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December 12, 1980

Malnutrition in Hospitalized Patients

Author Affiliations

From the Evans Department of Clinical Research and the Clinical Nutrition Unit, University Hospital, Boston University Medical Center.

JAMA. 1980;244(23):2630-2635. doi:10.1001/jama.1980.03310230032019

"MALNUTRITION" is a medically definable syndrome that is responsive to therapy. Yet most physicians accept protein malnutrition as an inevitable consequence of illness, and wasting continues in patients even though nutrition intervention techniques are available for those in whom a chance exists for recovery from their primary illness.

NUTRITIONAL HISTORY Fuel Reserves and Metabolism  To understand the development of protein-calorie malnutrition in the hospitalized patient, we first have to understand the energy reserves available to the healthy person and the interplay between various fuels, both exogenous and endogenous, as patients respond to disease and therapy. In Fig 1 the energy reserves of a 70-kg man are presented diagramatically. Even the nonobese person has approximately 135,000 calories stored as triglycerides in adipose tissue. Such fuels are useful and can be consumed during periods of stress. There is little stored carbohydrate, with perhaps 80 calories available from circulating glucose, 250 to 300