Malnutrition is at its most basic level any nutritional imbalance. While it can be overnutrition, such as being overweight, obese, or morbidly obese, providers more commonly equate malnutrition with undernutrition, which is a continuum of inadequate intake, impaired absorption, altered transport, and altered nutrient utilization.
Before 2012, no standard criteria existed for adult or pediatric malnutrition. Providers often equated low serum albumin or prealbumin with malnutrition, even if there was no weight loss or dietary invention. As a result, the Baltimore U.S. Attorney launched fraud and abuse investigations against Johns Hopkins Bayview, Good Samaritan Hospital, and Kernan Hospital, all in Baltimore, within the past five years.
Malnutrition is also underdiagnosed, given the lack of physician knowledge of standardized criteria and a dependence on the serum albumin or prealbumin as a clinical indicator, according to James S. Kennedy, MD, CCS, president of CDIMD in Smyrna, Tennessee.
The landscape changed dramatically in 2012 with the release of a consensus statement by The American Academy of Nutrition and Dietetics (the Academy) and the American Society for Parental and Enteral Nutrition (ASPEN) standardizing the criteria for adult malnutrition.