龄的BMI降低或使用特定性别的临界值的低FFMI同时出现的情况。
