Body composition in chronic undernutrition

Abstract

Anthropometric (height, weight, and skinfolds), biochemical (serum proteins, albumin, and cholesterol), metabolic (nitrogen balance and creatinine excretion), hematological (plasma volume, hemoglobin, hematocrit, bone marrow hemosiderin, percent transferrin saturation, vitamin B12, and folic acid) variables and body water compartments (total and extracellular) have been measured in 49 adult male subjects who exhibited a wide range of nutritional states from normal to severely undernourished. Changes in body composition associated with moderate degrees of nutritional compromise were related principally to decreases in body cell mass (-15%). Body fat was normal. With severe nutritional involvement, both fat depots (-29%) and body cell mass (-29%) were significantly diminished. Muscle cell mass was more affected than other cells in the body (-41%). These data could indicate that in the group with moderate compromise, energy reserves (and hence energy balance) were maintained but dietary protein deficiencies were not compensated for. Both calorie and protein deficiencies were evident in the subjects with severe undernutrition. Multiple regression equations (r greater than 0.8) were developed that allow prediction of muscle cell mass, fat-free weight, and body cell mass from simple anthropometry and serum albumin levels. Decreases in serum albumin concentration were best related to deficits in muscle mass (r = 0.77).

Effects of changes in water compartments on physiology and metabolism

“…It shows that the more severe the malnutrition, the larger the extracellular water inflation and the intracellular water depletion. In this study (Barac-Nieto et al, 1978), nitrogen balance can be shown to be inversely correlated to the degree of cellular dehydration (as assessed from the ratio of intracellular water over fat-free mass). However, nitrogen balances were very close to zero, probably reflecting that chronic malnutrition results in adaptation of protein metabolism to limit proteolysis.…”

“…There are few studies challenging this theory at the whole-body level. It appears that protein metabolism is probably regulated by Data are taken from the work of Barac-Nieto et al (1978). cellular hydration in humans.…”

“…Malnutrition induces extracellular expansion and intracellular water shrinkage (Barac-Nieto et al, 1978). Table 1 summarises the changes in water spaces during mild, intermediary or severe malnutrition of field workers in Columbia.…”

Utility of Standard Nutritional Parameters in Detecting Body Cell Mass Depletion in Patients With End-Stage Liver Disease

“…Patients were classified into 2 groups: patients with an absolute BCM in the lowest quartile of values among patients of the same sex and patients in the lowest quartile of values among patients of the same sex. Absolute cutoff points of BCM normalized for height reported previously 23,24 for healthy and malnourished patients were not used because method and temporal differences between these earlier reports and our current study made direct comparisons potentially invalid. Data are presented as means Ϯ SD.…”

“…Normalization of BCM for height is necessary because absolute values of BCM vary widely with body habitus. 23,24 Reference to a physical characteristic provides a more definitive index of BCM. Height is considered a better index for normalization than weight because height is not affected by fluid retention (ascites) or malnutrition.…”