Protein‐Energy Malnutrition in Elderly Medical Patients

TLDR

The study assessed the prevalence of protein‑energy malnutrition, its evolution during hospitalization, and its association with short‑term in‑hospital mortality in patients aged 70 and older. Researchers performed a prospective time‑series study measuring mid‑arm circumference, triceps skinfold, serum albumin, prealbumin, and retinol‑binding protein at admission and day 15 in 324 patients ≥70 years, and used step‑wise discriminant analysis to evaluate these parameters as mortality predictors. Protein‑energy malnutrition affected 30% of men and 41% of women, with mid‑arm circumference and albumin declining over 15 days while triceps skinfold remained stable; these parameters, along with age, predicted in‑hospital mortality with 73% sensitivity, 69% specificity, and 70% correct classification, indicating preferential mobilization of lean body mass for energy during stay.

Abstract

To evaluate (1) the prevalence of protein-energy malnutrition in elderly patients; (2) the changes in nutritional status during the hospital stay; and (3) (main objective) the relationship between simple nutritional parameters and short-term in-hospital mortality.Prospective time series at admission and on the 15th day of hospitalization.Medical care unit in a teaching hospital.Consecutive sample of 324 hospitalized patients greater than or equal to 70 years (86.4% of eligible patients). Norms of measurements were obtained from a referred sample of healthy control subjects (26 males and 36 females).Mid-arm circumference, triceps skinfold thickness, serum albumin, prealbumin, and retinol-binding protein levels were measured in patients at admission and on the 15th day. (1) Prevalence of PEM was 30% in male and 41% in female patients. (2) Both mid-arm circumference and serum albumin level decreased over the first 15 days of hospital stay (53 patients, paired t test, P less than 0.05). Triceps skinfold thickness did not change. (3) A step-wise discriminant-function analysis determined the utility of the parameters at admission as predictors of in-hospital mortality before the 15th day. Mid-arm circumference, triceps skinfold thickness, albumin, and prealbumin levels, as well as age, are predictors of in-hospital mortality, with 73% sensitivity, 69% specificity, and 70% of correctly classified patients of both sexes.Parameters used are predictors for short-term in-hospital mortality of elderly patients hospitalized in an acute medical unit. The lean body mass is preferentially mobilized for energy during hospitalization.