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Fasting, intermittent or continuous, religious or therapeutic, is knowing a growing craze. Despite few randomized controlled studies, therapeutic fasting is prescribed in various chronic diseases, as diabetes, hypertension and also cancer. Fasting is applied to lose weight in overweight and obese patients. However, weight loss is often associated with fat-free mass loss. Chronic caloric restriction has been associated with longevity in animal studies, while it has been poorly studied in humans to date. Good quality studies are needed to better understand the effects of fasting on health and diseases.Le jeûne volontaire, intermittent ou continu, religieux ou thérapeutique, connaît un engouement grandissant. Malgré la rareté des études randomisées et contrôlées chez l’homme, le jeûne thérapeutique est souvent proposé dans certaines pathologies chroniques, telles que le diabète de type 2, l’hypertension artérielle et le cancer. Il est aussi pratiqué dans le but de maigrir chez les sujets en surpoids ou obèses. Sa pratique n’est pas sans risques. La perte de poids est souvent associée à une perte de masse maigre, facteur de mauvais pronostic. Enfin, alors que la restriction calorique est associée à la longévité dans certaines études animales, ses effets ont été peu étudiés chez l’homme. Des études cliniques de bonne qualité sont nécessaires pour une meilleure évaluation des effets du jeûne sur la santé et lors de maladies.

L’etablissement de directives de type «Choosing Wisely » est un processus dynamique: la Societe Suisse de Medecine Intensive (SSMI) souhaite faire evoluer la medecine intensive vers une approche plus intelligente et integrant le feed-back de ses membres et d’autres societes. Cette lettre est un exemple d’une telle evolution constructive et d’une collaboration entre les societes SSMI et Societe Suisse de Nutrition Clinique (SSNC). La nutrition parenterale (NP) necessite une prescription precise et une adaptation a l’etat du patient: elle peut etre requise tres tot pendant le sejour en soins intensifs. Les avantages et les limites de la NP avant le 4e jour necessitent une evaluation minutieuse.

BACKGROUND & AIMS: This position paper summarizes theoretical and practical aspects of the monitoring of artificial nutrition and metabolism in critically ill patients, thereby completing ESPEN guidelines on intensive care unit (ICU) nutrition. METHODS: Available literature and personal clinical experience on monitoring of nutrition and metabolism was systematically reviewed by the ESPEN group for ICU nutrition guidelines. RESULTS: We did not identify any studies comparing outcomes with monitoring versus not monitoring nutrition therapy. The potential for abnormal values to be associated with harm was clearly recognized. The necessity to create locally adapted standard operating procedures (SOPs) for follow up of enteral and parenteral nutrition is emphasised. Clinical observations, laboratory parameters (including blood glucose, electrolytes, triglycerides, liver tests), and monitoring of energy expenditure and body composition are addressed, focusing on prevention, and early detection of nutrition-related complications. CONCLUSION: Understanding and defining risks and developing local SOPs are critical to reduce specific risks. ispartof: CLINICAL NUTRITION vol:38 issue:2 pages:584-593 ispartof: location:England status: published

Fasting, intermittent or continuous, religious or therapeutic, is knowing a growing craze. Despite few randomized controlled studies, therapeutic fasting is prescribed in various chronic diseases, as diabetes, hypertension and also cancer. Fasting is applied to lose weight in overweight and obese patients. However, weight loss is often associated with fat-free mass loss. Chronic caloric restriction has been associated with longevity in animal studies, while it has been poorly studied in humans to date. Good quality studies are needed to better understand the effects of fasting on health and diseases.

Undernutrition represents a wide-spread clinical state in outpatients and inpatients. It is associated with a high morbidity and mortality, an impaired quality of life, and increased healthcare costs. Early diagnosis and treatement help to reduce these medical and economic consequences. Oral nutritive supplements (ONS) are simple, effective and economic medical treatments to fight against undernutrition. However, they are insufficiently used for outpatients because of lack of knowledge. This article reviews the impact of ONS, their indications and contraindications and their modalities of prescription and focuses especially on community-dwelling patients.La dénutrition est un état clinique répandu chez les personnes hospitalisées et ambulatoires. Elle augmente la morbi-mortalité, les coûts et diminue la qualité de vie. Un diagnostic et une prise en charge précoces permettent de diminuer ses conséquences médico-économiques. Les suppléments nutritifs oraux (SNO) sont un traitement médical simple, efficace et économique pour lutter contre la dénutrition. Ils sont peu utilisés chez les patients ambulatoires, car méconnus. Cet article précise l’impact des SNO, les indications et les contre-indications, et les modalités de prescription, en se focalisant sur les patients ambulatoires.

Summary Introduction The international ICALIC initiative aims at developing a new indirect calorimeter according to the needs of the clinicians and researchers in the field of clinical nutrition and metabolism. The project initially focuses on validating the calorimeter for use in mechanically ventilated acutely ill adult patient. However, standard methods to validate the accuracy of calorimeters have not yet been established. This paper describes the procedures for the in-vitro tests to validate the accuracy of the new indirect calorimeter, and defines the ranges for the parameters to be evaluated in each test to optimize the validation for clinical and research calorimetry measurements. Methods Two in-vitro tests have been defined to validate the accuracy of the gas analyzers and the overall function of the new calorimeter. 1) Gas composition analysis allows validating the accuracy of O2 and CO2 analyzers. Reference gas of known O2 (or CO2) concentration is diluted by pure nitrogen gas to achieve predefined O2 (or CO2) concentration, to be measured by the indirect calorimeter. O2 and CO2 concentrations to be tested were determined according to their expected ranges of concentrations during calorimetry measurements. 2) Gas exchange simulator analysis validates O2 consumption (VO2) and CO2 production (VCO2) measurements. CO2 gas injection into artificial breath gas provided by the mechanical ventilator simulates VCO2. Resulting dilution of O2 concentration in the expiratory air is analyzed by the calorimeter as VO2. CO2 gas of identical concentration to the fraction of inspired O2 (FiO2) is used to simulate identical VO2 and VCO2. Indirect calorimetry results from publications were analyzed to determine the VO2 and VCO2 values to be tested for the validation. Results O2 concentration in respiratory air is highest at inspiration, and can decrease to 15% during expiration. CO2 concentration can be as high as 5% in expired air. To validate analyzers for measurements of FiO2 up to 70%, ranges of O2 and CO2 concentrations to be tested were defined as 15–70% and 0.5–5.0%, respectively. The mean VO2 in 426 adult mechanically ventilated patients was 270 ml/min, with 2 standard deviation (SD) ranges of 150–391 ml/min. Thus, VO2 and VCO2 to be simulated for the validation were defined as 150, 250, and 400 ml/min. Conclusion The procedures for the in-vitro tests of the new indirect calorimeter and the ranges for the parameters to be evaluated in each test have been defined to optimize the validation of accuracy for clinical and research indirect calorimetry measurements. The combined methods will be used to validate the accuracy of the new indirect calorimeter developed by the ICALIC initiative, and should become the standard method to validate the accuracy of any future indirect calorimeters.

Aims of the study Patients with an acute or chronically negative nutritional balance are at nutritional risk. Oral nutritional supplements (ONS) are simple and effective medical treatments of nutritional risk. In the ambulatory setting, in Switzerland, ONS are reimbursed by public insurance under conditions defined by Swiss Society for Clinical Nutrition. The reimbursement requires a medical prescription for ONS and their delivery at the patient's home by a homecare service. The indication for the ONS, defined as a Nutritional Risk Screening-2002 (NRS-2002) score ≥3, must also be present. This survey aimed to document: (i) the existence of a medical prescription for ONS during hospitalisation and discharge for home, (ii) the adequacy of the indication for ONS during hospitalisation and at discharge for home, and (iii) the continuation or not of ONS treatment 1 month after discharge for home. Methods This prospective survey included adult patients hospitalised in the departments of surgery, medicine or rehabilitation and who were about to receive ONS for the first time. Patients already on ONS, with major consciousness disorders, who refused to take ONS or to participate to the survey were excluded. The existence of a medical prescription for ONS and the adequacy of the indication (Nutritional Risk Screening-2002 [NRS-2002] score ≥3) were evaluated at first ONS delivery and at hospital discharge. At home, the continuation of ONS consumption was evaluated by the homecare service 1 month after discharge. Results are presented as mean ± standard deviation or frequencies and percentages, and comparisons between patients with and without ONS at discharge for home. Results A total of 416 patients (age 71.7 ± 14.1 yr, 52.6% male, body mass index 23.6 ± 5.2 kg/m2) were included. At the first delivery of ONS, 44.5% (n = 185) of patients had no medical prescription for the supplements, and 82.7% (n = 344) had an NRS-2002 score ≥3. Out of 207 patients discharged for home, only 24.2% (n = 50) had an adequate homecare ONS prescription and 68% (n = 141) had a NRS-2002 score ≥3. One month after discharge for home, 76% (n = 29) were still taking ONS. Conclusions In our survey, only few patients receiving ONS during the hospital stay had a medical prescription for ONS during the hospitalisation and at discharge for home. For most patients receiving ONS during hospitalisation and at discharge for home, an NRS-2002 score of ≥3 was present. If a medical prescription was provided, ONS were generally continued one month after discharge for home. Clinical trial registration number NCT02476110.

National audience; L’insuffisance respiratoire chronique obstructive secondaire à la broncho-pneumopathie chronique obstructive (BPCO) combine les effets délétères de l’hypoxie chronique, l’inflammation chronique, l’insulinorésistance, l’augmentation de la dépense énergétique, la fonte musculaire, et le déconditionnement à l’exercice. Comme pour d’autres maladies chroniques, la perte de masse non grasse diminue la survie. Préserver la masse et la fonction musculaires en maintenant le métabolisme mitochondrial oxydatif est un point clé de la prise en charge du patient BPCO. Du fait du vieillissement de la population, de l’augmentation de prévalence de la BPCO et du progrès médical, les années futures vont connaître l’augmentation de la prévalence de la dénutrition chez les patients BPCO. L’androgénopénie, ou l’hypogonadisme, définie par une testostéronémie libre inférieure à 50 pg/mL, est observée chez 40 % des patients BPCO. Comme les androgènes stimulent l’anabolisme musculaire, l’androgénopénie s’associe à une fonte musculaire. Des études, dont une récente méta-analyse, indiquent que l’androgénothérapie pouvait augmenter l’indice de masse corporelle et la masse non grasse, ainsi que la qualité de vie des patients BPCO, mais, seule, était insuffisante pour améliorer la fonction respiratoire. Deux essais randomisés multicentriques ont démontré que l’association androgénothérapie–exercice physique–compléments nutritionnels oraux contenant des acides gras poly-insaturés oméga-3, pendant au moins trois mois, diminuait la morbi-mortalité. Ce traitement multimodal est optimisé dans le cadre de la réhabilitation respiratoire, qui est le traitement de référence de la dénutrition du patient BPCO. / Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to augmentation in future decades. Androgenopenia, or hypogonadism, defined by free testosterone plasma concentrations below 50 pg/mL, is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies, including one recent meta-analysis, indicate that androgen substitution could improve body mass index and fat-free mass as well as quality of life in COPD patients, but, alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids in the context of pulmonary rehabilitation, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation, which is the reference therapy of COPD-associated undernutrition

Non celiac gluten sensitivity may explain digestive and general symptoms in patients without celiac disease but this recently described entity is controversial. The role of gluten in comparison to other nutriments such as saccharides and polyols (FODMAPs) remains debated. If a gluten-free diet is clearly indicated in celiac disease and wheat allergy, it remains debatable in non-celiac gluten sensitivity given weak and contradictory evidence. There is no strong evidence for a strict indication to a gluten-free diet in endocrinological, psychiatric, and rheumatologic diseases, or to improve performance in elite sports.

This review aims to highlight the synergies between clinical nutrition, body composition and cancer treatment. Body composition is already a powerful tool to diagnose cachexia and determine response to nutritionnal intervention. It may be used in the future to fine tune body surface area (BSA) based drug dose determination thanks to its capacity to predict chemotoxicity. The overall aim of nutritionnal intervention is to optimize the oncological care by reducing treatment interruptions and improving the quality of life. However, to achieve this goal, nutritionnal intervention has to be very accurate as most of the failures result from inappropriate intervention.

Epidemiological studies have shown that vitamin or trace-element deficiencies are frequent in the general population. Food intake can be incriminated, but various drugs may also precipitate micronutrient deficits. Indeed, the consequences of pharmacotherapy on micronutrients are yet modestly explored in clinical practice settings. We aim at sensitizing physicians on the impact of frequently used drugs on vitamins and trace-elements. High risk populations for micronutrient deficiencies and indications for substitution are discussed.

Progresses in cancer treatment transformed cancer into a chronic disease associated with growing nutritional problems. Poor nutritional status of cancer patients worsens morbidity, mortality, overall cost of care and decreases patients' quality of life, oncologic treatments tolerance and efficacy. These adverse effects lead to treatment modifications or interruptions, reducing the chances to control or cure cancer. Implementation of an interdisciplinary and longitudinal integration of nutritional care and nutritional information into cancer treatment (The OncoNut Program) could prevent or treat poor nutritional status and its adversely side effects.

Le risque de denutrition est eleve en reanimation. Ce risque va s’accroitre dans les annees futures en raison du vieillissement de la population et de l’augmentation de la prevalence de l’obesite, des maladies chroniques et du cancer, situations a haut risque de perte de masse maigre (MM). L’evaluation clinicobiologique de l’etat nutritionnel est insuffisante pour estimer la perte de MM. Le deficit energetique, conduisant a la perte de MM, est correle au pronostic et a l’evolution clinique durant le sejour en reanimation et a des consequences sur la fonction musculaire et la qualite de vie du patient a la sortie. L’evaluation de la composition corporelle devrait donc etre integree a la pratique clinique dans le cadre d’une prise en charge nutritionnelle precoce et optimisee. En raison de sa simplicite, de sa reproductibilite et de son faible cout, l’impedancemetrie corporelle bioelectrique (ICB) apparait comme la methode de choix. L’ICB permet de calculer l’angle de phase, qui est directement associe au pronostic du patient. Etant donne la perte importante deMMdurant le sejour en reanimation, les fluctuations hydriques inferieures a ± 2 kg n’empecheraient pas d’identifier cette perte. L’ICB pourrait etre utilisee comme methode de mesure des variations hydriques. La composition corporelle peut aussi etre evaluee de maniere fiable par la tomodensitometrie (TDM). La mesure reguliere de la MM en reanimation devrait permettre d’optimiser la prise en charge nutritionnelle et, secondairement, de reduire les complications et les couts lies a la denutrition, ainsi que d’ameliorer la qualite de vie.

The links between nutrition and cancer onset are now well established by epidemiological studies. The scientific evidence is presented in a report of the World Cancer Research Foundation (WCRF). Protective factors towards overall cancer risk are fruit and vegetable consumption and physical activity. Overweight and obesity, intakes of alcoholic beverage, fat, salt, high temperature cooked and processed red meat, increase cancer risk. In addition, beta-carotene systematic supplementation could increase lung cancer risk in smokers. As optimal controlling of these risk factors can decrease cancer mortality by 25%, nutritional counselling must be integrated in the global strategy of primary and secondary prevention of cancers.

Undernutrition is a widespread problem in the intensive care and is associated with a worse clinical outcome. Enteral nutrition is the recommended nutritional support in ICU patients. However, enteral nutrition is frequently insufficient to cover protein-energy needs. The initiation of supplemental parenteral nutrition, when enteral nutrition is insufficient, could optimize the nutritional therapy. Such a combination could allow reducing morbidity, length of stay and recovery, as well as improving quality of life and health care costs. Prospective studies are currently underway to test this hypothesis.

Dysphagia is very frequent in hospitals and the geriatric population. It leads to serious physical and psychological consequences such as aspiration, lung infection, progressive undernutrition which all impair the quality of life and the survival. Early diagnosis and appropriate treatment of dysphagia are therefore essential to avoid or minimize these complications which increase the length of hospital stay and cost. This review describes the symptoms and the clinical approach of dysphagia. The importance of informing and sensitizing all the health care providers to this pathology is highlighted. It also emphazised the need of an interdisciplinary management of dysphagia, including the dietetic approach.

The subjective global assessment (SGA) defines nutritional and functional status of patients with the aim of identifying who could benefit from a nutritional intervention. The SGA was designed to evaluate the nutritional risk of infectious complications among the surgical patients. Later on, it became largely utilized to evaluate the nutritional status of other groups of patients, because it is reliable and easy to use. However, it is important to verify that the SGA is an adequate test also in other clinical situations. This review analyses recent literature regarding the actual utilization of the SGA in clinical situations frequently associated to malnutrition: kidney diseases, AIDS, cancer, aging. The reproducibility of SGA depends on the experience of the caregiver administering it. Its validation compared to more objective parameters like visceral proteins or body composition is not always obvious. In several studies the SGA does not seem enough sensitive to detect a beginning of malnutrition. Its specificity and predictive validity were demonstrated in all of the clinical situations analyzed. In conclusion, the SGA is a tool adequate to identify patients with a nutritional risk and who would benefit of a nutritional intervention aiming at preventing associated complications.

The deleterious consequences of hospital malnutrition are progressively being recognized by the public. The Committee of the Ministers of the European Council has released a resolution for food and nutrition and ask the state members to apply national recommendations in their hospitals. The evaluated domains and actions to be undertaken are based on 4 elements: Access to a healthy and varied food supply is a fundamental human right; a high number of patients hospitalized in Europe are malnourished (30-60%); the demonstration that malnutrition of hospitalized patients increases length of hospital stay and medical costs; the demonstrated beneficial effects of a hospital food service and of optimal nutritional care on morbidity, healing and quality of life. The resolution indicates clearly the options to be followed to optimize the actions and decisions at three levels: patient care, support services, and administration. All caregivers must be involved in the implementation of the recommendations in a way to adapt them to the local needs and restrictions. This review summarizes the actions to be taken by medical and other caregivers in order to sensitize them to the above-mentioned problems and to initiate practical options to treat malnourished patients or patients at risk of becoming malnourished.

MUST (Malnutrition Universal Screening Tool) is a nutritional screening tool easy to use by any trained care-giver and valid for any adult patient. It considers body mass index, weight change and acute disease effect equally and determines a malnutrition risk score. If necessary, anthropometric measures may be simpliyfied by alternative methods. MUST is reliable between different healthcare settings et promotes detection and management of malnutrition during the patient medical course.

The effect of oxygen in modulating metabolism has been largely investigated in vitro and in animal studies, but very little in humans. Body weight loss and muscle fatigability is a common finding in chronic obstructive pulmonary diseases, often difficult to reverse despite an optimal nutritional intake. The aim of this paper is to review recent literature regarding pathological and physiological situations characterized by hypoxia exposure, particularly chronic obstructive pulmonary diseases and high altitude staying.

Nutritional status has a prognostic value in the clinical evolution of patients who are malnourished, are becoming malnourished or are in process of being rehabilitated. The evaluation of nutritional status is based on a comprehensive approach, and includes body composition measurement by bio-impedance analysis (BIA). BIA determines the quantity of body fat-free and fat mass and has a precision around 4%. The reliability of BIA depends on the use of body composition prediction equations that are adapted to the subjects studied and on the inclusion of various anthropometric parameters (weight, height, sex, age, race, etc). BIA remains imprecise in the presence of abnormal distribution of body compartments (ascites, dialysis, lipodystrophy) or of extreme weights (cachexia, severe obesity). Multi-frequency or segmental BIA were developed to overcome hydration abnormalities and variations in body geometry. However, these techniques require further validation. This review discusses the indications and limitations of BIA.

A patient's nutritional support is a critical part of his general health care scheme. It aims to prevent or correct malnutrition, reduce morbidity, length of hospital stay and treatment costs. It equally optimises the patient's convalescence and quality of life. An optimal support requires the nutritional evaluation of the patient which includes determination of the energy expenditure. Once the energy needs have been evaluated, the clinician is then able to treat any nutritional deficiencies. This article therefore looks at the different methods available for predicting and measuring energy expenditure. The clinical limitations of these techniques and particular cases encountered (intensive care unit, anorexia and severe obesity, geriatrics, HIV infection, etc) will also be discussed.

Malnutrition is very frequent in hospitalized patients, particularly if they are elderly and suffer of chronic diseases. Many studies show the correlation between the degree of malnutrition and the frequency of complications, the length of hospital stay and the rate of mortality. However, despite the rising interest of scientists for the role of nutrition in the pathogenesis of the diseases, little attention is devoted to the nutritional status of patients. This article reviews the recent literature regarding hospital malnutrition. At hospital admission, 30 to 40% of patients presents a certain degree of malnutrition. However, only a small percentage is recognized to be malnourished and receive an adequate treatment. The reason for this attitude of medical and paramedical teams seems to be a low priority assigned to nutrition. In addition, they seem to lack the most basic knowledge regarding the metabolic needs of their patients. Another finding, reported by several surveys, is that a large portion of hospital food is not consumed by the patients but is wasted. In fact, meals are not sufficiently-adapted to the taste and the appetite of those for whom they are prepared. This article summarizes the recommendation of the Europe Council regarding the nutritional evaluation and treatment of patients.

Nutritional support of cancer patients should ideally contribute to improve the immune defence, maintain the protein body pool and sensitize the tumour to oncologic treatments. Such a goal is not easy to achieve, because any nutritional support efficient at stimulating immune response and protein syntheses might also simultaneously stimulate the tumour growth. Contradictory observations have been reported for several nutrients contained in the nutritive solutions available on the market. This is the case for glutamine, arginine, omega-3 fatty acids and nucleotides. Their clinical use during oncologic therapies deserves further testing and analysis.

Total parenteral nutrition (TPN) requires the perfusion of more than 40 compounds (glucose, amino acids, lipids, electrolytes, vitamins and trace elements). Many systems of application are used. With the help of pharmacists, the current types of products and methods of TPN administration, as well as the evolution of TPN practice were evaluated in the Swiss hospitals during three consecutive years. Six different TPN systems are commonly used for adult patients. All lead to the administration of TPN in "all-in-one" admixtures. For adults, formula compounding is provided in large hospitals only. For pediatric TPN, formula compounding is routinely performed in the hospitals because individualized compositions are not available commercially. Regarding TPN-admixtures outpatients, they are mostly compounded in hospital pharmacies and delivered by 3 large hospitals. Compositions of TPN formula comply, on average, with European guidelines. An increased number of multidisciplinary nutritional support teams is still necessary to optimize the medical and economical management of TPN.

Some nutrients, such as glutamine, arginine, omega-3 fatty acids and nucleotides have been shown to modulate the immune and intestinal systems. They affect the synthesis of proteins and the expression of enzymes, as well as the activation and the proliferation of leukocytes and enterocytes. Since these immunonutrients modulate the response of tissues with rapid cell turnover, such as spleen, thymus, bone marrow and intestinal mucosa, they may also affect, such as suggested by some preliminary results, cancer cell proliferation and tumour growth. Therefore, further investigations are needed to understand the underlying mechanisms and to determine possible advantages and limitations of their administration to cancer patients.

Short space flights affect nutritional intakes, body composition and functional parameters. Prolonged space flights (SF) over weeks or months further worsen these alterations and result in acute or chronic physical deterioration at earth return. Current planning of SF to Mars, with microgravity conditions for more than 2 years, stresses the need for developing and optimising a nutritional program and physical countermeasures to prevent body mass atrophy and functional body alterations. This review presents the models of microgravity simulation on earth and the main effects of weightlessness on body composition, protein metabolism, hormonal profile and muscle function. It summarizes contradictory findings related to the oxidative stress related to SF. It discusses potential countermeasures (nutrition, physical activity) to the negative effects of microgravity on human body. Future research possibilities in ground and space medicine are evoked.

Weight and body mass index are used in clinical routine to detect malnourished patients. However, a study performed at the emergency admission of the University Hospital of Geneva shows that the prevalence of malnutrition is very underestimated when based on body mass index instead of fat-free mass. Indeed, a third of the patients with normal body mass index, i.e. between 20 and 24.9 kg/m2, present a fat-free mass under percentile 10. This suggests that the body mass index alone cannot be used as diagnostic criteria for malnutrition. This review describes the prevalence of malnutrition at the emergency admission of the University Hospital of Geneva, the prevalence of malnutrition in the literature and its relationship with length of hospital stay and mortality.