Look for medical or surgical conditions or chronic disease that can place one at nutritional risk secondary to increased requirements, or compromised intake or assimilation like: critical illness, severe burns, major abdominal surgery, multi-trauma, closed head injury, previous gastrointestinal surgery, severe gastrointestinal hemorrhage, enterocutaneous fistula, gastrointestinal obstruction, mesenteric ischemia, severe acute pancreatitis, chronic pancreatitis, inflammatory bowel disease, celiac disease, bacterial overgrowth, solid or hematologic malignancy, bone marrow transplant, acquired immune deficiency syndrome, and organ failure/transplant-kidney, liver, heart, lung, or gut.

A number of conditions or diseases are characterized by severe acute inflammatory response including critical illness, major infection/sepsis, adult respiratory distress syndrome, systemic inflammatory response syndrome, severe burns, major abdominal surgery, multi-trauma, and closed head injury.

Many conditions or diseases are more typically associated with mild to moderate chronic inflammatory response. Examples include cardiovascular disease, congestive heart failure, cystic fibrosis, inflammatory bowel disease, celiac disease, chronic pancreatitis, rheumatoid arthritis, solid tumors, hematologic malignancies, sarcopenic obesity, diabetes mellitus, metabolic syndrome, cerebrovascular accident, neuromuscular disease, dementia, organ failure/transplant-kidney, liver, heart, lung, or gut, periodontal disease, pressure wounds, and chronic obstructive pulmonary disease. Note that acute exacerbations, infections, or other complications may superimpose acute inflammatory response on such conditions or diseases.

Examples of starvation-associated conditions that generally have little or no inflammatory component include anorexia nervosa or compromised intake in the setting of major depression.

Look for dietary practices including therapeutic, weight reduction, vegetarian, macrobiotic, and fad diets. Also record use of dietary supplements, including vitamins, minerals, and herbals. Ask about dietary intake. Recall, record, and food frequency tools are available.

It is estimated that ≥50% of adults take dietary supplements.

BMI = weight in kg/(height in meters)²

BMI <18.5 kg/m² proposed screen for malnutrition per National Institutes of Health guidelines. BMI ≤15 kg/m² is associated with increased mortality. Comparison with ideal body weight for stature can also be determined from reference tables. Note hydration status and edema at the time body weight is determined.

Look for loss of muscle mass and subcutaneous fat.

Temporal and neck muscle wasting may be readily observed. Anthropometrics including skin-folds and circumferences can be useful but require training to achieve reliability.

Hair findings are indicative of certain nutrient deficiencies.

Loss: protein, B₁₂, folate

Brittle: biotin

Color change: zinc

Dry: vitamins A and E

Easy pluckability: protein, biotin, zinc

Coiled, corkscrew: vitamins A and C

Alopecia is common in severely malnourished persons.

Ask about excessive hair loss on pillow or when combing hair.

Skin findings are indicative of certain nutrient deficiencies.

Desquammation: riboflavin

Petechiae: vitamins A and C

Perifollicular hemorrhage: vitamin C

Ecchymosis: vitamins C and K

Xerosis, bran-like desquamation: essential fatty acid

Pigmentation, cracking, crusting: niacin

Acneiform lesions, follicular keratosis, xerosis: vitamin A

Acro-orificial dermatitis, erythematous, vesiculbullous, and pustular: zinc

Characteristic nutritional dermatitis and skin findings may be observed with a number of nutrient deficiencies. Wounds and pressure sores should also be noted as indicators of compromised nutritional status.

Ocular findings are indicative of certain nutrient deficiencies.

Bitot's spots: vitamin A

Xerosis: vitamin A

Angular palpebritis: riboflavin

Also ask about difficulties with night vision/night blindness; indicates vitamin A deficiency.

Perioral findings are indicative of certain nutrient deficiencies.

Angular stomatitis and cheilosis: B complex, iron, and protein

Glossitis: niacin, folate, and vitamin B₁₂

Magenta tongue: riboflavin

Bleeding gums, gingivitis, tooth loss: vitamin C

Angular stomatitis, cheilosis, and glossitis are associated with vitamin and mineral deficiencies. Note poor dentition, caries, and tooth loss. Difficulty swallowing and impairment of gag should also be recognized.

Extremity findings indicate certain nutrient deficiencies.

Arthralgia: vitamin C

Calf pain: thiamine

Extremities may also exhibit loss of muscle mass and/or peripheral edema. Neurological findings in the extremities may also result from deficiencies described below.

Mental and nervous system findings indicate certain nutrient deficiencies.

Ophthalmoplegia and foot drop: thiamine

Paresthesia: thiamine, vitamin B₁₂, and biotin

Depressed vibratory and position senses: vitamin B₁₂

Anxiety, depression, and hallucinations: niacin

Memory disturbance: vitamin B₁₂

Hyporeflexia, loss of lower extremity deep tendon reflexes: thiamine and vitamin B₁₂

Conduct formal cognitive and depression assessments as appropriate. Dementia and depression are common causes of malnutrition among older persons. Wernicke-Korsakoff syndrome may be observed with severe thiamine deficiency.