Revamping Malnutrition Assessment in Transplant and Geriatric Populations: A Multifactorial Approach

Retrospective data from a heart transplant cohort in Poland show routine single laboratory markers largely miss malnutrition.

Clinical practice has long leaned on single markers such as albumin, prealbumin, total lymphocyte count and BMI thresholds; these routine laboratory markers frequently misclassify transplant and older patients because inflammation and fluid shifts alter values. In populations with immunosuppression and comorbid inflammatory states, protein redistribution and volume changes can move laboratory values independently of true nutritional decline.

The investigators performed a retrospective analysis of heart transplant recipients and compared nutritional endpoints with diagnostic metrics including albumin, prealbumin, lymphocyte count, total protein and CRP. Across the tested measures, CRP showed correlation with malnutrition risk; most single laboratory tests lacked discrimination in this inflammatory, fluid-shift-prone population.

Acute-phase responses, fluid balance, protein redistribution and immunosuppression can decouple routine biomarkers from true nutritional depletion. A multifactorial approach—combining targeted laboratory data, anthropometrics, clinical history and simple functional measures such as recent weight-loss trajectory and handgrip strength—provides a more accurate assessment, reduces false negatives, and better stratifies risk over time.