Recognizing Malnutrition in Everyday Practice



Peter A. McCullough, MD: Well, malnutrition is something that really should be in the physicians’ diagnostic approach to patients with chronic illnesses. Malnutrition is defined as involuntary weight loss of more than 5% of body weight and that’s occurred over a period of 3 months or so, a fairly reliable indicator that, in fact, malnutrition is present. There are laboratory tests that are complementary in terms of making the diagnosis, including a drop in the serum albumin and serum pre-albumin, otherwise known as transthyretin. It’s important, because all the studies agree malnutrition and its consequences have been related to a variety of adverse outcomes across a whole spectrum of chronic diseases.

Nicolaas Deutz, MD, PhD: Physicians should actually also have very simple questions to screen for potential malnutrition, like measuring a blood pressure or a heart rate. I think that’s very important that physicians start to do that in their common practice. Patients actually are usually more aware of the presence of the malnutrition, because of, nowadays, all the information that’s available on the internet. So, they will ask the physician, “I am starting losing weight. What should I do?” Malnutrition is on the radar of a lot of people, and they all know that if you lose weight while you did not want to do that, that’s an ominous sign. Physicians and patients should really work together on this topic and both define that malnutrition is something that is a sign of something severe, but also can be treated.

If I think about my physician colleagues, nutrition is not taught in medical school. It’s very hard for physicians to think about nutrition as being something very important for older adults. On the other hand, geriatricians or physicians working with older people are all aware of the importance of a good nutritional condition. So, there is a lot of discussion, but usually in relation to older adults who get sick. What is not discussed a lot is how important it is to stop this malnutrition, and to stop people losing muscle mass and weight.

Peter A. McCullough, MD: Malnutrition is important to treat because it is one of the few modifiable factors that’s present in patients with a whole array of chronic diseases. And if that factor can be modified, research suggests that outcomes can be improved. In fact, mortality can be decreased. So, treatment of malnutrition really involves a comprehensive nutritional assessment to identify the macronutrient deficiencies. And macronutrients are divided into carbohydrates, proteins, and fats, as well as micronutrient deficiencies. Micronutrients include vitamins and trace minerals. A nutritional laboratory panel and physical examination are the traditional approaches. And, then, the treatment really involves supplementation, and supplementation can be through food diets. However, for many patients with chronic illnesses such as cancer, heart failure, chronic inflammatory or autoimmune diseases, food diets become a challenge, because of lack of interest in eating or a lack in taste and enjoyment in eating. So, many times we have to move to what’s called nutraceutical supplements. And nutraceuticals are forms of food, as well as supplemented macronutrients and micronutrients. Most of the time they come in forms of liquid shakes or bars.

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