Cachexia: Examination

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?)
  • 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).