Malnutrition severity (ASPEN/Academy 2012 consensus characteristics)
Rule malnutrition version 2026.11-1 · condition: Malnutrition
Published source
Consensus statement: Academy of Nutrition and Dietetics and ASPEN: characteristics recommended for the identification and documentation of adult malnutrition (White JV et al., J Acad Nutr Diet 2012;112:730-738) (2012). Table: clinical characteristics; at least two of six characteristics; acute illness and chronic illness contexts. https://www.andeal.org/files/Docs/White%202012%20Malnutrition%20Consensus%20-%20Table%20Clinical%20Characteristics.pdf · public page checked 2026-11-14
Acute illness, moderate: intake <75% for >7 d; weight loss 1-2%/1 wk, 5%/1 mo, 7.5%/3 mo; mild fat, muscle or fluid; grip N/A. Acute, severe: intake <=50% for >=5 d; >2%/1 wk, >5%/1 mo, >7.5%/3 mo; moderate fat or muscle loss; moderate-severe fluid; grip reduced. Chronic, moderate: intake <75% for >=1 mo; 5%/1 mo, 7.5%/3 mo, 10%/6 mo, 20%/1 y; mild fat, muscle or fluid. Chronic, severe: intake <=75% for >=1 mo; >5, >7.5, >10, >20% over the same periods; severe fat, muscle or fluid; grip reduced.
Also: GLIM criteria for the diagnosis of malnutrition (Cederholm et al., Clin Nutr 2019) (2019). Tables 3-4: one phenotypic + one etiologic criterion; stage 2 (severe) = >10% loss within 6 mo or >20% beyond 6 mo, BMI <18.5 (<70 y) / <20 (>=70 y), severe muscle deficit. link
Contested or local convention. GLIM (2019) is an alternative, internationally endorsed framework with different thresholds; an organization must choose one per policy. This rule encodes ASPEN/Academy 2012 and lists GLIM as the alternative.
Inputs
- nutr_context
- Context from the dietitian assessment ("acute" or "chronic" illness)
- intake_pct
- Energy intake as % of estimated need
- intake_days
- Duration of reduced intake (days)
- wt_loss_pct
- Weight loss (%)
- wt_loss_days
- Period of the weight loss (days)
- fat_loss
- Subcutaneous fat loss (0 none, 1 mild, 2 moderate, 3 severe)
- muscle_loss
- Muscle mass loss (0-3)
- fluid
- Fluid accumulation (0-3)
- grip_reduced
- Grip strength measurably reduced
Thresholds
- t.a_sev_intake_pct
- 50
- t.a_sev_intake_days
- 5
- t.a_mod_intake_pct
- 75
- t.a_mod_intake_days
- 7
- t.c_intake_pct
- 75
- t.c_intake_days
- 30
Derived values
| Name | Expression |
|---|---|
| a_sev_intake | intake_pct <= t.a_sev_intake_pct and intake_days >= t.a_sev_intake_days |
| a_mod_intake | intake_pct < t.a_mod_intake_pct and intake_days > t.a_mod_intake_days |
| a_sev_wt | (wt_loss_days <= 7 and wt_loss_pct > 2) or (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) |
| a_mod_wt | (wt_loss_days <= 7 and wt_loss_pct >= 1) or (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) |
| c_sev_intake | intake_pct <= t.c_intake_pct and intake_days >= t.c_intake_days |
| c_mod_intake | intake_pct < t.c_intake_pct and intake_days >= t.c_intake_days |
| c_sev_wt | (wt_loss_days <= 31 and wt_loss_pct > 5) or (wt_loss_days <= 92 and wt_loss_pct > 7.5) or (wt_loss_days <= 183 and wt_loss_pct > 10) or (wt_loss_days <= 366 and wt_loss_pct > 20) |
| c_mod_wt | (wt_loss_days <= 31 and wt_loss_pct >= 5) or (wt_loss_days <= 92 and wt_loss_pct >= 7.5) or (wt_loss_days <= 183 and wt_loss_pct >= 10) or (wt_loss_days <= 366 and wt_loss_pct >= 20) |
| n_assessed | known(intake_pct, wt_loss_pct, fat_loss, muscle_loss, fluid, grip_reduced) |
| n_severe | case(nutr_context == 'acute', count(a_sev_intake, a_sev_wt, fat_loss >= 2, muscle_loss >= 2, fluid >= 2, grip_reduced), nutr_context == 'chronic', count(c_sev_intake, c_sev_wt, fat_loss >= 3, muscle_loss >= 3, fluid >= 3, grip_reduced), null) |
| n_moderate | case(nutr_context == 'acute', count(a_sev_intake or a_mod_intake, a_sev_wt or a_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), nutr_context == 'chronic', count(c_sev_intake or c_mod_intake, c_sev_wt or c_mod_wt, fat_loss >= 1, muscle_loss >= 1, fluid >= 1, grip_reduced), null) |
Outcomes
| Outcome | When | Status | Supports |
|---|---|---|---|
| severe {n_severe} severe characteristics ({nutr_context} illness context) | n_severe >= 2 | supported | E43 Severe protein-calorie malnutrition ({nutr_context} illness context) |
| moderate {n_moderate} moderate-or-worse characteristics, fewer than two severe ({nutr_context} illness context) | n_moderate >= 2 | supported | E44.0 Moderate (non-severe) protein-calorie malnutrition ({nutr_context} illness context) |
| one_characteristic Only one consensus characteristic documented; two are required | n_moderate == 1 | judgement | — |
| not_met {n_assessed} characteristics assessed and none met | n_moderate == 0 and n_assessed >= 2 | not_supported | — |
ICD-10-CM specificity ladder (FY2026 CC/MCC status as a secondary diagnosis)
- E46 Protein-calorie malnutrition, unspecified · CC
- E44.0 Moderate protein-calorie malnutrition · CC (refines E46)
- E43 Severe protein-calorie malnutrition · MCC (refines E46)
Query topic: nutrition documentation · prompts for an undocumented diagnosis: yes
Where clinical judgement is required
- Physical-exam grades (fat, muscle, fluid) are the dietitian's; the rule counts them only when quoted from the note.
- The social/environmental context is not encoded.