At which body mass index and degree of weight loss should hospitalized elderly patients be considered at nutritional risk?

The Subjective Global Assessment, the Nutrition Risk Score and a Danish counterpart are simple screening methods to detect patients at risk of nutrition-related complications. The cut-off points used in the screening are a body mass index (BMI) less than 20 kg/m2 (18.5 kg/m2 in the Danish version) and weight loss more than 5% during the last 1–6 months — regardless of age. This review of the literature indicates that the optimal range of BMI for elderly people is increasing from 20 to 25 kg/m2 to 24–29 kg/m2. It also suggests that a clinically significant weight loss for the elderly is around 5% annually, less than in younger age groups. And finally, even though intervention studies have shown an overall positive effect of nutritional support of the elderly patients, there seems to be a high percentage of the old, especially those initially malnourished, who will not benefit from the support. The conclusion is that other cut-off points should be used for the elderly (65+ years) patients, i.e. BMI less than 24 kg/m2 or any degree of weight loss. This means that nutritional support will be initiated in time to reduce the nutrition related complications.