A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height [determination of BMI]; further:
- Inspection (viewing).
- Skin, mucous membranes, and sclerae (white part of the eye) [pallor, “hunger belly,” alopecia (hair loss), Bitot’s spots – whitish spots on the cornea caused by vitamin A deficiency, cheilosis – painful redness and swelling of the lips with tearing, dermatitis (inflammatory skin disease), ecchymoses – small patchy skin bleeding; patchy skin markings, generalized edema (water retention all over the body), gingivitis (bleeding gums), glossitis (inflammation of the tongue), skin hemorrhages, hyperpigmentation, keratosis pilaris (“friction skin”) – a keratinization disorder, pellagra – vitamin B3 deficiency disease (symptoms: Diarrhea (diarrhea), dermatitis (inflammatory skin disease) and dementia), perifollicular hemorrhages – hemorrhages around the hair follicle, peripheral edema – water retention, especially on the lower legs, cracks in the fingernails, seborrhea “sebaceous flow” from Lat. sebum: sebum and Gr. “ροή”: flow) – overproduction of skin oils by the sebaceous glands, stomatitis (inflammation of the oral mucosa)]
- Auscultation (listening) of the heart [differential diagnosis: heart failure (cardiac insufficiency)]
- Auscultation of the lungs [differential diagnosis: chronic obstructive pulmonary disease (COPD); possible sequelae: pneumonia (pneumonia)]
- Palpation (palpation) of the abdomen (abdomen) (pressure pain?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
- Inspection (viewing).
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings. The assessment of malnutrition is done according to the following scheme.
BMI (kg/m²) | Triceps skin fold (mm) man/woman | Mid-arm muscle circumference(cm) man/woman | Classification of malnutrition |
19-25 | 12,5/ 16,5 | 29,3/ 28,5 | Normal weight |
< 18,5 | 10,0/ 13,2 | 23,4/ 22,8 | Grade 1 of malnutrition |
< 17,0 | 7,5/ 9,9 | 20,5/ 19,9 | Grade 2 of malnutrition |
< 16,0 | 5,0/ 6,6 | 17,6/ 17,1 | Grade 3 of malnutrition |
Furthermore, there are several schemes that define malnutrition differently:
Subjective Global Assessment of Nutritional Status (SGA)
In this test to assess malnutrition, the following parameters are considered:
- Weight loss in the last six months
- Food intake
- Gastrointestinal symptoms such as diarrhea (diarrhea) or nausea/vomiting.
- General physical status
- Stress
- Clinical signs such as loss of subcutaneous fat (subcutaneous adipose tissue) or appearance of edema (water retention)
As a result, there is a subjective assessment of nutritional status:
- A= well nourished
- B= moderately malnourished or suspected malnutrition.
- C= severely malnourished
Nutritional Risk Index
This index refers to malnutrition when:
- BMI < 20.5 kg/m²
- Weight loss > 5% in three months
- Current decreased food intake
- Severity of the disease
This test is mainly used in the hospital.
Malnutrition Universal Screening Tool (MUST) for adults
This test applies the following parameters to assess malnutrition:
- BMI
- Unintentional weight loss
- Acute disease
Parameter | 0 points | 1 point | 2 points |
BMI (kg/m²) | ≥ 20,0 | 20,0-18,5 | ≤ 18,5 |
Weight loss (%) | ≤ 5 | 5-10 | ≥ 10 |
Acute illness | None | Food abstinence expected to last more than five days |
Evaluation
Total | Risk | Measure | Implementation |
0 points | Low | Repeat test | Clinic: weeklyHome: monthlyOutpatient: annual |
1 point | Medium | Observe | Clinic: dietary protocol over three daysHome: dietary protocol over three daysOutpatient: Repeat test in a few months; SGA* , dietary counseling if necessary. |
2 points | High | Treat | Clinic/home/outpatient: SGA, begin nutrition therapy |
* SGA (= Subjective Global Assessment of Nutritional Status).