Severe Malnutrition in the Context of Acute Disease or Injury Severe malnutrition related to inadequate protein-energy intake via parenteral nutrition infusion in the setting of acute disease or injury (status post small bowel resection) as evidenced by parenteral nutrition meeting <50% of estimated energy needs for ≥5 days; moderate muscle wasting (temporalis, pectoralis, deltoids, trape zius, supraspinatus, infraspinatus) and moderate subcutaneous fat loss (orbital fat pads, buccal fat pads); severe fluid accumulation in lower extremities (bilateral 3+ edema).


Severe Malnutrition in the Context of Chronic Disease or Condition Severe malnutrition related to inadequate protein-energy intake with increased protein-energy needs in setting of chronic disease or condition (chemo-xrt treatment for stage 3 lung cancer) as evidenced by minimal oral intake for >1-2 months; significant weight loss of 8% (12 lb) in 3 months; severe subcutaneous fat loss (orbital fat pads, triceps, ribs, iliac crest) and muscle wasting (temporalis, pectoralis, trapezius, deltoids, interosseous, quad riceps); 3+ edema at ankles; reduced hand grip strength.


Severe Malnutrition in the Context of Social or Environmental Circumstances Severe malnutrition related to inadequate protein intake and lack of nutrient-dense foods with excessive ETOH intake in the setting of starvation as evidenced by intake of ≤75% of estimated protein needs ≥1 month (consumption of 7 beers per day with 1 meal and chips); significant weight loss of 12.5% (20 lb) in 6 months; severe muscle wasting (temporalis, pectoralis, deltoids, trapezius) and severe subcutaneous fat loss (orbital fat pads, triceps, ribs); and measurably reduced hand grip strength.


Abbreviations: ADLs=activities of daily living; chemo-xrt=chemotherapy-radiation therapy; EER=estimated energy requirement; ESKD=end-stage kidney disease; ETOH= alcohol; HD=hemodialysis; PES=problem, etiology, signs/symptoms


PES STATEMENT EXAMPLES PEDIATRIC MALNUTRITION INDICATORS 4


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