In some elderly persons, Helicobacter pylori infections have been associated with severe anorexia and weight loss. Malabsorption syndromes, particularly late onset of celiac disease and pancreatic insufficiency, should also be considered. Cholelithiasis can result in early satiation and weight loss. The Specific Global Assessment of nutritional status has been validated for use in hospitalized patients with gastrointestinal disorders but requires further validation for determining malnutrition among elderly persons. The Nutrition Screening Index was developed to identify elderly persons at risk of nutritional problems but has poor specificity and sensitivity.
Weight loss is the single best factor for predicting persons at risk of malnutrition.
Skinfold thickness measurements have little diagnostic value. Albumin is an excellent measure of protein status. Acute illness associated with cytokine release can also lower cholesterol levels. The combination of anergy and signs of malnutrition correlates more strongly with a poor outcome than does either one alone. In persons with kwashiorkor, anergy and edema are often present.