Outcome of protein-energy malnutrition in elderly medical patients

Purpose To assess the impact of protein-energy malnutrition (PEM) on mortality and the long-term variations in the nutritional status of subjects admitted as emergency cases in a 9-month prospective follow-up study. Patients and methods The study comprised 205 patients without cancer aged 75 years (±1). Malnourished subjects were identified as having at least three nutritional variables (which included weight index, triceps skinfold thickness, arm muscle circumference, serum albumin, and delayed cutaneous hypersensitivity reaction) below the reference range. Results The mortality was 44% in the 41 malnourished patients and 18% in the 164 nonmalnourished subjects (P<0.001). Among malnourished patients with congestive heart failure the mortality was 80%. Multivariate analysis revealed congestive heart failure, multiple organ disease, and PEM to be predictors of death. When the interaction between these disorders and PEM was considered, the prognostic relevance of PEM remained among the patients with cardiac congestion. Of the surviving subjects, 125 were reexamined after 9 months. At admission, more than half of the patients had displayed elevated levels of serum acid glycoprotein as evidence of an ongoing inflammation and subnormal recordings for serum albumin and delayed cutaneous hypersensitivity. At the reexamination, these variables had normalized in the well-nourished patients and in the 9 patients who had recovered from PEM, but remained unchanged in the 10 patients with persistent PEM. The latter patients were severely malnourished, commonly infected, and often hospitalized. Conclusions Protein-energy malnutrition in noncancer medical patients is associated with an excess mortality in those with congestive heart failure. Improvement of PEM is accompanied by a decline in inflammatory activity.