Chapter 072. Malnutrition and Nutritional Assessment (Part 1)

Harrisons Internal Medicine Chapter 72. Malnutrition and Nutritional AssessmentMalnutrition and Nutritional Assessment: IntroductionMalnutrition can arise from primary or secondary causes, with the former resulting from inadequate or poor-quality food intake and the latter from diseases that alter food intake or nutrient requirements, metabolism, or absorption. Primary malnutrition occurs mainly in developing countries and under conditions of war or famine. Secondary malnutrition, the main form encountered in industrialized countries, was largely unrecognized until the early 1970s, when it became appreciated that persons with adequate food supplies can become malnourished asa result of acute or chronic diseases that alter nutrient...
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Chapter 072. Malnutrition and Nutritional Assessment (Part 1) Chapter 072. Malnutrition and Nutritional Assessment (Part 1) Harrisons Internal Medicine > Chapter 72. Malnutrition and NutritionalAssessment Malnutrition and Nutritional Assessment: Introduction Malnutrition can arise from primary or secondary causes, with the formerresulting from inadequate or poor-quality food intake and the latter from diseasesthat alter food intake or nutrient requirements, metabolism, or absorption. Primarymalnutrition occurs mainly in developing countries and under conditions of war orfamine. Secondary malnutrition, the main form encountered in industrializedcountries, was largely unrecognized until the early 1970s, when it becameappreciated that persons with adequate food supplies can become malnourished asa result of acute or chronic diseases that alter nutrient intake or metabolism.Various studies have shown that protein-energy malnutrition (PEM) affects one-third to one-half of patients on general medical and surgical wards in teachinghospitals. The consistent finding that nutritional status influences patient prognosisunderscores the importance of preventing, detecting, and treating malnutrition. Protein-Energy Malnutrition The two major types of PEM are marasmus and kwashiorkor. Theseconditions are compared in Table 72-1. Marasmus and kwashiorkor can occursingly or in combination, as marasmic kwashiorkor. Kwashiorkor can occurrapidly, whereas marasmus is the end result of a gradual wasting process thatpasses through stages of underweight, then mild, moderate, and severe cachexia. Table 72-1 Comparison of Marasmus and Kwashiorkor Marasmus Kwashiorkora Clinical Energy intake Protein intake duringsetting stress state Marasmus Kwashiorkora Time course Months or years Weeksto develop Clinical Starved appearance Well-nourishedfeatures appearance Weight Marasmus Kwashiorkorafindings index Marasmus Kwashiorkora Mortality Low unless related to High underlying disease Diagnostic Triceps skinfold Marasmus Kwashiorkora Edema a The findings used to diagnose kwashiorkor must be unexplained by othercauses. b Tested by firmly pulling a lock of hair from the top (not the sides or back),grasping with the thumb and forefinger. An average of three or more hairsremoved easily and painlessly is considered abnormal hair pluckability.