Malnutrition in the ICU: Current recommendations for the assessment of nutritional status and a review of the use of albumin as an indicator of malnutrition

Abstract

Many critically ill patients have malnutrition at presentation or develop it during hospitalization, and this complication adversely affects outcomes, including length of stay, morbidity, and mortality. All ICU patients should be evaluated for malnutrition using simple screening tools, such as the Nutritional Risk Screening and Subjective Global Assessment. Laboratory tests, including serum albumin levels, are inaccurate indicators of malnutrition and do not provide a simple method for screening. In particular, albumin levels often fall rapidly because of transcapillary efflux and altered hepatic synthesis during acute illness. Current guidelines recommend that the nutritional status should be assessed by a review of recent energy intake, recent weight loss, and current body mass index and bedside assessment of muscle mass, fluid accumulation, and grip strength. An integrated analysis of nutritional status provides a better assessment and helps develop patient specific therapeutic interventions.