Malnutrition Diagnosis
How to Use The ASPEN/AND Criteria Tool▼
- Select Clinical Context: Choose Acute, Chronic, or Social/Environmental. This is crucial as it sets the diagnostic thresholds.
- Use Calculators (Optional): For Energy Intake and Weight Loss, you can use the built-in calculators to automatically determine the correct severity level.
- Evaluate Physical Findings: Select the severity for the remaining physical characteristics based on your clinical assessment.
- Diagnose: A diagnosis of malnutrition requires at least two of the six characteristics to be present. The tool will provide a final diagnosis based on your selections.
About The ASPEN/AND Criteria▼
The following table is adapted from the Academy of Nutrition and Dietetics (Academy)/American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) clinical characteristics to support a diagnosis of malnutrition [2].
| Clinical Characteristic | Acute Illness or Injury | Chronic Illness | Social or Environmental | |||
|---|---|---|---|---|---|---|
| Non-severe (moderate) | Severe | Non-severe (moderate) | Severe | Non-severe (moderate) | Severe | |
| Energy Intake | < 75% for > 7 days | ≤50% for ≥5 days | < 75% for ≥1 month | < 75% for ≥3 months | ≤50% for ≥1 month | |
| Weight Loss | 1-2% in 1 wk 5% in 1 mo 7.5% in 3 mo | >2% in 1 wk >5% in 1 mo >7.5% in 3 mo | 5% in 1 mo 7.5% in 3 mo 10% in 6 mo 20% in 1 yr | >5% in 1 mo >7.5% in 3 mo >10% in 6 mo >20% in 1 yr | 5% in 1 mo 7.5% in 3 mo 10% in 6 mo 20% in 1 yr | >5% in 1 mo >7.5% in 3 mo >10% in 6 mo >20% in 1 yr |
| Body Fat Loss | Mild | Moderate | Mild | Severe | Mild | Severe |
| Muscle Mass Loss | Mild | Moderate | Mild | Severe | Mild | Severe |
| Fluid Accumulation | Mild | Moderate to severe | Mild | Severe | Mild | Severe |
| Reduced Grip Strength | Measurably reduced | |||||
Guide to Choosing a Malnutrition Tool▼
The selection of a malnutrition diagnosis tool involves a critical balance between usability, objectivity, and applicability to specific patient populations. The trend is shifting from the subjective SGA towards more structured, consensus-based frameworks like GLIM, which aim to standardize malnutrition diagnosis globally.
| Feature | SGA (Subjective Global Assessment) | ASPEN/AND Criteria | GLIM (Global Leadership Initiative on Malnutrition) |
|---|---|---|---|
| Usability | High: Quick bedside assessment. | Moderate: Requires collecting data on at least two of six specific criteria. | Moderate to High: A two-step process (screening then assessment). |
| Resource Requirements | Low: No special equipment is needed. | Moderate: May require equipment (e.g., handgrip dynamometer). | Moderate: May require equipment for muscle mass assessment. |
| Key Strengths | Highly practical, cost-effective, extensive validation [6]. | Objective criteria, incorporates inflammation [2]. | Global consensus, flexible, comprehensive framework [1]. |
| Key Limitations | Highly subjective, lower inter-rater reliability. | Can be complex to apply consistently. | Newer, with less long-term outcome data. |
| Performance in Oncology | Strong: The PG-SGA variant is considered a reference standard for predicting outcomes [3]. | - | Good: Shows good agreement with PG-SGA and predicts survival, but may have lower specificity [3]. |
| Performance in Elderly | Fair to Good: Widely used but subjectivity can be a challenge. | - | Strong: Designed to be applicable to older adults and shows good concordance with comprehensive geriatric nutritional assessments [4]. |
| Performance in Surgical/ICU | Fair: Useful for general assessment but may be less predictive of mortality in the ICU compared to specialized tools [5]. | Good: Emphasis on inflammation is highly relevant in critically ill and post-operative patients. | Good: Relevant criteria, but like SGA, may be outperformed by ICU-specific risk scores (e.g., mNUTRIC) for predicting mortality [5]. |
References▼
- Cederholm, T., Jensen, G. L., Correia, M. I. T. D., et al. (2019). GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clinical Nutrition, 38(1), 1-9.
- White, J. V., Guenter, P., et al. (2012). Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 36(3), 275–283.
- de van der Schueren, M. A. E., et al. (2021). A systematic review and meta-analysis of the diagnostic accuracy of the GLIM criteria for malnutrition. Clinical Nutrition.
- Bellanti, F., et al. (2021). The Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition in older adults: A systematic review. The Journal of Nutrition, Health & Aging.
- Saptari, R. L., et al. (2024). Comparative analysis of malnutrition screening tools in predicting mortality in critically ill patients: SGA, GLIM, and mNutric Score. Journal of Critical Care.
- Detsky, A. S., McLaughlin, J. R., Baker, J. P., et al. (1987). What is subjective global assessment of nutritional status? Journal of Parenteral and Enteral Nutrition, 11(1), 8-13.