Muscle loss: The new malnutrition challenge in clinical practice.

Recent definitions of malnutrition include low muscle mass within its diagnostic criteria. In fact, malnutrition is one of the main risk factors of skeletal muscle loss contributing to the onset of sarcopenia. However, differences in the screening and diagnosis of skeletal muscle loss, especially as a result of malnutrition in clinical and community settings, still occur mainly as techniques and thresholds used vary in clinical practice.

The objectives of this position paper are firstly to emphasize the link between skeletal muscle loss and malnutrition-related conditions and secondly to raise awareness for the timely identification of loss of skeletal muscle mass and function in high risk populations. Thirdly to recognize the need to implement appropriate nutritional strategies for prevention and treatment of skeletal muscle loss and malnutrition across the healthcare continuum. Malnutrition needs to be addressed clinically as a muscle-related disorder and clinicians should integrate nutritional assessment with muscle mass measurements for optimal evaluation of these two interrelated entities to tailor interventions appropriately.

The design of monitoring/evaluation and discharge plans need to include multimodal interventions with nutrition and physical exercise that are key to preserve patient's muscle mass and function in clinical and community settings. Skeletal muscle loss is one of the main features of malnutrition in community dwelling and hospitalized patients and dramatically impacts on their need for care and quality of life. Early identification of malnutrition in high risk populations is essential, yet current tools to screen/diagnose malnutrition based on measures of body weight do not reflect skeletal muscle loss. Malnutrition needs to be addressed as a muscle-related disorder across the continuum of care in clinical practice. Early intervention is key to prevent or minimise loss of muscle mass and function. Multimodal interventions including nutrition and exercise need to be implemented to counteract malnutrition related skeletal muscle loss. High protein, vitamin D and other key nutrients, leucine or its active metabolite, HMB, are all valuable approaches to restore muscle anabolism and combat malnutrition in hospital, and in community health and care settings.

Monitoring and discharge plans are important to ensure continuity of nutritional care between settings, and to ensure patients receive optimal treatment for the right duration of time to support muscle mass and functional recovery. Malnutrition needs to be addressed as a muscle-related disorder across the continuum of care in clinical practice. Some key messages are provided to tailor appropriate interventions.