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Invited Commentary
Nutrition, Obesity, and Exercise
November 20, 2019

Nutritional Support Among Medical Inpatients—Feed the Cold (and Malnourished) and Starve the Febrile

Author Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk
JAMA Netw Open. 2019;2(11):e1915707. doi:10.1001/jamanetworkopen.2019.15707

Acute illness results in a severe catabolic state with marked proteolysis and loss of lean body mass. Loss of lean body mass has profound consequences, resulting in marked functional disability and increasing the risk of falls, bone fractures, and generalized frailty. The consequences of acute illness on functional outcomes are best illustrated by the study of Herridge and colleagues,1 who followed 109 patients who had survived acute respiratory distress syndrome. In their study, patients had lost 18% of their baseline body weight by the time they were discharged, and all complained of weakness and fatigue; at 12 months, the distance walked in 6 minutes was 66% of that predicted. Furthermore, after 5 years of follow-up, functional ability had not improved over values at 1 year.

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