L’évaluation nutritionnelle chez le sujet âgé en 2008

Malnutrition is frequent in elderly patients and results from multifactorial mechanisms, including age-related metabolic alterations, reduction of food intake and intercurrent diseases, especially inflammatory processes, that compromise nutritional status. Nutritional evaluation must be systematically and repeatedly performed and based primarily on clinical parameters such as weight, body mass index, weight loss, anthropometric measurements and dietetic history eventually combined in scores such as the mini-nutritional assessment (MNA). Fat-free mass evaluated by bioimpedance analysis has a prognostic value. Hypoalbuminemia is indicative of bad prognosis and may be combined with weight loss in the geriatric nutritional risk index (GNRI) to assess the nutritional risk. The determination of plasma transthyretin (prealbumin) is especially useful to assess acute malnutrition state and the response to nutritional support. Routine determination of the above criteria may be facilitated by the spreading of simple integrated tools and a better education of health professionals to the screening and active treatment of malnutrition in the elderly.