A nurse is reviewing the laboratory findings of a client who has protein-calorie malnutrition

1. Kondrup J., Rasmussen H.H., Hamberg O., Stanga Z. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin. Nutr. 2003;22:321–336. doi: 10.1016/S0261-5614(02)00214-5. [PubMed] [CrossRef] [Google Scholar]

2. Poulia K.-A., Yannakoulia M., Karageorgou D., Gamaletsou M., Panagiotakos D.B., Sipsas N.V., Zampelas A. Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin. Nutr. 2012;31:378–385. doi: 10.1016/j.clnu.2011.11.017. [PubMed] [CrossRef] [Google Scholar]

3. Mueller C., Compher C., Ellen D.M. ASPEN Clinical Guidelines. J. Parenter. Enter. Nutr. 2011;35:16–24. doi: 10.1177/0148607110389335. [PubMed] [CrossRef] [Google Scholar]

4. Jensen G.L. Malnutrition and Inflammation—“Burning Down the House” J. Parenter. Enter. Nutr. 2015;39:56–62. doi: 10.1177/0148607114529597. [PubMed] [CrossRef] [Google Scholar]

5. Kirkland L.L., Kashiwagi D.T., Brantley S., Scheurer D., Varkey P. Nutrition in the hospitalized patient. J. Hosp. Med. 2013;8:52–58. doi: 10.1002/jhm.1969. [PubMed] [CrossRef] [Google Scholar]

6. Buzby G.P., Mullen J.L., Matthews D.C., Hobbs C.L., Rosato E.F. Prognostic nutritional index in gastrointestinal surgery. Am. J. Surg. 1980;139:160–167. doi: 10.1016/0002-9610(80)90246-9. [PubMed] [CrossRef] [Google Scholar]

7. Ingenbleek Y., Carpentier Y.A. A prognostic inflammatory and nutritional index scoring critically ill patients. Int. J. Vitam. Nutr. Res. 1985;55:91–101. [PubMed] [Google Scholar]

8. Detsky A.S., Baker J.P., Johnston N., Whittaker S., Mendelson R.A., Jeejeebhoy K.N. What is subjective global assessment of nutritional status? J. Parenter. Enter. Nutr. 1987;11:8–13. doi: 10.1177/014860718701100108. [PubMed] [CrossRef] [Google Scholar]

9. Reilly H.M., Martineau J.K., Moran A., Kennedy H. Nutritional screening—Evaluation and implementation of a simple Nutrition Risk Score. Clin. Nutr. 1995;14:269–273. doi: 10.1016/S0261-5614(95)80063-8. [PubMed] [CrossRef] [Google Scholar]

10. Kovacevich D.S., Boney A.R., Braunschweig C.L., Perez A., Stevens M. Nutrition Risk Classification: A Reproducible and Valid Tool for Nurses. Nutr. Clin. Pract. 1997;12:20–25. doi: 10.1177/011542659701200120. [PubMed] [CrossRef] [Google Scholar]

11. Vellas B., Guigoz Y., Garry P.J., Nourhashemi F., Bennahum D., Lauque S., Albarede J.L. The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15:116–122. doi: 10.1016/S0899-9007(98)00171-3. [PubMed] [CrossRef] [Google Scholar]

12. Ferguson M., Capra S., Bauer J., Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition. 1999;15:458–464. doi: 10.1016/S0899-9007(99)00084-2. [PubMed] [CrossRef] [Google Scholar]

13. Laporte M., Villalon L., Thibodeau J., Payette H. Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities. J. Nutr. Health Aging. 2001;5:292–294. [PubMed] [Google Scholar]

14. Thorsdottir I., Gunnarsdottir I., Eriksen B. Screening Method Evaluated by Nutritional Status Measurements can be Used to Detect Malnourishment in Chronic Obstructive Pulmonary Disease. J. Am. Diet. Assoc. 2001;101:648–654. doi: 10.1016/S0002-8223(01)00163-8. [PubMed] [CrossRef] [Google Scholar]

15. Elia M. The ‘MUST’ Report. Nutritional Screening for Adults: A Multidisciplinary Responsibility. Development and Use of the ‘Malnutrition Universal Screening Tool’ (MUST) for Adults. [(accessed on 10 March 2019)];2003 Available online: https://eprints.soton.ac.uk/362499/

16. Kruizenga H.M., Van Tulder M.W., Seidell J.C., Thijs A., Ader H.J., Van Bokhorst-de van der Schueren M.A. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am. J. Clin. Nutr. 2005;82:1082–1089. doi: 10.1093/ajcn/82.5.1082. [PubMed] [CrossRef] [Google Scholar]

17. De Ulíbarri J.I., González-Madroño A., De Villar N., González P., González B., Mancha A., Rodriguez F., Fernández G. CONUT: A tool for controlling nutritional status. First validation in a hospital population. Nutr. Hosp. 2005;20:38–45. [PubMed] [Google Scholar]

18. Kuzu M.A., Terzioğlu H., Genç V., Erkek A.B., Özban M., Sonyürek P., Elhan A.H., Torun N. Preoperative Nutritional Risk Assessment in Predicting Postoperative Outcome in Patients Undergoing Major Surgery. World J. Surg. 2006;30:378–390. doi: 10.1007/s00268-005-0163-1. [PubMed] [CrossRef] [Google Scholar]

19. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group Perioperative Total Parenteral Nutrition in Surgical Patients. [(accessed on 10 March 2019)]; Available online: https://www.nejm.org/doi/10.1056/NEJM199108223250801?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov

20. Ng T.P., Nyunt M.S.Z., Gao Q., Wee S.L., Yap P., Yap K.B. Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA): Development and validation of a nutritional prognostic index. Clin. Nutr. ESPEN. 2017;22:54–63. doi: 10.1016/j.clnesp.2017.08.012. [PubMed] [CrossRef] [Google Scholar]

21. Jensen G.L., Mirtallo J., Compher C., Dhaliwal R., Forbes A., Grijalba R.F., Hardy G., Kondrup J., Labadarios D., Nyulasi I., et al. Adult Starvation and Disease-Related Malnutrition. J. Parenter. Enter. Nutr. 2010;34:156–159. doi: 10.1177/0148607110361910. [PubMed] [CrossRef] [Google Scholar]

22. White J.V., Guenter P., Jensen G., Malone A., Schofield M. Consensus Statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition. J. Parenter. Enter. Nutr. 2012;36:275–283. doi: 10.1177/0148607112440285. [PubMed] [CrossRef] [Google Scholar]

23. Zhang Z., Pereira S.L., Luo M., Matheson E.M. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis. Nutrients. 2017;9:829. doi: 10.3390/nu9080829. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

24. Cabrerizo S., Cuadras D., Gomez-Busto F., Artaza-Artabe I., Marín-Ciancas F., Malafarina V. Serum albumin and health in older people: Review and meta analysis. Maturitas. 2015;81:17–27. doi: 10.1016/j.maturitas.2015.02.009. [PubMed] [CrossRef] [Google Scholar]

25. Corti M.-C., Guralnik J.M., Salive M.E., Sorkin J.D. Serum Albumin Level and Physical Disability as Predictors of Mortality in Older Persons. JAMA. 1994;272:1036–1042. doi: 10.1001/jama.1994.03520130074036. [PubMed] [CrossRef] [Google Scholar]

26. Kudsk K.A., Tolley E.A., DeWitt R.C., Janu P.G., Blackwell A.P., Yeary S., King B.K. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. J. Parenter. Enter. Nutr. 2003;27:1–9. doi: 10.1177/014860710302700101. [PubMed] [CrossRef] [Google Scholar]

27. Gibbs J., Cull W., Henderson W., Daley J., Hur K., Khuri S.F. Preoperative Serum Albumin Level as a Predictor of Operative Mortality and Morbidity: Results from the National VA Surgical Risk Study. Arch. Surg. 1999;134:36–42. doi: 10.1001/archsurg.134.1.36. [PubMed] [CrossRef] [Google Scholar]

28. Hernández J.L., Riancho J.A., Matorras P., González-Macías J. Clinical evaluation for cancer in patients with involuntary weight loss without specific symptoms. Am. J. Med. 2003;114:631–637. doi: 10.1016/S0002-9343(03)00115-3. [PubMed] [CrossRef] [Google Scholar]

29. Levitt D.G., Levitt M.D. Human serum albumin homeostasis: A new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int. J. Gen. Med. 2016;9:229–255. doi: 10.2147/IJGM.S102819. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

30. Takeda H., Ishihama K., Fukui T., Fujishima S., Orii T., Nakazawa Y., Shu H.J., Kawata S. Significance of rapid turnover proteins in protein-losing gastroenteropathy. Hepato-Gastroenterology. 2003;50:1963–1965. [PubMed] [Google Scholar]

31. Beck F.K., Rosenthal T.C. Prealbumin: A Marker for Nutritional Evaluation. Am. Fam. Physician. 2002;65:1575–1580. [PubMed] [Google Scholar]

32. Ingenbleek Y. Plasma Transthyretin as a Biomarker of Sarcopenia in Elderly Subjects. Nutrients. 2019;11:895. doi: 10.3390/nu11040895. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

33. Spiekerman A. Nutritional assessment (protein Nutriture) Anal. Chem. 1995;67:429–436. doi: 10.1021/ac00108a026. [PubMed] [CrossRef] [Google Scholar]

34. Dellière S., Cynober L. Is transthyretin a good marker of nutritional status? Clin. Nutr. 2017;36:364–370. doi: 10.1016/j.clnu.2016.06.004. [PubMed] [CrossRef] [Google Scholar]

35. Li L., Dai L., Wang X., Wang Y., Zhou L., Chen M., Wang H. Predictive value of the C-reactive protein-to-prealbumin ratio in medical ICU patients. Biomark. Med. 2017;11:329–337. doi: 10.2217/bmm-2016-0266. [PubMed] [CrossRef] [Google Scholar]

36. Harriman S., Rodych N., Hayes P., Moser M.A. The C-reactive protein-to-prealbumin ratio predicts fistula closure. Am. J. Surg. 2011;202:175–178. doi: 10.1016/j.amjsurg.2010.06.021. [PubMed] [CrossRef] [Google Scholar]

37. Shen Q., Liu W., Quan H., Pan S., Li S., Zhou T., Ouyang Y., Xiao H. Prealbumin and lymphocyte-based prognostic score, a new tool for predicting long-term survival after curative resection of stage II/III gastric cancer. Br. J. Nutr. 2018;120:1359–1369. doi: 10.1017/S0007114518002854. [PubMed] [CrossRef] [Google Scholar]

38. Shimura T., Shibata M., Inoue T., Owada-Ozaki Y., Yamaura T., Muto S., Hasegawa T., Shio Y., Suzuki H. Prognostic impact of serum transthyretin in patients with non-small cell lung cancer. Mol. Clin. Oncol. 2019;10:597–604. doi: 10.3892/mco.2019.1837. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

39. Wang W., Wang C.-S., Ren D., Li T., Yao H.-C., Ma S.-J. Low serum prealbumin levels on admission can independently predict in-hospital adverse cardiac events in patients with acute coronary syndrome. Medicine. 2018;97:e11740. doi: 10.1097/MD.0000000000011740. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

40. Lee J.L., Oh E.S., Lee R.W., Finucane T.E. Serum Albumin and Prealbumin in Calorically Restricted, Nondiseased Individuals: A Systematic Review. Am. J. Med. 2015;128:1203. doi: 10.1016/j.amjmed.2015.03.032. [PubMed] [CrossRef] [Google Scholar]

41. Shetty P.S., Jung R.T., Watrasiewicz K.E., James W.P. Rapid-turnover transport proteins: AN index of subclinical protein-energy malnutrition. Lancet. 1979;314:230–232. doi: 10.1016/S0140-6736(79)90241-1. [PubMed] [CrossRef] [Google Scholar]

42. Bharadwaj S., Ginoya S., Tandon P., Gohel T.D., Guirguis J., Vallabh H., Jevenn A., Hanouneh I. Malnutrition: Laboratory markers vs nutritional assessment. Gastroenterol. Rep. 2016;4:272–280. doi: 10.1093/gastro/gow013. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

43. Fletcher J.P., Little J.M., Guest P.K. A Comparison of Serum Transferrin and Serum Prealbumin as Nutritional Parameters. J. Parenter. Enter. Nutr. 1987;11:144–147. doi: 10.1177/0148607187011002144. [PubMed] [CrossRef] [Google Scholar]

44. Roza A.M., Tuitt D., Shizgal H.M. Transferrin—A Poor Measure of Nutritional Status. J. Parenter. Enter. Nutr. 1984;8:523–528. doi: 10.1177/0148607184008005523. [PubMed] [CrossRef] [Google Scholar]

45. Briassoulis G., Zavras N., Hatzis T. Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutrition. 2001;17:548–557. doi: 10.1016/S0899-9007(01)00578-0. [PubMed] [CrossRef] [Google Scholar]

46. Sergi G., Coin A., Enzi G., Volpato S., Inelmen E.M., Buttarello M., Peloso M., Mulone S., Marin S., Bonometto P. Role of visceral proteins in detecting malnutrition in the elderly. Eur. J. Clin. Nutr. 2006;60:203–209. doi: 10.1038/sj.ejcn.1602289. [PubMed] [CrossRef] [Google Scholar]

47. Shenkin A., Cederblad G., Elia M., Isaksson B. Laboratory assessment of protein-energy status. Clin. Chim. Acta. 1996;253:S5–S9. doi: 10.1016/0009-8981(96)06289-4. [PubMed] [CrossRef] [Google Scholar]

48. Neaton J.D., Blackburn H., Jacobs D., Kuller L., Lee D.-J., Sherwin R., Shih J., Stamler J., Wentworth D. Serum Cholesterol Level and Mortality Findings for Men Screened in the Multiple Risk Factor Intervention Trial. Arch. Intern. Med. 1992;152:1490–1500. doi: 10.1001/archinte.1992.00400190110021. [PubMed] [CrossRef] [Google Scholar]

49. Isley W.L., Underwood L.E., Clemmons D.R. Dietary components that regulate serum somatomedin-C concentrations in humans. J. Clin. Investig. 1983;71:175–182. doi: 10.1172/JCI110757. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

50. Campillo B., Paillaud E., Bories P.N., Noel M., Porquet D., Le Parco J.C. Serum levels of insulin-like growth factor-1 in the three months following surgery for a hip fracture in elderly: Relationship with nutritional status and inflammatory reaction. Clin. Nutr. 2000;19:349–354. doi: 10.1054/clnu.2000.0124. [PubMed] [CrossRef] [Google Scholar]

51. López-Hellin J., Baena-Fustegueras J.A., Schwartz-Riera S., García-Arumí E. Usefulness of short-lived proteins as nutritional indicators surgical patients. Clin. Nutr. 2002;21:119–125. doi: 10.1054/clnu.2001.0515. [PubMed] [CrossRef] [Google Scholar]

52. Burgess E.J. Insulin-Like Growth Factor 1: A Valid Nutritional Indicator during Parenteral Feeding of Patients Suffering an Acute Phase Response. Ann. Clin. Biochem. 1992;29:137–144. doi: 10.1177/000456329202900203. [PubMed] [CrossRef] [Google Scholar]

53. Unterman T.G., Vazquez R.M., Slas A.J., Martyn P.A., Phillips L.S. Nutrition and somatomedin. XIII. Usefulness of somatomedin-C in nutritional assessment. Am. J. Med. 1985;78:228–234. doi: 10.1016/0002-9343(85)90431-0. [PubMed] [CrossRef] [Google Scholar]

54. Livingstone C. Insulin-like growth factor-I (IGF-I) and clinical nutrition. Clin. Sci. 2013;125:265–280. doi: 10.1042/CS20120663. [PubMed] [CrossRef] [Google Scholar]

55. Rachakonda V., Borhani A.A., Dunn M.A., Andrzejewski M., Martin K., Behari J. Serum Leptin Is a Biomarker of Malnutrition in Decompensated Cirrhosis. PLoS ONE. 2016;11:e0159142. doi: 10.1371/journal.pone.0159142. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

56. Acar S., Çatlı G., Küme T., Tuhan H., Gürsoy Çalan Ö., Demir K., Böber E., Abaci A. Increased concentrations of serum nesfatin-1 levels in childhood with idiopathic chronic malnutrition. Turk. J. Med. Sci. 2018;48:378–385. [PubMed] [Google Scholar]

57. Tuerk M., Fazel N. Zinc deficiency. Curr. Opin. Gastroenterol. 2009;25:136–143. doi: 10.1097/MOG.0b013e328321b395. [PubMed] [CrossRef] [Google Scholar]

58. Marcellini F., Giuli C., Papa R., Gagliardi C., Dedoussis G., Herbein G., Fulop T., Monti D., Rink L., Jajte J., et al. Zinc status, psychological and nutritional assessment in old people recruited in five European countries: Zincage study. Biogerontology. 2006;7:339–345. doi: 10.1007/s10522-006-9048-4. [PubMed] [CrossRef] [Google Scholar]

59. Kvamme J.-M., Grønli O., Jacobsen B.K., Florholmen J. Risk of malnutrition and zinc deficiency in community-living elderly men and women: The Tromsø Study. Public Health Nutr. 2015;18:1907–1913. doi: 10.1017/S1368980014002420. [PubMed] [CrossRef] [Google Scholar]

60. Makonnen B., Venter A., Joubert G. A Randomized Controlled Study of the Impact of Dietary Zinc Supplementation in the Management of Children with Protein–Energy Malnutrition in Lesotho. II: Special Investigations. J. Trop. Pediatr. 2003;49:353–360. doi: 10.1093/tropej/49.6.353. [PubMed] [CrossRef] [Google Scholar]

61. Droogsma E., Van Asselt D.Z.B., Scholzel-Dorenbos C.J.M., Van Steijn J.H.M., Van Walderveen P.E., Van Der Hooft C.S. Nutritional status of community-dwelling elderly with newly diagnosed Alzheimer’s disease: Prevalence of malnutrition and the relation of various factors to nutritional status. J. Nutr. Health Aging. 2013;17:606–610. doi: 10.1007/s12603-013-0032-9. [PubMed] [CrossRef] [Google Scholar]

62. Koyama A., Hashimoto M., Tanaka H., Fujise N., Matsushita M., Miyagawa Y., Hatada Y., Fukuhara R., Hasegawa N., Todani S., et al. Malnutrition in Alzheimer’s Disease, Dementia with Lewy Bodies, and Frontotemporal Lobar Degeneration: Comparison Using Serum Albumin, Total Protein, and Hemoglobin Level. PLoS ONE. 2016;11:e0157053. doi: 10.1371/journal.pone.0157053. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

63. Ingenbleek Y. Why should plasma transthyretin become a routine screening tool in elderly persons? J. Nutr. Health Aging. 2009;13:640–642. doi: 10.1007/s12603-009-0175-x. [PubMed] [CrossRef] [Google Scholar]

64. Fouque D., Kalantar-Zadeh K., Kopple J., Cano N., Chauveau P., Cuppari L., Franch H., Guarnieri G., Ikizler T.A., Kaysen G., et al. A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73:391–398. doi: 10.1038/sj.ki.5002585. [PubMed] [CrossRef] [Google Scholar]

65. Rymarz A., Bartoszewicz Z., Szamotulska K., Niemczyk S. The Associations between Body Cell Mass and Nutritional and Inflammatory Markers in Patients with Chronic Kidney Disease and in Subjects Without Kidney Disease. J. Ren. Nutr. 2016;26:87–92. doi: 10.1053/j.jrn.2015.09.005. [PubMed] [CrossRef] [Google Scholar]

66. Kanda E., Kato A., Masakane I., Kanno Y. A new nutritional risk index for predicting mortality in hemodialysis patients: Nationwide cohort study. PLoS ONE. 2019;14:e0214524. doi: 10.1371/journal.pone.0214524. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

67. Schuetz P., Fehr R., Baechli V., Geiser M., Deiss M., Gomes F., Kutz A., Tribolet P., Bregenzer T., Braun N., et al. Individualised Nutritional Support in Medical Inpatients at Nutritional Risk: A Randomised Clinical Trial. [(accessed on 20 May 2019)];Lancet. 2019 doi: 10.1016/S0140-6736(18)32776-4. Available online: http://www.sciencedirect.com/science/article/pii/S0140673618327764 [PubMed] [CrossRef] [Google Scholar]


Page 2

Anthropometric parameters and biomarkers in various nutritional assessment and screening tools (adapted from [3] with an update, in chronological order of publication.

Nutritional Assessment and Screening ToolAnthropometric Parameters and HistoryBiomarkers
Prognostic Nutritional Index [6]Triceps skin foldAlbumin, transferrin, skin sensitivity
Prognostic Inflammatory and Nutritional Index [7]NoneAlbumin, prealbumin, C-reactive protein, α1-acid glycoprotein
Subjective Global Assessment (SGA) [8]Weight history, diet history, primary diagnosis, stress level, physical symptoms (s.c. fat, muscle wasting, edema), functional capacity, gastrointestinal symptomsNone
Birmingham Nutrition Risk Score [9]Weight loss, BMI, appetite, ability to eat, stress factor, (severity of diagnosis)None
Nutrition Risk Classification [10]Weight loss, percentage ideal body weight, dietary intake, gastrointestinal functionNone
Mini Nutritional Assessment (MNA; [11] Weight data, height, mid-arm circumference, calf circumference, diet history, appetite, feeding modeAlbumin, prealbumin, cholesterol, lymphocyte count
Malnutrition Screening Tool [12] Appetite, unintentional weight lossNone
Simple Screening Tool [13]Body mass index (BMI), percentage weight lossAlbumin
Full nutritional assessment [14]BMI, information on unintended weight loss, triceps skinfold thickness, mid-arm muscle circumference Serum albumin, prealbumin, and total lymphocyte count
Malnutrition Universal Screening Tool (MUST) [15]BMI, change in weight, presence of acute diseaseNone
Nutritional Risk Screening (NRS) 2002 [1]Weight loss, BMI, food intake, diagnosis (severity)None
Short Nutrition Assessment Questionnaire [16] Recent weight history, appetite, use of oral supplement or tube feedingNone
Controlling nutritional status (CONUT) [17]NoneSerum albumin, total cholesterol and total lymphocyte count
Maastricht Index [18]Percentage ideal body weightAlbumin, prealbumin, lymphocyte count
Nutritional Risk Index [19] Present and usual body weightAlbumin
Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA) [20]Nutritional historyAlbumin, hemoglobin, total cholesterol and lymphocyte count