A study has shown that 31% of people over age 65 in Newberry county, S. C. were at high risk for nutritional problems⁴. Other studies have reported 30-54% malnutrition in hospitalized patients⁵. In about 1999, we were involved in the case of a national top-ten competition male body builder who had a splendid "build" (enhanced by an induced lipoatrophy to visually enhance transcutaneous muscle definition) but was found to have protein calorie malnutrition (PCM, or PEM...protein energy malnutrition) based on low serum albumin and low absolute blood lymphocyte count. In about 2000 we evaluated an 86 y/o lady 3 months post right brain stroke who had lost 20 pounds in that interval...being almost sure that she had PCM; but parameters showed good nutritional values. In one hospital, a laboratorian was beside a 350 pound patient's doctor & remarked, "There is no way he can be malnourished, just by his size! I'll eat my hat if you can prove malnutrition!" Malnutrition may be subtle.

The benefit of paying close attention to nutritional status of hospitalized patients can be as much as an overall reduction in length of stay of 2 days (critical care and ICU types by 12 days)².

In late 2008, it has come out that adults should have some 30 grams protein in each of their 3 meals per day (spaced out during the day...not just at one meal per day) in order to avoid loss of normal muscle mass (sarcopenia).

• Physical examination:

  • does patient look malnourished? Marasmus is the slowly progressive loss of fat & muscle tissue because of chronic insufficiency of caloric intake. Kwashiorkor is protein and caloric deficiency coming about during a relatively short time. The worst situation is the latter turn of events accelerated on top of the former!

• Weight and/or body mass index: get this more exacting number calculated on-line here [on-line calculator]

• Serum proteins:

  • somatomedin C: half-life is 2 hours.

  • fibronectin: half-life is 15 hours.

  • retinol-binding protein (RBP): half life is 24 hours.

  • prealbumin (thyroxin-binding pre-albumin or transthyretin): half-life is 48 hours.

  • transferrin: half-life is 10 days.

  • C-reactive protein (CRP): half life 19 hours.

  • albumin levels: half-life is 20 days; >3.5 is normal; mild depletion @ 3-3.4; moderate depletion @ 2.1-2.9; severe depletion @ <2.1.

• Serum lipids:

  • cholesterol:

• Serum minerals:

  • zinc:

• Serum vitamins:

  • vitamin A: too much can injure the liver & even cause alopecia; too little can lead to vision disorders; severe infant and childhood deficiencies leave the children vulnerable to lethal complicating effects of childhood illnesses such as diarrhea, measles, etc.

  • vitamin B1 (thiamine): alcoholics prone to deficits

  • vitamin B12:

  • vitamin C:

• Blood cells:

  • total lymphocyte count decreased in PCM (PEM): >1500 is normal; mild depletion @ 1201-1500; moderate depletion @ 800-1200; severe depletion @ <800.

• Interpretation notes:
  • if total CRP within normal range and low proteins, then they are most likely low because of PCM (protein calorie malnutrition)/PEM (protein energy malnutrition)¹
  • "instant nutritional index": alb. <3.5 and/or total lymphocyte count <1100 means "possible malnourished status"

References:

1. Carlson TH, Therapeutic Nutrition Monitoring, ADVANCE for Medical Lab. Professionals, 27 May 1996.

2. Getting the Scoop on Nutrition Testing, CAP Today, 16(1):1, 60-68, January 2002.

3. Proteins Used in Nutritional Assessment, Spiekerman AM, Clinics In Lab. Medicine 13(2):353-369, June 1993.

4. Ryan & Bundrick, J. S. C. Med. Assoc., Nutritional Screening of Older South Carolinians: a Pilot Study, p.260-262, June 1995.

5. Spiekerman AM, Rosser AR, Bernstein LH, Determination of Malnutrition in Hospitalized Patients With the Use of a Group-based Reference, Arch. Path. Lab. Med. 117:184186, Feb. 1993.

6. Finding Malnourished Patients in a Community Hospital: Development of a Nutritional Assessment Service, Nelson S, Bottsford JE, Long JM, J. S. C. Med. Assoc., Jan. 1983, p. 9-13.

(posted about 2000; latest addition 11/13/08)