Protein-energy malnutrition and involuntary weight loss: nutritional and pharmacological strategies to enhance wound healing

Abstract

Clinically significant involuntary weight loss (IWL) is defined as a loss of 4.5 kg or > 5% of the usual body weight over a period of 6 - 12 months, especially when progressive. Weight loss of > 10% of normal body weight is considered to represent protein-energy malnutrition (PEM). Despite progress in our understanding of the aetiology and pathophysiology of IWL and PEM, these conditions remain frequent and serious problems in several high-risk populations in both acute and long-term care facilities. In patients with IWL and PEM, nonhealing wounds signal a catabolic process that requires prompt nutritional intervention. Aggressive nutritional therapy that provides adequate protein, calories and micronutrients, combined with an anabolic agent such as oxandrolone, may provide the most optimal environment for restoration of lean body mass and body weight and in turn, promote wound healing. More research, however, is needed to define optimal nutritional and anabolic therapies for these patients given the associated high morbidity and cost of care.

Anthropometric characteristics, high prevalence of undernutrition and weight loss: impact on outcomes in patients with adolescent idiopathic scoliosis after spinal fusion

“…A clinically important finding from this study was the significantly increased risk of superficial wound infection in patients who lost [10 % body weight during the hospital stay. Weight loss of [10 % of normal body weight, represents protein-energy malnutrition [27], and is hence a marker of nutritional status [19]. The current study reinforces the previous recognition of increased wound infection risk associated with suboptimal nutritional status after spinal surgery [11,13,15,16].…”

“…Based on the current study, surgical strategies to mitigate severe postoperative weight loss in AIS may be of clinical benefit as regards decreasing wound infection risks in particular. Such measures including routine pre-and postoperative nutritional screening, recording of serial weight and percentage weight loss measurements, nutritional supplementation, and dietary counselling at hospital discharge, as required, are all amenable to intervention [27]. Despite the clear need to nutritionally support these patients after surgery, there are feeding challenges as outlined in the current study, and consensus on an optimal approach is lacking.…”

“…Serum albumin (i.e. a measure of visceral protein stores) and TLC are widely used indicators of nutritional status [11,13,14], however, as serum albumin has a long half-life of 12-20 days [27,28], the level may not accurately reflect true nutritional status. Serum albumin can be low for other reasons, such as liver or renal disease.…”

Nutritional Assessment of Bariatric Surgery Patients Presenting for Plastic Surgery: A Prospective Analysis

“…8,10 Similarly, low caloric intake has been shown to decrease collagen synthesis, extracellular matrix protein deposition, and formation of granulation tissue. 7 This leads to decreased wound tensile strength and increased rates of skin and fascial wound breakdown.…”

“…The surgical literature is replete with reports demonstrating that adequate assessment of nutritional status before surgery is essential for reducing postoperative complications. [7][8][9][10][11] Inherent to this evaluation is recognition that the stress of surgery increases the body's protein-calorie expenditure by 10 to 25 percent. 12,13 Specific nutritional and metabolic perturbations that may follow gastric bypass include negative protein balance, blood glucose instability, and vitamin deficiencies.…”