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Recommendations Summary

UWL: Nutrition Diagnosis of Involuntary Weight Loss 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    UWL: Nutrition Diagnosis of Involuntary Weight Loss

    The Registered Dietitian (RD) will use clinical judgment in interpreting nutrition assessment data to diagnose unintended weight loss and/or underweight in the older adult.  Studies support an association between increased mortality and underweight (BMI < 20 kg/m2 or current weight compared with usual or desired body weight) and/or unintended weight loss (5% in 30 days, or any further weight loss after meeting this criteria).

    Rating: Strong
    Imperative

    • Risks/Harms of Implementing This Recommendation

      • Failure to make a nutrition diagnosis of involuntary weight loss may lead to lack of treatment and increased risk of mortality.
      • Continued involuntary weight loss without nutrition intervention may lead to potential for litigation.

    • Conditions of Application

      • Lack of treatment may be warranted in accordance with advance directives.
      • For some individuals, unintended weight loss may be irreversible due to underlying medical conditions.

    • Potential Costs Associated with Application

      Although medical nutrition therapy (MNT) costs and reimbursement vary, MNT is essential for improved outcomes.

    • Recommendation Narrative

      • Five studies support an association between underweight and/or unintended weight loss and increased mortality but the definition is inconsistent. 
      • One study reported that mortality was 50% for subjects with a BMI < 20 kg/m2 (Saletti et al, 2005), but additional research suggests that the current BMI thresholds may not apply to the elderly (Sanchez-Garcia et al, 2007). 
      • Two studies report that weight loss was associated with a 2 to 10-fold increased risk for death (Sullivan et al, 2002; Sullivan et al, 2004), and one study reported that those who were severely underweight were four times more likely to have unintentional weight loss of 10 pounds in 6 months (Martin et al, 2007).

    • Recommendation Strength Rationale

      • Conclusion Statement in support of these recommendations received Grade II

    • Minority Opinions

      Consensus reached.