| The need for consistent criteria for identifying malnutrition. | |
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MedLine Citation:
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PMID: 19858685 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The lack of consistent criteria for diagnosing malnutrition and protein-energy malnutrition (PEM) creates problems in educating medical students and physicians, setting the parameters for observational and controlled clinical trials, and formulating clinical guidelines. There is no validated formal definition of malnutrition (or PEM), and the tools that have been developed to screen for it, or diagnose it, vary in their agreement. I make the following suggestions. First, avoid unqualified use of the term 'malnutrition', as it is ambiguous. Second, carefully distinguish between screening and diagnosis, which have different aims and implications. Third, consider the notion that in medicine the diagnosis of PEM is reached by 'narrative-interpretive' reasoning, which regards the disease as a pathophysiological entity in a specific clinical context. I recommend that the concept of PEM as a disease (not a score) be imbedded in teaching and the practice of medicine, and in the design of clinical trials and the setting of guidelines. Fourth, disagreements in screening-derived risk scores and uncertainty in diagnosis are difficult to avoid, but only in the grey zone. It would be prudent, at least until the greater medical world considers the nutritional paradigm plausible enough to invest in it, to enroll only patients who have unambiguously diagnosed PEM in prospective trials with hard clinical endpoints. |
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Authors:
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L John Hoffer |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review Date: 2009-08-20 |
Journal Detail:
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Title: Nestlé Nutrition workshop series. Clinical & performance programme Volume: 12 ISSN: 1422-7584 ISO Abbreviation: Nestle Nutr Workshop Ser Clin Perform Programme Publication Date: 2009 |
Date Detail:
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Created Date: 2009-10-27 Completed Date: 2009-11-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101121826 Medline TA: Nestle Nutr Workshop Ser Clin Perform Programme Country: Switzerland |
Other Details:
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Languages: eng Pagination: 41-52 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2009 S. Karger AG, Basel. |
Affiliation:
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Lady Davis Institute for Medical Research, McGill University, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Que., Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Humans Malnutrition / diagnosis*, epidemiology Mass Screening / standards Narration Nutrition Assessment Nutritional Status Protein-Energy Malnutrition / diagnosis, epidemiology Risk Factors |
| Grant Support | |
ID/Acronym/Agency:
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MOP-8725//Canadian Institutes of Health Research |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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