Navigating complexity: The challenge of reaching consensus on the diagnosis of malnutrition in patients with obesity via a modified delphi study

IF 2.6 Q3 NUTRITION & DIETETICS
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.
导航复杂性:通过修正德尔菲研究达成肥胖症患者营养不良诊断共识的挑战。
背景与目的:诊断肥胖患者的(疾病相关的)营养不良具有挑战性,因为超重和疾病相关的生理变化以及饮食摄入不足之间存在复杂的相互作用,这些因素在临床评估中经常被忽视。目前全球对营养不良的定义没有充分考虑到肥胖患者的独特特征。本研究旨在为这一人群的营养不良制定一个可行的定义。方法:采用改进的三轮德尔菲法,于2024年3月至7月对25名专家进行调查,对肥胖患者的营养不良诊断达成共识。在第一轮中,参与者使用5分李克特量表评估45个陈述。这一轮的反馈为第二轮的修订提供了指导,第二轮的重点是营养不良全球领导力倡议(GLIM)标准,并引入了9项修订后的声明。第三轮进一步完善了这些陈述,使用二元同意/不同意量表确定了最终共识。≥70%的共识阈值被设定为所有回合的共识,未达到该阈值的陈述将不予决定。结果:第1轮的参与率为88% (n=22),第2轮为77% (n=17),第3轮为50% (n=11)。在第一轮评估的45份声明中,11份被接受,32份尚未决定,2份被拒绝。第二轮提出了九项订正发言,其中七项获得接受,两项尚未作出决定。在第三轮中,对9个陈述进行了评估,其中6个被接受,3个仍未决定。共识支持采用GLIM标准作为工作定义的基础。然而,体重减轻和肌肉质量的阈值以及功能参数的相关性仍未得到解决。c反应蛋白阈值是一致的,但由于在解释肥胖慢性低度炎症方面的挑战,它们的相关性存在争议。参与者强调了评估饮食质量和数量的重要性,建议营养师参与以提高准确性。结论:虽然没有一个诊断肥胖患者营养不良的工作定义,但本研究为进一步的研究奠定了重要的基础。未来研究的关键领域包括改进和验证与非自愿体重减轻、肌肉质量、炎症标志物和饮食摄入相关的参数。
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来源期刊
Clinical nutrition ESPEN
Clinical nutrition ESPEN NUTRITION & DIETETICS-
CiteScore
4.90
自引率
3.30%
发文量
512
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.
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