Abstract：
(Protein-energy) malnutrition in individuals living with obesity presents complex diagnostic challenges due to the distinctive physiological characteristics of obesity. This narrative review critically examines the identification of malnutrition within the population with obesity, distinguishing malnutrition in obesity from related conditions such as sarcopenic obesity. While noting some shared features, the review highlights key differences between these conditions. The review also highlights the limitations of current malnutrition screening tools, which are not designed for individuals living with obesity. These tools primarily rely on anthropometric measurements, neglecting (among others) nutrient intake assessment, which hinders accurate malnutrition detection. Additionally, this review discusses limitations in existing diagnostic criteria, including the Global Leadership Initiative on Malnutrition (GLIM) criteria, when applied to individuals living with obesity. Challenges include the identification of appropriate cut-off values for phenotypic criteria (unintentional weight loss, low body mass index and muscle mass) and aetiological criteria such as reduced food intake and inflammation for the population with obesity. Overall, this review emphasises the need for modified screening tools and diagnostic criteria to recognise and assess malnutrition in obesity, leading to improved clinical outcomes and overall wellbeing.
摘要：
由于肥胖的独特生理特征，肥胖患者的（蛋白质能量）营养不良提出了复杂的诊断挑战。这篇叙述性综述严格审查了肥胖人群中营养不良的识别，将营养不良与相关疾病如肌肉减少性肥胖区分开来。虽然注意到一些共享功能，审查强调了这些条件之间的主要区别。审查还强调了当前营养不良筛查工具的局限性，不是为肥胖患者设计的。这些工具主要依靠人体测量，忽略(除其他外)营养素摄入量评估，这阻碍了准确的营养不良检测。此外,这篇综述讨论了现有诊断标准的局限性，包括全球营养不良领导力倡议(GLIM)标准，当应用于肥胖个体时。挑战包括确定表型标准的适当截止值(无意的体重减轻，低体重指数和肌肉质量）和病因标准，例如肥胖人群的食物摄入量减少和炎症。总的来说,这篇综述强调需要改进的筛查工具和诊断标准来识别和评估肥胖中的营养不良。导致改善的临床结果和整体福祉。
