Differentiating Subtypes (Hypoalbuminemic vs Marasmic) of Protein‐Calorie Malnutrition: Incidence and Clinical Significance in a University Hospital Setting

Abstract

Clinical nutrition assessment has identified two types of protein-calorie malnutrition (PCM), a stress-induced hypoalbuminemic form (HAF-PCM) and a marasmic form (MF-PCM) generated by adaptation to starvation. This study evaluated the differences between these two patterns of PCM with regard to precipitating factors and the clinical sequelae of mortality, cost of total parenteral nutrition, length of hospitalization, and rate of sepsis and nosocomial infection. Of 220 patients receiving total parenteral nutrition over a 12-month period (0.7% of 30, 127 admissions), 180 were included in this study. HAF-PCM was diagnosed in 45% and MF-PCM in 25% of study patients. HAF-PCM was more common in older age groups. Women had PCM less often than did men (57% vs 83%), but whereas men developed both forms of PCM equally, women were more likely to develop HAF-PCM. Prolonged mechanical ventilation increased the likelihood of both patterns, whereas the presence of malignancy, concomitant organ failure, trauma, burns, or surgery did not increase the likelihood of developing either pattern of PCM. HAF-PCM increased the length of hospitalization by 29% and the cost of total parenteral nutrition by 42%. The presence of HAF-PCM increased four-fold the odds of dying, and the odds of developing nosocomial infection and sepsis almost 2.5 times above that seen in its absence. MF-PCM had no clinical effect of its own on any of the outcome parameters, but instead exerted only an interactive synergistic effect with HAF-PCM on length of hospitalization and cost of total parenteral nutrition.

Nutritional status of adult inpatients in Bujumbura, Burundi (impact of HIV infection)

“…But paradoxically, the body fat mass was preserved among HIV seropositive subjects. This malnutrition pattern is similar to that of kwashiorkor, a condition related to caloric and protein de®ciencies associated with an aggression factor (Mac Clave et al, 1992) which, in many cases in our study population, was TB. This pro®le, also observed in HIV seropositive subjects from industrialised countries (Sluys et al, 1993;Kotler et al, 1996) contrasts with that of HIV seronegative subjects recruited in our study (decreased fat and fat free mass suggestive of insuf®cient food intake) (Shizgal, 1981).…”

Body Composition and Energy Expenditure in Obese Patients prior to and following Biliopancreatic Diversion for Obesity

“…Fur thermore, studies carried out with multidilutional technique in very long-term BPD postobese subjects have demonstrated a fully pre served intra-/extracelluiar fluid ratio [2], Therefore, given our previous data, it can be suggested that the extracellular dilatation fol lowing bariatric surgery is caused by malnu trition. The findings of this longitudinal inEur Sung Res 1996:28:295-298 297 vestigation are in full agreement with such a suggestion [12]. In the BPD subjects, the FFM size is close to that nonoperated subjects with very similar BWs, whilst REE values were slightly higher.…”

Parenteral with enteral nutrition in the critically ill

“…Two scores of underlying chronic illness were recorded (MacCabe and Jackson [18] and Knaus et al [19]) and the Simplified Acute Physiology Score [20], a score of severity within the first 24 h in ICU. To assess any underlying malnutrition, height, usual weight, body mass index [weight/(height) 2 ], Subjective Global Assessment (SGA) or Detsky et al score [21], and other malnutrition indices based on albumin weight changes such as the Buzby et al Nutritional Risk Index (NRI) [22], and the MacClave et al score [23] were also used. Follow-up on days 0, 4, 7, 14, 21, and 90 was performed with the Organ System Failure (OSF) score [24], weight, electrolytes, kidney, and liver function tests.…”