A major problem in nutritional support is identifying patients at risk. Recent studies suggest that these patients can be identified. Which of the following findings identify the patient at risk?

A. Weight loss of greater than 10% over 2 to 4 months.

B. Serum albumin of less than 3 gm. per 100 ml. in the hydrated state.

C. Malnutrition as identified by global assessment.

D. Serum transferrin of less than 220 mg. per 100 ml.

E. Functional impairment by history.

DISCUSSION: All of these are at least partially correct. It is not clear whether weight loss of 10% or 15% is the required threshold, but it certainly is close. Serum albumin of less than 3 gm per 100 ml. remains the most constant identifier of patients at risk in the literature and has been so for years. Global assessment in the hands of an experienced investigator is quite efficacious at identifying persons at risk. Serum transferrin is certainly a confirmatory identifier of patients with malnutrition—and may be even a primary one. Graham Hill and his co-workers have pioneered the concept of global assessment using functional parameters, and in the hands of an experienced observer is quite a reasonable way of approaching and identifying patients at risk.