Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 391

Weight loss, particularly if unintentional, should be first interpreted as a sign of malnutrition. Malnutrition is a complex syndrome with different clinical presentations. After screening for malnutrition, diagnosing malnutrition according to the GLIM consensus is based on recognising etiological and phenotypic criteria (see Table 14.1).⁴⁰ Etiological factors include decreased dietary intake or assimilation, or inflammation. Phenotypic criteria are weight loss >5% within the past six months or >10% beyond six months, or low BMI. Diagnosing malnutrition based on low BMI without identifying a cause of malnutrition may overestimate the prevalence of malnutrition.

The spectrum of clinical presentations can be categorized according to the level of inflammation markers (see Table 14.1). Starvation or malnutrition due to reduced food intake or assimilation is observed with C‐reactive protein (CRP, mg L^–) <3 mg L^–1. Low‐medium intensity inflammation is described as inflammageing but was not shown to be associated with a decrease in body mass. Inflammageing can be classified as inadequate nutrition leading to increased risk for diseases associated with ageing.⁴¹ Conditions associated with medium inflammation lead to chronic malnutrition, called cachexia. Finally, high‐level inflammation associated with severe sepsis or trauma induces malnutrition with hypercatabolism (see Figure 14.1).