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December 5, 1986

Criteria for the Diagnosis of Malnutrition

Author Affiliations

New England Deaconess Hospital Boston
Harvard Medical School Boston
New England Deaconess Hospital Harvard Medical School Boston

JAMA. 1986;256(21):2962-2963. doi:10.1001/jama.1986.03380210058020

To the Editor.—  We read with great concern the letter entitled "Criteria for the Diagnosis of Malnutrition,"1 in which the author cautioned clinicians about the use of serum protein concentrations in the assessment of nutritional status. The tone of the letter leaves the reader with the false impression that these biochemical tests cannot be used to assess the nutritional status of hospitalized patients.2The author cites as an example a "fasted patient who is otherwise healthy and whose serum albumin and other serum protein levels are maintained in the normal range throughout the fast, presumably by using the amino acids in muscle catabolism." In fact, in a fasted, unstressed, wellnourished or overnourished individual, the liver's synthesis of serum proteins can be supported for long periods of time (>24 days) by the redistribution of nutrients from the body cell mass.3,4 It is well documented that continued starvation will