Key messages

• All the traditional markers of malnutrition lose their specificity in the sick adult as each may be affected by a number of non-nutritional factors.

• Nutritional assessment is required for patients presenting with clinical evidence of malnutrition, patients with chronic diseases, such as cancer, alcoholism, liver disease, and kidney disease, patients with acute conditions accompanied by high catabolic rates, and geriatric patients.

• The initial nutritional status and the extent of the disease-related catabolic process are the main risk factors for nutritionally related complications. Subjective global assessment including careful recording of patient history, physical examination, and weight measures allow assessment and classification of nutritional status.

• Muscle function evaluated by hand-grip strength and serum albumin, which is the most useful biological test, provide an objective measure of risk assessment. Calculation of a nutritional index according to the patient's disease is helpful for determining a percentage risk of complications and thus the need for nutritional support.

• A high index of suspicion remains the best way of uncovering potentially harmful nutritional deficits. Introduction

A normal nutritional status is a key element in the ability of a patient to overcome a critical illness. Normal body composition and function are maintained in adults by a daily diet providing nutrients meeting the needs of the individual. Malnutrition, the result of extended inadequate intake on body composition and function, is responsible per se for increased morbidity and mortality. Thus assessment of nutritional status must be performed in critically ill patients. All the traditional markers of malnutrition lose their specificity in the sick adult as each may be affected by a number of non-nutritional factors. Therefore interpretation of the results must be cautious.

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