Hostname: page-component-7c8c6479df-24hb2 Total loading time: 0 Render date: 2024-03-29T13:26:08.478Z Has data issue: false hasContentIssue false

Use of BMI in the assessment of undernutrition in older subjects: reflecting on practice

Published online by Cambridge University Press:  07 March 2007

Z. Cook
Affiliation:
Leeds Community Nutrition and Dietetic Services, St Mary's Hospital, Leeds, LS12 3QE, UK
S. Kirk
Affiliation:
Nuffield Institute, University of Leeds,Leeds, LS2 9PL, UK
S. Lawrenson
Affiliation:
Leeds Community Nutrition and Dietetic Services, St Mary's Hospital, Leeds, LS12 3QE, UK
S. Sandford
Affiliation:
Leeds Community Nutrition and Dietetic Services, St Mary's Hospital, Leeds, LS12 3QE, UK
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

In recent years there has been a proliferation of nutrition screening tools but undernutrition remains prevalent amongst older subjects. Screening tools commonly include BMI as the widely-accepted ‘gold standard’ indicator of malnutrition. Whilst BMI may be an appropriate tool for population studies when it can be measured accurately in research conditions, the use of BMI in clinical practice may mask important weight changes and result in a failure to alert healthcare staff to a nutritional problem. The inclusion of BMI has been identified as a barrier to completing the screening process at ward level. Also, feedback from dietitians working with older subjects indicates that 72.5% of those using BMI express concerns that it is of limited use for practical reasons or that the reference range (20–25 kg/m2) is not appropriate to older subjects. Further evidence questions whether or not BMI is applicable for inclusion in methods used to identify an older subject at risk of undernutrition in a variety of care settings. In view of these findings it is advocated that weight change over a period of time together with clinical judgement is a far superior prognostic indicator of undernutrition. Despite screening, there is evidence that inpatients continue to lose weight before discharge. Further experiential evidence from both community and ward settings suggests that inadequacies in care planning, food provision and a lack of assistance with feeding are common. In order to improve the management of undernutrition in older subjects it is therefore recommended that the focus of attention should be on addressing these practical issues and on the effective monitoring of these processes.

Type
BAPEN Symposium 3 on ‘From beginners to zimmers’
Copyright
Copyright © The Nutrition Society 2005

References

Baker, JP, Detsky, AS, Wesson, DE, Wolman, SL, Stewart, S, Whitewell, J, Langer, B, Jeejeebhoy, KN (1982) Nutrition assessment: a comparison of clinical judgement and objective measurements. New England Journal of Medicine 306, 969972 Google Scholar
Bastow, MD (1982) Anthropometrics revisited. Proceedings of the Nutrition Society 41, 381388 CrossRefGoogle ScholarPubMed
Beck, AM, Ovesen, L (1998) At which body mass index and degree of weight loss should hospitalized elderly people be considered at nutritional risk. Clinical Nutrition 17, 195198 Google Scholar
Beck, AM, Ovesen, L, Osler, M (1999) The ‘Mini Nutritional Assessment’ (MNA) and the ‘Determine your Nutritional Health’ Checklist (NSI checklist) as predictors of morbidity and mortality in an elderly Danish population. British Journal of Nutrition 81, 3136 Google Scholar
British Association, for Parenteral and, Enteral Nutrition, Malnutrition Advisory Group (2000) Guidelines for Detection and Management of Malnutrition. Reddich, Worcs.: BAPEN.Google Scholar
British Association for Parenteral and Enteral Nutrition Malnutrition Advisory Group (2003) ‘Malnutrition Universal Screening Tool’ (‘MUST’). http://www.bapen.org.uk/pdfs/Must/MUST-Complete.pdf Google Scholar
Burr, ML, Phillips, KM (1984) Anthropometric norms in the elderly. British Journal of Nutrition 51, 165169 Google Scholar
Caroline Walker Trust (1995) Eating Well for Older People: Practical and National Guidelines for Food in Residential and Nursing Homes and for Community Meals London: Caroline Walker TrustGoogle Scholar
Coroni-Huntley, J, Harris, TB, Everett, DF, Albanes, D, Micozzi, MS, Miles, TP, Feldman, JJ (1991) An overview of body weight of older persons including the impact on mortality. The National Health and Nutrition Examination Survey I – Epidemiologic Follow-up Study. Journal of Clinical Epidemiology 44, 743753 Google Scholar
de Onis, M, Habicht, J (1996) Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. American Journal of Clinical Nutrition 64, 650658 Google Scholar
Department of Health Department of Health (2001a) Essence of Care. London: Department of Health.Google Scholar
Department of HealthDepartment of Health (2001b) The NHS Plan. section 4.168: Better Hospital Food. London: Department of Health.Google Scholar
Department of HealthDepartment of Healthc ) National Service Framework for Older People. London: Department of Health.Google Scholar
Dey, DK, Rothenberg, E, Sundh, V, Bosaeus, I, Steen, B (2001) Body mass index, weight change and mortality in the elderly. A 15 year longitudinal population study of 70 year olds. European Journal of Clinical Nutrition 55, 482492 Google Scholar
Finch, S, Doyle, W, Lowe, C, Bates, CJ, Prentice, A, Smithers, G, Clarke, PC &, Walls, AWG (1998) National Diet and Nutrition Survey People Aged 65 Years and Over. Vol. 1: Report of the Diet and Nutrition Survey. London: The Stationery Office.Google Scholar
Galanos, AN, Pieper, CF, Cornoni-Huntley, JC, Bales, CW, Fillenbaum, GG (1994) Nutrition function: Is there a relationship between body mass index and the functional capabilities of community dwelling elderly. Journal of American Geriatrics Society 42, 368373 Google Scholar
Jebb, SA (1998) Measuring body composition: From the laboratory to the clinic. In Clinical Obesity, pp. 1849 [Kopelman, P and Stock, M, editors]. Oxford: Blackwell Science.Google Scholar
Jensen, GL, Friedmann, JM, Coleman, CD, Smiciklas-Wright, H (2001) Screening for hospitalization and nutritional risks among community-dwelling older persons. American Journal of Clinical Nutrition 74, 201205 Google Scholar
Katalin, GL, Harris, TB, Coroni-Huntley, J, Simonsick, EM, Wallace, RB, Cook, NR, Ostfeld, AM, Blazer, DG (1995) Does weight loss from middle age to old age explain the inverse weight mortality relationship in old age. American Journal of Epidemiology 141, 312321 Google Scholar
Keys, A, Fidanza, F, Karvonen, MJ, Kimura, N, Taylor, HL (1972) Indices of relative weight and obesity. Journal of Chronic Diseases 25, 329343 CrossRefGoogle ScholarPubMed
Kirk, SFL, Hawke, T, Sandford, S, Wilks, Z, Lawrenson, S (2003) Are the methods used to calculate BMI accurate and valid for the use in older people. Journal of Human Nutrition and Dietetics 16, 366367 Google Scholar
Landi, F, Zuccala, G, Gambassi, G, Incalzi, RA, Manigrasso, L, Pagano, F, Carbonin, P, Bernabei, R (1999) Body mass index and mortality among older people living in the community. Journal of the American Geriatrics Society 47, 10721076 Google Scholar
Lehmann, AB, Bassey, EJ, Morgan, K, Dallosso, HM (1991) Normal values for weight, skeletal size and body mass indices in 890 men and women aged over 65 years. Clinical Nutrition 10, 1822 CrossRefGoogle ScholarPubMed
McWhirter, JP, Pennington, CR (1994) Incidence and recognition of malnutrition in hospital. British Medical Journal 308, 945948 CrossRefGoogle ScholarPubMed
Nightingale, JMD, Walsh, N, Bullock, ME, Wicks, AC (1996) Three simple methods of detecting malnutrition on medical wards. Journal of the Royal Society of Medicine 89, 144148 Google Scholar
Rajala, SA, Kanto, AJ, Haavisto, MV, Kaarela, RH, Koivunen, MJ, Heikinheimo, RJ (1990) Body weight and the three-year prognosis in very old people. International Journal of Obesity 14, 9971003 Google Scholar
Royal College, of Physicians (2002) Nutrition and Patients – A Doctors Responsibility. London: Royal College of Physicians.Google Scholar
Voluntary Organisations, Involved in, Caring for, Elderly Sector (1998) Eating Well for Older People with Dementia: A Good Practical Guide for Residential and Nursing Homes and Others Involved in Caring for Older People with Dementia. Potters Bar, Herts.: VOICES; Gardner Merchant Healthcare Services.Google Scholar
World Health OrganizationWorld Health Organization (1998) Obesity: Preventing and Managing the Global Epidemic. WHO Technical Report Series no.894.Geneva:WHO.Google Scholar
Wynn, A &, Wynn, M (1995) What is a desirable weight for the elderly? Geriatric Medicine July issue, 18.Google Scholar