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Clinical depletion Deficit of nutrients in the clinical situation is only in some cases (for example anorexia nervosa) the only cause of malnutrition. Weight loss is caused by the catabolic influence of the disease, the decrease of fat free mass, also when there is no negative energy balance (van Leeuwen, 2000). Malnutrition Malnutrition is often defined as short on nutrients leading to a diminished biological function. In this definition there is the assumption of an inadequate nutritional intake. No attention is paid to the effect of the disease-process on the nutritional status of the patient. In patients not only the food influences the nutritional status, but also the disease.The nutritional status influences the patient’s reaction to the disease.
Clinical depletion Another word for malnutrition by disease is ‘clinical depletion’. Chronic and acute malnutrition A difference must be made between chronic and acute malnutrition. The chronic form may occur in patients prior to hospitalisation as a result of disease or medical conditions that lead to low energy and protein intake and poor food choices. During hospitalisation the acute form may occur as a result of reduced or absent food intake due to illness, drug therapy or depression. Moreover, the acute form may also occur from increased energy expenditure in hypermetabolic states such as trauma or surgery (Konstantinides 1998).
Nutritional assessment Nutritional Assessment is required as an integral part of patient care. At this moment there is not enough awareness to this issue. However there is a broad range of parameters to evaluate nutritional status, no golden standard is found yet. Nutritional status affects every patient’s response to illness. (Ravasco, 2002). Malnutrition or depletion? Malnutrition caused by lack of intake shows Marasmus signs (Right). The person is thin. When disease plays a part you often see Kwasiorkor, weight loss is being masked by fluid retention in the body (Left).  Literature and further reading:
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