Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-26T16:50:59.003Z Has data issue: false hasContentIssue false
  • English
  • Français

Protein–energy undernutrition in hospital in-patients

Published online by Cambridge University Press:  09 March 2007

Clare A. Corish  and
Nicholas P. Kennedy
Clare A. Corish*
Affiliation:
Unit of Nutrition and Dietetic Studies, Department of Clinical Medicine, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Republic of Ireland
Nicholas P. Kennedy
Affiliation:
Unit of Nutrition and Dietetic Studies, Department of Clinical Medicine, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Republic of Ireland
*
*Corresponding author: Mrs Clare Corish, fax +353 1 454 2043, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Impaired nutritional status has been frequently reported in surveys estimating its prevalence amongst patients in hospital. While there is no doubt that protein–energy undernutrition has serious implications for health, recovery from illness or surgery and hospital costs, lack of nationally or internationally accepted cut-off points and guidelines for most nutrition-related variables make nutritional assessment difficult and proper comparisons between studies impossible. In reviewing published work in which the prevalence of undernutrition has been assessed, it can be seen that each study defined undernutrition, or nutritional risk, using different methodology. This present review aims to highlight the problems which arise when deciphering these studies, and the resulting difficulty in determining the true prevalence of undernutrition and nutritional risk, amongst both general and specific groups of hospital in-patients. It is widely agreed that routine hospital practices can further adversely affect the nutritional status of sick patients in hospital. How this occurs, and the potential effects of impaired nutritional status on clinical outcome are examined. The methods currently available to assess nutritional status are evaluated in the knowledge that such assessments are difficult in clinical practice. The review concludes by proposing that if we want the medical and nursing professions to consider the nutritional status of hospital patients seriously, definitions of undernutrition and nutritional risk, and cut-off values for the nutritional variables measured must be agreed to allow evidence-based practice. Outcome measures which allow clear comparisons between groups and treatments must be used in studies assessing the effects of nutritional interventions.

Keywords

UndernutritionNutritional statusNutritional risk assessment
Type
Review article
Information
British Journal of Nutrition , Volume 83 , Issue 6 , June 2000 , pp. 575 - 591
Copyright
Copyright © The Nutrition Society 2000

References

Allison, SP (1992) The uses and limitations of nutritional support Clinical Nutrition 11, 319–330.Google Scholar
Allison, SP (1995) Cost-effectiveness of nutritional support in the elderly Proceedings of the Nutrition Society 54, 693–699.Google Scholar
American Society for Parenteral and Enteral Nutrition (1993) Rationale for adult nutrition support guidelines Journal of Parenteral and Enteral Nutrition 17, 5S–11S.Google Scholar
American Society for Parenteral and Enteral Nutrition (1995) Standards for nutrition support: hospitalized patients Nutrition in Clinical Practice 10, 208–219.Google Scholar
Anker, SDPonikowski, PVarney, S, Chua, TPClark, AL, Webb-Peploe, KMHarrington, DKox, WJPoole Wilson, PA and Coats, AJS (1997) Wasting as independent risk factor for mortality in chronic heart failure Lancet 349, 1050–1053.Google Scholar
Arora, NS and Rochester, DF (1982) Respiratory muscle strength and maximal voluntary ventilation in undernourished patients American Review of Respiratory Diseases 126, 5–8.Google ScholarPubMed
Bashir, YGraham, TRTorrance, AGibson, GJ and Corris, PA (1990) Nutritional state of patients with lung cancer undergoing thoracotomy Thorax 45, 183–186.CrossRefGoogle ScholarPubMed
Bastow, MDRawlings, J and Allison, SP (1983) Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial British Medical Journal 287, 1589–1592.CrossRefGoogle ScholarPubMed
Beattie, AHBaxter, JPPrach, AT and Pennington, CR (1998) An evaluation of the use of enteral nutritional supplements post operatively in malnourished surgical patients Proceedings of the Nutrition Society 58, 112A.Google Scholar
Beier-Holgersen, R and Boesby, S (1996) Influence of postoperative enteral nutrition on postsurgical infections Gut 39, 833–835.CrossRefGoogle ScholarPubMed
Bettany, EA and Powell-Tuck, J (1995) Malnutrition: incidence, diagnosis, causes, effects and indications for nutritional support European Journal of Gastroenterology and Hepatology 7, 494–500.Google ScholarPubMed
Bishop, CWBowen, PE and Ritchley, SI (1981) Norms for nutritional assessment of American adults by upper arm anthropometry American Journal of Clinical Nutrition 34, 2530–2539.CrossRefGoogle ScholarPubMed
Bistrian, BR (1990) Recent advances in parenteral and enteral nutrition: A personal perspective Journal of Parenteral and Enteral Nutrition 14, 329–334.CrossRefGoogle ScholarPubMed
Bistrian, BRBlackburn, GLHallowell, E and Heddle, R (1974) Protein status of general surgical patients Journal of the American Medical Association 230, 858–860.CrossRefGoogle ScholarPubMed
Bistrian, BRBlackburn, GLVitale, JCochran, D and Naylor, J (1976) Prevalence of malnutrition in general medical patients Journal of the American Medical Association 253, 1567–1570.CrossRefGoogle Scholar
Blackburn, GLBistrian, BRMaini, BS, Schlamm, HT and Smith, MS (1977) Nutritional and metabolic assessment of the hospitalized patient Journal of Parenteral and Enteral Nutrition 1, 11–22.CrossRefGoogle ScholarPubMed
Blackburn, GL and Thornton, PA (1979) Nutritional assessment of the hospitalized patient Medical Clinics of North America 63, 1103–1115.CrossRefGoogle ScholarPubMed
Braun, SRDixon, RM and Keim, NL (1984) Predictive clinical value of nutritional assessment factors in COPD Chest 85, 353–357.CrossRefGoogle ScholarPubMed
Burr, ML and Phillips, KM (1984) Anthropometric norms in the elderly British Journal of Nutrition 51, 165–169.CrossRefGoogle ScholarPubMed
Busby, GPMullen, JL Mathews DC, Hobbs, CL and Rosato, EF (1980) Prognostic nutritional index in gastrointestinal surgery American Journal of Surgery 139, 160–167.Google Scholar
Butterworth, CE (1974) The skeleton in the hospital closet Nutrition Today 9, 4–8.CrossRefGoogle Scholar
Chandra, RK (1997) Nutrition and the immune system: an introduction American Journal of Clinical Nutrition 66, 460S–463S.CrossRefGoogle ScholarPubMed
Charney, P (1995) Nutrition Assessment in the 1990s: Where are we now? Nutrition in Clinical Practice 10, 131–139.CrossRefGoogle ScholarPubMed
Chicago Society of Actuaries (1959) Build and Blood Pressure Study, vols. I and II. Chicago, IL: Chicago Society of Actuaries.Google Scholar
Christensen, TBendix, T and Kehlet, H (1982) Fatigue and cardiorespiratory function following abdominal surgery British Journal of Surgery 69, 417–419.CrossRefGoogle ScholarPubMed
Christou, N (1990) Perioperative nutritional support: immunologic defects Journal of Parenteral and Enteral Nutrition 14, 186S–192S.CrossRefGoogle ScholarPubMed
Chumlea, WCRoche, AF and Mukherjee, D (1986) Some anthropometric indices of body composition for elderly adults Journal of Gerontology 41, 36–39.CrossRefGoogle ScholarPubMed
Chumlea, WCRoche, AF and Steinbaugh, ML (1985) Estimating stature from knee height for persons 60–90 years of age Journal of the American Geriatric Society 33, 116–120.Google Scholar
Chumlea, WCSteinbaugh, MLRoche, AF, Mukherjee, D and Gopalaswamy, N (1985) Nutritional anthropometric assessment in elderly persons 65 to 90 years of age Journal of Nutrition in the Elderly 4, 39–51.CrossRefGoogle Scholar
Church, JMChoong, SY and Hill, GL (1984) Abnormalities of muscle metabolism and histology in malnourished patients awaiting surgery: effects of a course of intravenous nutrition British Journal of Surgery 71, 563–569.CrossRefGoogle ScholarPubMed
Coats, KGMorgan, SLBartolucci, AA and Weinsier, RL (1993) Hospital-associated malnutrition: a reevaluation 12 years later Journal of the American Dietetic Association 93, 27–33.CrossRefGoogle ScholarPubMed
Congleton, J (1999) The pulmonary cachexia syndrome: aspects of energy balance Proceedings of the Nutrition Society 58, 321–328.CrossRefGoogle ScholarPubMed
Corish, CFlood, P and Kennedy, NP (2000) Anthropometric data of healthy elderly Irish subjects Proceedings of the Nutrition Society (In the Press).Google Scholar
Corish, CFlood, PMulligan, S and Kennedy, NP (1998) Prevalence of undernutrition and weight loss changes during the course of hospitalization among patients admitted to two Dublin hospitals Proceedings of the Nutrition Society 57, 10A.Google Scholar
Corish, CFlood, PReynolds, JV and Kennedy, NP (1998) Nutritional characteristics of Irish patients undergoing resection of major carcinoma Proceedings of the Nutrition Society 57, 145A.Google Scholar
De Jong, PCMWesdorp, RICOVolovics, ARouffart, M, Greep, JM and Soeters, PB (1985) The value of objective measurements to select patients who are malnourished Clinical Nutrition 4, 61–66.Google Scholar
Delmi, MRapin, C-H, Bengoa, J-M, Delmas, PDVasey, H and Bonjour, J-P (1990) Dietary supplementation in elderly patients with fractured neck of femur Lancet 335, 1013–1016.Google Scholar
Dempsey, DTMullen, JL and Busby, GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it? American Journal of Clinical Nutrition 47, 352–356.Google Scholar
Detsky, ASBaker, JPO'Rourke, KJohnston, N, Whitwell, JMendelson, RA and Jeejeebhoy, KN (1987) Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery Journal of Parenteral and Enteral Nutrition 11, 440–446.CrossRefGoogle ScholarPubMed
Detsky, ASMcLaughlin, JR, Baker, JPJohnson, NWhittaker, S, Mendelson, RA and Jeejeebhoy, KN (1987) What is subjective global assessment of nutritional status? Journal of Parenteral and Enteral Nutrition 11, 8–13.CrossRefGoogle ScholarPubMed
Detsky, AS and Smalley, PS (1994) Is this patient malnourished? Journal of the American Medical Association 271, 54–58.CrossRefGoogle ScholarPubMed
Dionigi, RCremaschi, REJemos, VDominioni, L and Monico, R (1986) Nutritional assessment and severity of illness classification systems: a critical review on their clinical relevance World Journal of Surgery 10, 2–11.CrossRefGoogle ScholarPubMed
Donahoe, MRogers, RMWilson, DO and Pennock, BE (1989) Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary disease American Review of Respiratory Disease 140, 385–391.CrossRefGoogle ScholarPubMed
Doshi, MKLawson, RIngoe, LEColligan, JM, Barton, JR and Cobden, I (1998) Effect of nutritional supplementation on clinical outcome in post-operative orthopedic patients Clinical Nutrition 17, 30S.Google Scholar
Dougherty, DBankhead, RKushner, R, Mirtallo, J and Winkler, M (1995) Nutrition care given new importance in JCAHO standards Nutrition in Clinical Practice 10, 26–31.CrossRefGoogle ScholarPubMed
Durnin, JVGA and Womersley, J (1974) Body fat assessed from total body density and its estimation from skinfold thickness British Journal of Nutrition 32, 77–97.Google Scholar
Dwyer, JTGallo, JJ and Reichel, W (1993) Assessing nutritional status in elderly patients American Family Physician 47, 613–620.Google ScholarPubMed
Edington, JKon, P and Martyn, CN (1996) Prevalence of malnutrition in general practice Clinical Nutrition 15, 60–63.CrossRefGoogle ScholarPubMed
Edington, JKon, P and Martyn, CN (1997) Prevalence of malnutrition after major surgery Journal of Human Nutrition and Dietetics 10, 111–116.CrossRefGoogle Scholar
Efthimiou, JFleming, JGomes, C and Spiro, SG (1988) The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease American Review of Respiratory Disease 137, 1075–1082.CrossRefGoogle ScholarPubMed
Ek, AC and Bjurulf, P (1987) Interrater variability in a modified Norton scale Scandinavian Journal of Caring Sciences 1, 99–102.Google Scholar
Ek, ACLarsson, Fvon Schenck, HThorslund, S, Unosson, M and Bjurulf, P (1990) The correlation between energy, malnutrition and clinical outcome in an elderly hospital population Clinical Nutrition 9, 185–189.Google Scholar
Elia, M (1995) Changing concepts of nutrient requirements in disease: implications for artificial nutritional support Lancet 345, 1279–1284.CrossRefGoogle ScholarPubMed
Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight in adults American Journal of Clinical Nutrition 68, 899–917.CrossRefGoogle Scholar
Falciglia, GO'Connor, J and Gelding, E (1988) Upper arm anthropometric norms in elderly white subjects Journal of the American Dietetic Association 88, 569–574.Google Scholar
Fellows, IWMacdonald, IABennett, T and Allison, SP (1985) The effect of undernutrition on thermoregulation in the elderly Clinical Science 69, 525–523.CrossRefGoogle ScholarPubMed
Finch, S, Doyle, W, Lowe, C, Bates, CJ, Prentice, A, Smithers, G & Clarke, PC (1998) National Diet and Nutrition Survey: People Aged 65 Years and Over. Vol. 1: Report of the Diet and Nutrition Survey. London: The Stationery Office.Google Scholar
Fischer, JE (1982) Nutritional assessment before surgery American Journal of Clinical Nutrition 35, 1128–1131.CrossRefGoogle ScholarPubMed
Flegal, KMCarroll, MDKuczmarski, RJ and Johnson, CL (1998) Overweight and obesity in the United States: prevalence and trends, 1960–1994 International Journal of Obesity Related Metabolic Disorders 22, 39–47.Google Scholar
Forse, RA and Shizgal, HM (1980) The assessment of malnutrition Surgery 88, 17–24.Google Scholar
Fowler, HW & Fowler, FG (1991) In The Concise Oxford Dictionary of Current English [Allan, RE, editor]. London: Oxford University Press.Google Scholar
Friedmann, JMJensen, GL and Smiciklas-Wright, & McCamish, MA (1997) Predicting early nonelective hospital readmission in nutritionally compromised older adults American Journal of Clinical Nutrition 65, 1714–1720.CrossRefGoogle ScholarPubMed
Frisancho, AR (1981) New norms of upper limb fat and muscle areas for assessment of nutritional status American Journal of Clinical Nutrition 34, 2540–2545.CrossRefGoogle ScholarPubMed
Gallagher-Allred, CRCoble Voss, CFinn, SC and McCamish, MA (1996) Malnutrition and clinical outcomes: the case for medical nutrition therapy Journal of the American Dietetic Association 96, 361–366, 369.CrossRefGoogle ScholarPubMed
Galuska, DASerdula, MPamuk, E, Siegel, PZ and Byers, T (1996) Trends in overweight among US adults from 1987 to 1993: a multistate telephone survey American Journal of Public Health 86, 1729–1735.CrossRefGoogle ScholarPubMed
Garriballa, SEParker, SGTaub, N and Castleden, M (1998) Nutritional status of hospitalized acute stroke patients British Journal of Nutrition 79, 481–487.CrossRefGoogle Scholar
Gianotti, LBraga, MRadaelli, G, Mariani, LVignali, A and Carlo, VD (1995) Lack of improvement of prognostic performance of weight loss when combined with other parameters Nutrition 11, 12–16.Google Scholar
Giner, MLaviano, AMeguid, MM and Gleason, JR (1996) In 1995 a correlation between malnutrition and poor outcome still exists Nutrition 12, 23–29.CrossRefGoogle ScholarPubMed
George, L (1994) Screen patients on admission (Letter) British Medical Journal 308, 1369.Google Scholar
Gray-Donald, KGibbons, LShapiro, SH and Martin, JG (1989) Effects of nutritional state on exercise performance in patients with chronic obstructive pulmonary disease American Review of Respiratory Disease 140, 1544–1548.Google Scholar
Han, TS and Lean, ME (1996) Lower leg length as an index of stature in adults International Journal of Obesity Related Metabolic Disorders 20, 21–27.Google Scholar
Haydock, DA and Hill, GL (1986) Impaired wound healing in surgical patients with varying degrees of malnutrition Journal of Parenteral and Enteral Nutrition 10, 550–554.CrossRefGoogle ScholarPubMed
Haydock, DA and Hill, GL (1987) Improved wound healing response in surgical patients receiving intravenous nutrition British Journal of Surgery 74, 320–323.Google Scholar
Heffernan, A and Moloney, M (2000) Patient satisfaction and food wastage in a private hospital — a comparison with two public hospitals Proceedings of the Nutrition Society.Google Scholar
Heslin, MJLatkany, LLeung, D, Brooks, ADHochwald, SN, Pisters, PWTShike, M and Brennan, MF (1997) A prospective randomised trial of early enteral feeding after resection of upper gastrointestinal malignancy Annals of Surgery 226, 567–580.Google Scholar
Heymsfield, SBBethel, RAAnsley, JD, Gibbs, DMFelner, JM and Nutter, DO (1978) Cardiac abnormalities in cachectic patients before and during nutritional repletion American Heart Journal 95, 584–593.Google Scholar
Hill, AAPlank, LD Finn PJ, Whalley, GASharpe, NClarke, MA and Hill, GL (1997) Massive nitrogen loss in critical surgical illness. Effect on cardiac mass and function Annals of Surgery 226, 191–197.CrossRefGoogle ScholarPubMed
Hill, GL (1992) Body composition research: implications for the practice of clinical nutrition Journal of Parenteral and Enteral Nutrition 16, 197–218.Google Scholar
Hill, GLBlackett, RLPickford, IBirkenshaw, L, Young, GAWarren, JB, Schorah, CG and Morgan, DB (1977) Malnutrition in surgical patients: an unrecognised problem Lancet i, 689–692.CrossRefGoogle Scholar
Hwang, T-L, Lue, M-C, Nee, Y-J, Jan, Y-Y and Chen, M-F (1994) The incidence of diarrhea in patients with hypoalbuminemia due to acute or chronic malnutrition during enteral feeding American Journal of Gastroenterology 89, 376–378.Google ScholarPubMed
Incalzi, RAGemma, ACapparella, O, Cipriani, LLandi, F and Carbonin, P (1996) Energy intake and in-hospital starvation. A clinically relevant relationship Archives of Internal Medicine 156, 425–429.CrossRefGoogle ScholarPubMed
Ingenbleek, Y and Carpentier, YA (1985) A prognostic inflammatory and nutritional index scoring critically ill patients International Journal of Vitamin Nutrition Research 55, 91–101.Google ScholarPubMed
Intersociety Professional Nutrition Education Consortium (1998) Bringing physician nutrition specialists into the mainstream: rationale for the Intersociety Professional Nutrition Education Consortium American Journal of Clinical Nutrition 68, 894–898.Google Scholar
Jackson, AA (1996) Nutrition in the undergraduate medical curriculum Proceedings of the Nutrition Society 55, 775–781.CrossRefGoogle ScholarPubMed
Jebb, SA (1999) Obesity: from molecules to man Proceedings of the Nutrition Society 58, 1–14.Google Scholar
Jeejeebhoy, KN (1988) The functional basis of assessment. In Nutrition and Metabolism in Patient Care, pp. 739–751 [Kinney, JM, Jeejeebhoy, KN, Hill, GL and Owen, OE, editors]. Philadelphia, PA: WB Saunders.Google Scholar
Jeejeebhoy, KNDetsky, AS and Baker, JP (1990) Assessment of nutritional status Journal of Parenteral and Enteral Nutrition 14, 193S–196S.Google Scholar
Jensen, MB and Hessov, I (1997) Randomization to nutritional intervention at home did not improve postoperative function, fatigue or well-being British Journal of Surgery 84, 113–118.Google Scholar
Kawerk, NSuccari-Aderschlag, M and Foglietti, MJ (1991) Microheterogeneity of alpha-1 glycoprotein in healthy elderly subjects: patterns obtained by crossed affino-immunoelectrophoresis Clinica Chimica Acta 202, 65–72.CrossRefGoogle ScholarPubMed
Keele, AMBray, MJEmery, PW, Duncan, HD and Silk, DBA (1997) Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients Gut 40, 393–399.CrossRefGoogle ScholarPubMed
Kinosian, BHooper, F and al-Ibrahim, M (1994) Assessing the risk of malnutrition-associated complications (NACs) among elderly medical inpatients Nutrition 10, 481A.Google Scholar
Klein, SKinney, JJeejeebhoy, K, Alpers, DHellerstein, M, Murray, M and Twomey, P (1997) Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition American Journal of Clinical Nutrition 66, 683–706.Google Scholar
Klidjian, AMFoster, KJKammerling, RM, Cooper, A and Karran, SJ (1980) Relation of anthropometric and dynamometric variables to serious postoperative complications British Medical Journal 281, 899–901.CrossRefGoogle ScholarPubMed
Knowles, JBFairburn, MSWiggs, BJ, Chan-Yan, C and Pardy, R (1988) Dietary supplementation and respiratory muscle performance in COPD Chest 93, 977–983.CrossRefGoogle Scholar
Kovacevich, DSBoney, ARBraunschweig, CL, Perez, A and Stevens, M (1997) Nutrition risk classification: a reproducible and valid tool for nurses Nutrition in Clinical Practice 12, 20–25.CrossRefGoogle ScholarPubMed
Kwok, T and Whitelaw, MN (1991) The use of armspan in nutritional assessment of the elderly Journal of the American Geriatric Society 39, 492–496.CrossRefGoogle ScholarPubMed
Landi, FZuccala, GGambassi, G, Incalzi, RAManigrasso, LPagano, F, Carbonin, P and Bernabei, R (1999) Body mass index and mortality among older people living in the community Journal of the American Geriatric Society 47, 1072–1076.Google Scholar
Lansey, SWaslien, CMulvihill, M and Fillit, H (1993) The role of anthropometry in the assessment of malnutrition in the hospitalized frail patient Gerontology 39, 346–353.Google Scholar
Larsson, JAkerlind, IPermerth, J and Hornvist, JO (1994) The relation between nutritional state and quality of life in surgical patients European Journal of Surgery 160, 329–334.Google Scholar
Launer, LJ and Harris, T (1996) Weight, height and body mass index distribution in geographically and ethnically diverse samples of older persons Age and Ageing 25, 300–306.CrossRefGoogle ScholarPubMed
Lennard-Jones, JE (1992) A Positive Approach to Nutrition as a Treatment. Report of a Working Party on the Role of Enteral and Parenteral Feeding in Hospital and at Home. London: King's Fund Centre.Google Scholar
Lennard-Jones, JEArrowsmith, HDavison, C, Denham, AF and Micklewright, A (1995) Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital Clinical Nutrition 14, 336–340.CrossRefGoogle ScholarPubMed
Lewis, MISieck, GCFournier, M and Belman, MJ (1986) Effect of nutritional deprivation on diaphragm contractility and muscle fibre size Journal of Applied Physiology 60, 596–603.Google Scholar
Lin, HC and Van Citters, GW (1997) Stopping enteral feeding for arbitrary gastric residual volume may not be physiologically sound: results of a computer simulation model Journal of Parenteral and Enteral Nutrition 21, 286–289.CrossRefGoogle Scholar
Lumbers, MDriver, LTHowland, RJ, Older, MWJ and Williams, CM (1996) Nutritional status and clinical outcome in elderly female surgical orthopedic patients Clinical Nutrition 15, 101–107.CrossRefGoogle Scholar
Lupo, LPannarale, OAltomare, D, Memeo, V and Rubino, M (1993) Reliability of clinical judgement in evaluation of the nutritional status of surgical patients British Journal of Surgery 80, 1553–1556.Google Scholar
McAleese, P and Odling-Smee, W (1994) The effect of complications on length of stay Annals of Surgery 220, 740–744.CrossRefGoogle ScholarPubMed
McClave, SA, Snider, HLLowen, CC, McLaughlin, AJ, Greene, LMMcCombs, RJ, Rodgers, LWright, RARoy, TM, Schumer, MP and Pfeifer, MA (1992) Use of residual volume as a marker for enteral feeding intolerance: prospective blinded comparison with physical examination and radiographic findings Journal of Parenteral and Enteral Nutrition 16, 99–105.Google Scholar
McGlone, PC, Davies, GJMurcott, APowell-Tuck, J and Dickerson, JWT (1997) Foods consumed by a Bengali population in a British hospital Proceedings of the Nutrition Society 56, 28A.Google Scholar
McGlone, PC, Dickerson, JWT and Davies, GJ (1995) The feeding of patients in hospital: a review Journal of the Royal Society of Health 115, 282–288.CrossRefGoogle ScholarPubMed
McLaren, SM, Dickerson, JWT and Wright, J (1997) Nutrition support offered to stroke patients at mealtimes: a direct, non-participant observation study Proceedings of the Nutrition Society 56, 255A.Google Scholar
McWhirter, JP, Hill, K and Pennington, CR (1994) The nutritional status of patients with gastrointestinal disease Nutrition 10, 495A.Google Scholar
McWhirter, JP and Pennington, CR (1994) Incidence and recognition of malnutrition in hospital British Medical Journal 308, 945–948.Google Scholar
Madden, MAMcCormick, PA, Davidson, BRolles, K, Burroughs, AK and Morgan, MY (1994) Nutritional status and survival of patients after liver transplant Nutrition 10, 504A.Google Scholar
Martin, AL (1994) The nutrition support team. Surviving and thriving in an era of reform Nutrition in Clinical Practice 9, 226–232.Google Scholar
Master, AMLasser, RP and Beckman, BA (1960) Tables of average weight and height of Americans aged 65 to 94 years Journal of the American Medical Association 172, 658–662.CrossRefGoogle ScholarPubMed
Mazolewski, PTurner, JFBaker, MKurtz, T and Little, AG (1999) The impact of nutritional status on the outcome of lung volume reduction surgery: a prospective study Chest 116, 693–696.CrossRefGoogle ScholarPubMed
Moran, BJ and Jackson, AA (1993) Perioperative nutritional support British Journal of Surgery 80, 4–5.Google Scholar
Morley, JE (1998) Protein–energy malnutrition in older subjects Proceedings of the Nutrition Society 57, 587–592.CrossRefGoogle ScholarPubMed
Mowe, MBohmer, T and Kindt, E (1994) Reduced nutritional status in an elderly population (> 70 y) is probable before disease and possibly contributes to the development of disease American Journal of Clinical Nutrition 59, 317–324.Google Scholar
Muhlethaler, RStuck, AEMinder, CE and Frey, BM (1995) The prognostic significance of protein energy malnutrition in geriatric patients Age and Ageing 24, 193–197.Google Scholar
Mullen, JLGertner, MH Busby GP, Goodhart, GL and Rosato, EF (1979) Implications of malnutrition in the surgical patient Archives of Surgery 114, 121–125.CrossRefGoogle ScholarPubMed
Naber, THJSchermer, Tde Bree, ANusteling, K, Eggink, LKruimel, JWBakkeren, JVan Heereveld, H and Katan, MB (1997) Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications American Journal of Clinical Nutrition 66, 1232–1239.CrossRefGoogle ScholarPubMed
Nightingale, JMDWalsh, NBullock, ME and Wicks, AC (1996) Three simple methods of detecting malnutrition on medical wards Journal of the Royal Society of Medicine 89, 144–148.Google Scholar
Nordenstrom, J and Thorne, A (1994) Benefits and complications of parenteral nutrition support European Journal of Clinical Nutrition 48, 531–537.Google Scholar
Odlind Olin, AOsterberg, P, Hadell, KArmyr, I, Jerstrom, S and Ljunungqvist, MD (1996) Energy-enriched hospital food to improve energy intake in elderly patients Journal of Parenteral and Enteral Nutrition 20, 93–97.CrossRefGoogle Scholar
Paul, AACole, TJAhmed, EA and Whitehead, RG (1998) The need for revised standards for skinfold thickness in infancy Archives of Disease in Childhood 78, 354–358.Google Scholar
Payne-James, JJde Gara, CJGrimble, GK, Bray, MJRana, SK, Kapadia, D and Silk, DBA (1992) Artificial nutrition support in hospitals in the United Kingdom — 1991: Second national survey Clinical Nutrition 11, 187–192.CrossRefGoogle ScholarPubMed
Payne-James, JJde Gara, CJGrimble, GK and Silk, DBA (1995) Artificial nutrition support in hospitals in the United Kingdom — 1994: Third national survey Clinical Nutrition 14, 329–335.Google Scholar
Pichard, CHoshino, EAllard, JPCharlton, MP, Atwood, HL and Jeejeebhoy, KN (1991) Intracellular potassium and membrane potential in rat muscles during malnutrition and subsequent refeeding American Journal of Clinical Nutrition 54, 489–498.Google Scholar
Potter, JKlipstein, KReilly, JJ and Roberts, M (1995) The nutritional status and clinical course of acute admissions to a geriatric unit Age and Ageing 24, 131–136.Google Scholar
Potter, JLanghorne, P and Roberts, M (1998) Routine protein energy supplementation in adults: systematic review British Medical Journal 17, 495–501.CrossRefGoogle Scholar
Potter, JMRoberts, MAReilly, JJ and McColl, JH (1998) An evaluation of protein–energy supplementation in medically ill patients to a geriatric unit Proceedings of the Nutrition Society 57, 88A.Google Scholar
Prentice, AM and Jebb, SA (1995) Obesity in Britain: gluttony or sloth? British Medical Journal 311, 437–439.Google Scholar
Rea, IMGillen, S and Clarke, E (1997) Anthropometric measurements from a cross-sectional survey of community dwelling subjects aged over 90 years of age European Journal of Clinical Nutrition 51, 102–106.CrossRefGoogle ScholarPubMed
Reeves, SLVarakamin, C and Henry, CJK (1996) The relationship between arm-span measurement and height with special to gender and ethnicity European Journal of Clinical Nutrition 50, 398–400.Google ScholarPubMed
Reilly, HM (1996) Screening for nutritional risk Proceedings of the Nutrition Society 55, 841–853.Google Scholar
Reilly, HMMartineau, JKMoran, A and Kennedy, H (1995) Nutritional screening — evaluation and implementation of a simple nutrition risk score Clinical Nutrition 14, 269–273.CrossRefGoogle ScholarPubMed
Reynolds, JVKanwar, SWelsh, FKSWindsor, ACJ, Murchan, PBarclay, GR and Guillou, PJ (1997) Does the route of feeding modify gut barrier function and clinical outcome in patients after major upper gastrointestinal surgery? Journal of Parenteral and Enteral Nutrition 21, 196–201.CrossRefGoogle ScholarPubMed
Reynolds, JVO'Farrelly, CFeighery, C, Murchan, PLeonard, N, Fulton, GO'Morain, C, Keane, FBV and Tanner, WA (1996) Impaired gut barrier function in malnourished patients British Journal of Surgery 83, 1288–1291.Google ScholarPubMed
Riley, RH and Burke, V (1997) Prevalence of obesity in surgical patients: a comparative survey in the United States and Australia Journal of Quality in Clinical Practice 17, 147–154.Google ScholarPubMed
Rushe, F and Moloney, M (1998) Patient satisfaction, nutrient content and actual intake of food served in two Dublin teaching hospitals Proceedings of the Nutrition Society 57, 166A.Google Scholar
Sagar, PM and MacFie, J (1994) Effect of preoperative nutritional status on the outcome of cardiac valve replacement Nutrition 10, 490A.Google Scholar
Sauleda, JGea, JOrozco-Levi, M, Corominas, JMinguella, J, Aguar, CBroquetas, J and Agusti, AG (1998) Structure and function relationships of the respiratory muscles European Respiratory Journal 11, 906–911.Google Scholar
Savage, SAHReilly, JJEdwards, CA and Durnin, JVGA (1999) Adequacy of standards for assessment of growth and nutritional status in infancy and early childhood Archives of Disease in Childhood 80, 121–124.Google Scholar
Schalkwijk, CGPoland, DCVan Dijk, WKok, A, Emeiss, JJDrager, AM, Doni, AVan Hinsbergh, VW and Stehouwer, CD (1999) Plasma concentration of C-reactive protein is increased in type 1 diabetic patients without clinical macroangiopathy and correlates with markers of endothelial dysfunction: evidence for chronic inflammation Diabetologia 42, 351–357.CrossRefGoogle ScholarPubMed
Schols, AMWJMostert, RSoeters, PB and Wouters, EFM (1991) Body composition and exercise performance in patients with chronic obstructive pulmonary disease Thorax 46, 695–699.CrossRefGoogle ScholarPubMed
Schols, AMWJSoeters, PDingemans, AMCMostert, RFrantzen, PJ and Wouters, EFM (1993) Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation American Review of Respiratory Disease 147, 1151–1156.Google Scholar
Shaw-Stiffel, TAZarney, LAPleban, WE, Rosman, DDRudolf, RA and Bernstein, LH (1993) Effect of nutrition status and other factors on length of hospital stay after major gastrointestinal surgery Nutrition 9, 140–145.Google ScholarPubMed
Shenkin, A (1997) Impact of disease on markers of macronutrient status Proceedings of the Nutrition Society 56, 433–441.CrossRefGoogle ScholarPubMed
Shenkin, A (1998) Micronutrients in adult nutritional support: requirements and benefits Current Opinion in Clinical Nutrition and Metabolic Care 1, 15–19.Google Scholar
Shenkin, ACederblad, GElia, M and Isaksson, B (1996) Laboratory assessment of protein–energy status Clinica Chimica Acta 253, 1–56.CrossRefGoogle ScholarPubMed
Shirley, R and Moloney, M (2000) A comparison of energy, food and nutrient intakes between a private and two public hospitals Proceedings of the Nutrition Society (In the press).Google Scholar
Simopoulos, A (1985) Dietary control of hypertension and obesity and body weight standards Journal of the American Dietetic Association 85, 419–422.Google Scholar
Smith, LC and Mullen, JL (1991) Nutritional assessment and indications for nutritional support Surgical Clinics of North America 71, 449–457.Google Scholar
Spiekerman, AMRudolf, RA and Bernstein, HH (1993) Determination of malnutrition in hospitalized patients with the use of a group-based Archives of Pathology Laboratory Medicine 117, 184–186.Google ScholarPubMed
Stephen, ADBeigg, CLElliot, ET, MacDonald, IA and Allison, SP (1997) Food provision, wastage and intake in elderly hospital patients Proceedings of the Nutrition Society 56, 220A.Google Scholar
Stephen, ADBeigg, CLElliot, ET, MacDonald, IA and Allison, SP (1998) A recipe for improving the nutritional intake in elderly patients Proceedings of the Nutrition Society 57, 89A.Google Scholar
Sullivan, DHSun, S and Walls, RC (1999) Protein–energy undernutrition among elderly hospitalised patients. A prospective study Journal of the American Medical Association 281, 2013–2019.Google Scholar
Sullivan, DHWalls, RC and Lipschitz, DA (1991) Protein–energy undernutrition and the risk of mortality within 1y of hospital discharge in a select population of geriatric rehabilitation patients American Journal of Clinical Nutrition 53, 599–605.Google Scholar
Tanner, JM and Whitehouse, RH (1975) Revised standards for triceps and subscapular skinfolds in British Children Archives of Disease in Childhood 42, 61–67.Google Scholar
Taren, DC and Schler, S (1990) The nutritional assessment of the successfully aged Clinical Nutrition 9, 7–16.Google Scholar
Thurnham, D (1997) Impact of disease on markers of micronutrient status Proceedings of the Nutrition Society 56, 421–431.Google Scholar
Townsend, S, Palmer, D and MacFie, J (1997) Inadequate oral intake in surgical patients: a rational indication for nutritional support Journal of Human Nutrition and Dietetics 10, 193–195.Google Scholar
Tucker, HN and Miguel, SG (1996) Cost containment through nutrition intervention Nutrition Reviews 54, 111–121.CrossRefGoogle ScholarPubMed
Unosson, MLarsson, JEk, AC and Bjurulf, P (1992) Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale Clinical Nutrition 11, 134–139.Google Scholar
Vanek, VW (1998) The use of serum albumin as a prognostic or nutritional marker and the pros and cons of IV albumin therapy Nutrition in Clinical Practice 13, 110–122.CrossRefGoogle ScholarPubMed
Van Itallie, TB (1996) Prevalence of obesity Endocrinology and Metabolism Clinics of North America 25, 887–905.CrossRefGoogle ScholarPubMed
Veterans Affairs Total Parenteral Nutrition Cooperative Study Group (1991) Perioperative total parenteral nutrition in surgical patients New England Journal of Medicine 325, 525–532.CrossRefGoogle Scholar
Watters, JMClancey, SMMoulton, SB, Briere, KM and Zhu, J-M (1993) Impaired recovery of strength in older patients after major abdominal surgery Annals of Surgery 218, 380–393.Google Scholar
Watters, JMKirkpatrick, SMNorris, SB, Shamji, FM and Wells, GA (1997) Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility Annals of Surgery 226, 369–380.CrossRefGoogle ScholarPubMed
Webb, ARNewman, LATaylor, M and Keogh, JB (1989) Hand grip dynamometry as a predictor of postoperative complications: reappraisal using age standardised grip strengths Journal of Parenteral and Enteral Nutrition 13, 30–33.CrossRefGoogle ScholarPubMed
Weinsier, RLHunker, EMKrumdieck, CL and Butterworth, CE (1979) Hospital malnutrition: a prospective evaluation of general medical patients during the course of hospitalization American Journal of Clinical Nutrition 32, 418–426.CrossRefGoogle ScholarPubMed
Welsh, FKSFarmery, SMRamsden, CGuillou, PJ and Reynolds, JV (1996) Reversible impairment in monocyte major histocompatibility complex class 11 expression in malnourished surgical patients Journal of Parenteral and Enteral Nutrition 20, 344–348.Google Scholar
Wesley, JR (1995) Nutrition support teams: past, present, and future Nutrition in Clinical Practice 10, 219–228.Google Scholar
Windsor, JA and Hill, GL (1988) Weight loss with physiologic impairment. A basic indicator of surgical risk Annals of Surgery 207, 290–296.CrossRefGoogle ScholarPubMed
Windsor, JAKnight, GS and Hill, GL (1988) Wound healing response in surgical patients: recent food intake is more important than nutritional status British Journal of Surgery 75, 135–137.CrossRefGoogle ScholarPubMed
World Health Organization (1995) Physical Status: The Use and Interpretation of Anthropometry. World Health Organization Technical Report no. 854. Geneva: WHO.Google Scholar
World Health Organization International Obesity Task Force (1998) Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO.Google Scholar
Yeh, S-S and Schuster, MW (1999) Geriatric cachexia: the role of cytokines American Journal of Clinical Nutrition 70, 183–197.Google Scholar
Young, VRMarchini, JS and Cortiella, J (1990) Assessment of protein nutritional status Journal of Nutrition 120, 1496–1502.CrossRefGoogle ScholarPubMed