Kalantar-Zadeh et al developed a malnutrition score for patients on hemodialysis. This can be used to quickly monitor a patient's nutrition status over time and allow for early intervention. The authors are from San Francisco, New York City and Berlin.
Parameters from medical history:
(1) weight change over past 6 months
(2) dietary intake
(3) gastrointestinal symptoms
(4) functional capacity (functional impairment associated with nutritional status)
(5) co-morbidity
Parameters from physical examination:
(6) decreased fat stores or loss of subcutaneous fat (below eyes, triceps, biceps, chest)
(7) signs of muscle wasting (temple, clavicle, scapula, ribs, quadriceps, knee, interosseous)
|
Parameter |
Finding |
Points |
|
weight change |
weight gain |
1 |
|
|
no change |
1 |
|
|
minor weight loss (< 5%) |
2 |
|
|
weight loss 5 – 10% |
3 |
|
|
weight loss 10.1 – 15% |
4 |
|
|
weight loss > 15% |
5 |
|
dietary intake |
no change |
1 |
|
|
sub-optimal solid diet |
2 |
|
|
moderate overall decrease |
3 |
|
|
full liquid diet |
3 |
|
|
hypocaloric liquid diet |
4 |
|
|
starvation |
5 |
|
gastrointestinal symptoms |
no symptoms |
1 |
|
|
nausea |
2 |
|
|
vomiting |
3 |
|
|
moderate GI symptoms |
3 |
|
|
diarrhea |
4 |
|
|
severe anorexia |
5 |
|
functional capacity |
no impairment (improved) |
1 |
|
|
difficulty with ambulation |
2 |
|
|
difficulty with normal activities |
3 |
|
|
limited to light activities |
4 |
|
|
bed or chair ridden with little or no activity |
5 |
|
co-morbidity |
hemodialyzed < 1 year and otherwise healthy |
1 |
|
|
mild comorbidity |
2 |
|
|
hemodialysis for 1-2 years |
2 |
|
|
moderate comorbidity |
3 |
|
|
hemodialysis for 2-4 years |
3 |
|
|
patient's age > 75 years |
3 |
|
|
severe comorbidity |
4 |
|
|
hemodialysis for > 4 years |
4 |
|
|
very severe multiple comorbidities |
5 |
|
decreased fat stores |
none (no change) |
1 |
|
|
mild |
2 |
|
|
moderate |
3 |
|
|
moderate to severe |
4 |
|
|
severe |
5 |
|
muscle wasting |
none (no change) |
1 |
|
|
mild |
2 |
|
|
moderate |
3 |
|
|
moderate to severe |
4 |
|
|
severe |
5 |
where:
• The description of comorbidities is given on page 1734.
malnutrition score =
= SUM(points for all 7 measures)
Interpretation:
• minimum score: 7
• malnutrition score: 35
• The higher the score, the greater the degree of malnutrition.
Performance:
• The score was compared with a series of anthropometric and laboratory measures and was found to correlate with malnutrition status of the patients in the study population.
Limitations:
• More studies are required to evaluate the performance characteristics of the score.
Specialty: Nutrition, Nephrology
