Implications of malnutrition in the surgical patient.

The substantial prevalence of malnutrition in the hospitalized patient population has only been recently recognized. Preoperative nutritional and immunological assessment was performed prospectively on admission in 64 consecutive surgical patients. Factors measured included weight loss, triceps skinfold, midarm muscle circumference, creatinine-height index, serum albumin level, serum transferrin level, total lymphocyte count, serum complement level, serum immunoelectrophoresis, lymphocyte T rosettes formation, neutrophil migration, and delayed hypersensitivity. Using these criteria for malnutrition, 97% of the patients had at least one abnormal measurement and 35% had at least three abnormal measurements. Patients were monitored for complications during their hospital course. Serum albumin level, serum transferrin level, and delayed hypersensitivity reactions were the only accurate prognostic indicators of postoperative morbidity and mortality. Substantial unrecognized malnutrition exists in the surgical patient population. An isolated indicator of malnutrition should be interpreted with caution. The visceral protein compartment (serum albumin and serum transferrin levels and delayed hypersensitivity) is the most accurate prognostic indicator of postoperative morbidity and mortality. Perioperative nutritional support may reduce operative morbidity and mortality in the malnourished operative candidate.

[1]  Sally H. Zigmond,et al.  Leukocyte locomotion and chemotaxis. New methods for evaluation, and demonstration of a cell-derived chemotactic factor. , 1973 .

[2]  A. Ballabio,et al.  The effects of total parenteral nutrition on immunodepression due to malnutrition. , 1977, Annals of surgery.

[3]  J. Meakins,et al.  Delayed Hypersensitivity: Indicator of Acquired Failure of Host Defenses in Sepsis and Trauma , 1977, Annals of surgery.

[4]  N. Abdou,et al.  The effects of protein calorie malnutrition on immune competence of the surgical patient. , 1974, Surgery, gynecology & obstetrics.

[5]  E. Stiehm,et al.  Immunologic responses in malnourished children. , 1975, The American journal of clinical nutrition.

[6]  J. Gordon,et al.  Rosette formation by peripheral lymphocytes. , 1970, Clinical and experimental immunology.

[7]  G. Blackburn,et al.  Prevalence of malnutrition in general medical patients. , 1976, JAMA.

[8]  E. Copeland,et al.  Effect of Intravenous Hyperalimentation on Established Delayed Hypersensitivity in the Cancer Patient , 1976, Annals of surgery.

[9]  G. Blackburn,et al.  Nutritional and metabolic assessment of the hospitalized patient. , 1977, JPEN. Journal of parenteral and enteral nutrition.

[10]  D. Wilmore,et al.  Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. , 1968, Surgery.

[11]  Frisancho Ar,et al.  Triceps skin fold and upper arm muscle size norms for assessment of nutritional status , 1974 .

[12]  N. Scrimshaw,et al.  Infectious disease in the malnourished. , 1970, The Medical clinics of North America.

[13]  E. Copeland,et al.  Nutrition as an adjunct to cancer treatment in the adult. , 1977, Cancer research.

[14]  F. Viteri,et al.  The creatinine height index: its use in the estimation of the degree of protein depletion and repletion in protein calorie malnourished children. , 1970, Pediatrics.

[15]  N. Abdou,et al.  Immunocompetence of patients with protein-calorie malnutrition. , 1973 .

[16]  N. Abdou,et al.  Immunocompetence of patients with protein-calorie malnutrition. The effects of nutritional repletion. , 1973, Annals of internal medicine.

[17]  H. O. Studley.  PERCENTAGE OF WEIGHT LOSS: BASIC INDICATOR OF SURGICAL RISK IN PATIENTS WITH CHRONIC PEPTIC ULCER , 1936 .

[18]  J. Rhoads,et al.  NUTRITIONAL PROBLEMS OF SURGICAL PATIENTS , 1955, Annals of the New York Academy of Sciences.

[19]  G. Goodhart.  Effect of Aminoglycosides on the Chemotactic Response of Human Polymorphonuclear Leukocytes , 1977, Antimicrobial Agents and Chemotherapy.

[20]  N. Scrimshaw,et al.  Interactions of nutrition and infection. , 1969, WHO chronicle.