Case 1

Try again! While a low BMI is one of the risk factors for malnutrition, a normal BMI does not preclude a diagnosis of malnutrition

Correct answer! This patient is at high risk for malnutrition. Recognizing the indicators of malnutrition in the history and exam is key to identifying this.    The malnutrition universal screening tool (MUST) is a simple questionnaire that can be used to identify patients at risk of malnutrition. https://www.mdcalc.com/calc/10190/malnutrition-universal-screening-tool-must#use-cases. Routine use of this screening tool can objectively identify patients who are malnourished or at risk of malnutrition.   Using this score, patients who are high risk for malnutrition include : Weight loss > 10% within the preceding 4 weeks Acutely ill patients with history of or anticipated to have no nutritional intake for 5 day BMI< 18.5 If untreated, malnutrition can lead to poorer health outcomes with increased morbidity and significantly reduced quality of life. Studies have shown that patients who are malnourished have higher rates of hospital admission, more complications, longer inpatient stays, and higher mortality. Early identification of malnutrition and subsequent intervention can mitigate poorer health outcomes.

Incorrect! Though the patient is eating 3 times./ day, he is still falling far below his caloric needs. His physical exam findings of temporal wasting and reduced calf muscle thickness indicate loss of fat and muscle stores, which indicate severe malnutrition.