Malnutrition in Adult
Alerts and Notices
Synopsis
Malnutrition can occur due to inadequate nutrient intake (inadequate access to nutrients or inadequate intake despite availability, as in anorexia nervosa), increased nutritional demands that outstrip intake (infection, cancer, traumatic injury and burns, other etiologies for inflammation), inadequate or impaired bowel absorption and transport, and altered nutrient utilization by the body.
While inadequate nutritional intake is the most common etiology of malnutrition in the developing setting and remains a significant and often underrecognized issue in the elderly, impaired utilization and increased demand due to inflammation are a more common etiology in the developed world.
Regardless of etiology, malnutrition is associated with both increased morbidity and mortality, and its presence is associated with increased frequency and length of hospitalization and higher health care costs.
No single parameter is definitive for adult malnutrition. Consensus guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN) define malnutrition as the presence of 2 of the following 6 findings:
- Insufficient energy intake
- Weight loss
- Loss of muscle mass
- Loss of subcutaneous fat
- Localized or generalized fluid accumulation that may mask weight loss
- Diminished functional status measured by hand-grip strength
Related topics: Protein-energy malnutrition, kwashiorkor, marasmus, bulimia, malabsorption syndrome, failure to thrive and neglect, vitamin and mineral deficiencies (vitamin A, vitamin B2, vitamin B6, vitamin B12, niacin, vitamin C, vitamin D, vitamin E, vitamin K, thiamine, folate, copper, iodine, zinc [acquired and hereditary], and iron)
Codes
ICD10CM:E46 – Unspecified protein-calorie malnutrition
T73.0XXA – Starvation, initial encounter
SNOMEDCT:
212968006 – Starvation
272588001 – Malnutrition
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Assess for underlying medical conditions in a malnourished adult:- Anorexia (anorexia nervosa, drug-induced anorexia)
- Bulimia
- Depression
- Malignancy
- Inflammatory bowel disease (see Crohn disease, ulcerative colitis)
- HIV disease
- Advanced liver disease (eg, liver cirrhosis)
- Congestive heart failure
- Renal failure
- Dementia
- Amyloidosis (AL amyloidosis, AA amyloidosis)
- Pancreatic insufficiency (eg, due to chronic pancreatitis)
- Celiac disease
- Diabetes mellitus (type 1 and type 2)
- Microscopic colitis
- Infectious diarrhea (eg, diarrheagenic Escherichia coli)
- Hypothyroidism or hyperthyroidism
- Cystic fibrosis
- Alcohol use disorder
- Drug abuse (see addiction disorders)
- Bariatric surgery (eg, resulting in dumping syndrome)
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:08/28/2018
Last Updated:05/26/2021
Last Updated:05/26/2021