Natasha Nalucha Mwala , Jeanne J.F.A. in ’t Hulst , Barbara S. van der Meij , Emmelyne Vasse , Jos W. Borkent , Carliene van Dronkelaar , Patty L.M. Lakenman , Esmee M. Reijnierse , Josje D. Schoufour , Peter J.M. Weijs , Renate Winkels , Maarten R. Soeters , Marian A.E. de van der Schueren
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引用次数: 0
Abstract
Background & aim
Diagnosing (disease-related) malnutrition in patients with obesity is challenging due to the complex interplay between excess body weight and physiological changes associated with illness and inadequate dietary intake, factors often overlooked in clinical assessments. Current global definitions of malnutrition do not adequately account for the distinctive characteristics of patients with obesity. This study aimed to develop a working definition of malnutrition in this population.
Methods
A modified three-round Delphi method was conducted between March and July 2024, involving 25 experts to achieve consensus on diagnosing malnutrition in obesity. In Round 1, participants evaluated 45 statements using a 5-point Likert scale. Feedback from this round guided revisions for Round 2, which focused on the Global Leadership Initiative on Malnutrition (GLIM) criteria and introduced nine revised statements. Round 3 further refined these statements, with the final consensus assessed using a binary agree/disagree scale. A threshold of ≥70 % agreement was set to define consensus in all rounds, with statements not meeting this threshold left undecided.
Results
Participation rates were 88 % (n = 22) in Round 1, 77 % (n = 17) in Round 2, and 50 % (n = 11) in Round 3. Of the 45 statements assessed in Round 1, 11 were accepted, 32 were undecided, and two were rejected. Round 2 introduced nine revised statements, of which seven were accepted and two remained undecided. In Round 3, nine statements were assessed, of which six were accepted, and three remained undecided. Consensus supported adopting the GLIM criteria as the foundation for the working definition. However, thresholds for weight loss and muscle mass and the relevance of functional parameters remained unresolved. C-reactive protein thresholds were agreed upon, but their relevance was debated due to the challenges in interpreting chronic low-grade inflammation in obesity. Participants emphasised the importance of assessing dietary quality and quantity, recommending dietitian involvement for improved accuracy.
Conclusion
Although a working definition for diagnosing malnutrition in patients with obesity was not achieved, this study lays a crucial foundation for further research. Key areas for future investigation include refining and validating parameters related to involuntary weight loss, muscle mass, inflammatory markers and dietary intake.
期刊介绍:
Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.