The diagnosis of protein malnutrition can be made when the serum albumin level is less than 2.8g/dl. Many of these patients have a 20% weight loss during the preceding 3 months, or they have a reduced ideal body weight (<90% for height). Patients at high risk for the development of malnutrition are those who are unlikely to ingest a minimum of 1500 kcal by day 5.
There are currently only three studies that support the importance of energy intake in malnourished patients. Elderly hospitalized patients who consume less than 50% of their estimated maintenance caloric requirement have an 8-fold increase in hospital mortality (11.8 vs 1.5%). This suggests that an intake of less than 1000 kcal may not be helpful. In a prospective study providing approximately 400 additional calories as 'sip feeds,' reduced mortality was seen in severely malnourished (body mass index <5th percentile), medically ill elderly patients. In this study, patients were randomized to receive 120 ml of enteral supplements provided by the registered nurse three times per day or provided no additional sip feeds. Patients who received the sip feeds had a significantly better energy intake (1409 kcal) than nonsupplemented patients (1090 kcal), and they had an increased overall weight gain compared with a loss in the controls. Patients in the severely undernourished group who received intervention had a significant reduction in mortality compared to controls (15 vs 35%, p < 0.05). The less malnourished or normals did not demonstrate the same benefit. In the third study, patients with less than 25% of recommended calorie intake (<600 kcal) had a 3.7-fold increased rate of nosocomial bloodstream infections. Candida and coagulase-negative Staphylococcus accounted for 63% of the nosocomial infections, with candida accounting for 29%.
See also: Anemia: Iron-Deficiency Anemia. Ascorbic Acid: Physiology, Dietary Sources and Requirements; Deficiency States. Cancer: Epidemiology of Gastrointestinal Cancers Other Than Colorectal Cancers; Epidemiology of Lung Cancer. Carbohydrates: Regulation of Metabolism. Cholesterol: Sources, Absorption, Function and Metabolism. Copper. Cytokines. Diabetes Mellitus: Etiology and Epidemiology; Classification and Chemical Pathology; Dietary Management. Fatty Acids: Metabolism. Glucose: Chemistry and Dietary Sources; Metabolism and Maintenance of Blood Glucose Level; Glucose Tolerance. Iodine: Deficiency Disorders. Iron. Lipids: Chemistry and Classification. Magnesium. Malnutrition: Secondary, Diagnosis and Management. Nutritional Assessment: Anthropometry; Biochemical Indices; Clinical Examination. Nutritional Support: Adults, Enteral; Adults, Parenteral. Protein: Deficiency. Vitamin A: Physiology; Deficiency and Interventions. Zinc: Deficiency in Developing Countries, Intervention Studies.
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