The document discusses malnutrition in elderly patients and its risk factors and assessment. It reports on studies finding that weight loss over 5kg increases mortality risk over 5 years. Risk factors for malnutrition include medical conditions, disabilities, social factors, and medications. Assessment of malnutrition involves evaluating weight loss, body mass index, albumin levels, nutritional screening tools, and food intake. Nutritional parameters like low BMI, albumin, and muscle mass are associated with higher complication rates.

1. Agathe Raynaud-Simon Service de Gériatrie, H ôpital Bichat APHP, Paris Faculté de Médecine Denis Diderot, Paris 7 Laboratoire de Biologie de la Nutrition, EA4466, Faculté de Pharmacie, Paris 5 Evaluation of malnutrition

2. Malnutrition

7. Evaluation of food intake

8. Nutritional parameters and life-threatening complications in geriatric patients Sullivan DH et al, J Gen Intern Med 2002; 17: 923 - 932 4,0% ≥ 22 kg/m ² 0,008 15,4% BMI < 22 kg/m ² 4,6% ≥ 18 mg/dL 0,046 10,5% Transthyretin < 18 mg/dL 5,3% ≥ 30 g/L 0,018 13,3% Albumin < 30 g/L 4,5% no <0,001 19% Weight loss > 5 % yes 3,2% > 323 mm 2,4% 286 – 323 mm <0,001 13,8% MAC < 286 mm P-Wert Complication rate Parameter

9. Malnutrition « Marasmus » Progressiv weight loss Protein and energy deficiency Muscle and fat loss Normal albuminemia No edema « Kwashiorkor » Rapid weight loss Protein deficiency Muscle mass loss Hypoalbuminemia Edema

10. Volkert D et al. Aktuel Ernaehr Med 2004; 29: 190-197 40 % 82  5 215 acute care, mixt Volkert (1992) 33 % 79  6 110 rehabilitation Sullivan (1994) 22 % 79  6 302 acute care, mixt Incalzi (1996) < 22 52 % 80  7 42 hip fracture Ponzer (1999) 35 % 83  4 99 acute care, mixt Dormenval (1999) 8 % > 70 116 ICU (respirator) Dardaine (2001) < 21 36 % 81  1 337 acute care, mixt Flodin (2000)  20 36 % 80  7 42 hip fracture Ponzer (1999) 31 % 78  9 201 stroke Gariballa (1998) 26 % 62 95 Parkinson Markus (1993) 21 % 82  5 215 acute care, mixt Volkert (1992) < 20 17 %  65 127 acute care, mixt DaCunha (2001) < 18,5 31 % 80  9 119 hip fracture Maffuli (1999) 9 % 82  5 215 acute care, mixt Volkert (1992) < 18 11 % 80  9 119 hip fracture Maffuli (1999) < 16 prevalence age n patients author BMI

12. Mini- MNA - risk factors - appetite - nutritional criteria NEW ! Kaiser, JNHA 2009

14. Assessment of nutritional status Body storage Weight, BMI How much fat? How much muscle? Metabolic homeostasis Albuminemia? Glycemia? Ca? P? …