Harrison's Internal Medicine Chapter 72. Malnutrition and Nutritional Assessment Malnutrition and Nutritional Assessment: Introduction Malnutrition can arise from primary or secondary causes, with the former resulting from inadequate or poor-quality food intake and the latter from diseases that alter food intake or nutrient requirements, metabolism, or absorption. Primary malnutrition occurs mainly in developing countries and under conditions of war or famine. Secondary malnutrition, the main form encountered in industrialized countries, was largely unrecognized until the early 1970s, when it became appreciated that persons with adequate food supplies can become malnourished as a result of acute or chronic diseases that alter nutrient. | Chapter 072. Malnutrition and Nutritional Assessment Part 1 Harrison s Internal Medicine Chapter 72. Malnutrition and Nutritional Assessment Malnutrition and Nutritional Assessment Introduction Malnutrition can arise from primary or secondary causes with the former resulting from inadequate or poor-quality food intake and the latter from diseases that alter food intake or nutrient requirements metabolism or absorption. Primary malnutrition occurs mainly in developing countries and under conditions of war or famine. Secondary malnutrition the main form encountered in industrialized countries was largely unrecognized until the early 1970s when it became appreciated that persons with adequate food supplies can become malnourished as a result of acute or chronic diseases that alter nutrient intake or metabolism. Various studies have shown that protein-energy malnutrition PEM affects one-third to one-half of patients on general medical and surgical wards in teaching hospitals. The consistent finding that nutritional status influences patient prognosis underscores the importance of preventing detecting and treating malnutrition. Protein-Energy Malnutrition The two major types of PEM are marasmus and kwashiorkor. These conditions are compared in Table 72-1. Marasmus and kwashiorkor can occur singly or in combination as marasmic kwashiorkor. Kwashiorkor can occur rapidly whereas marasmus is the end result of a gradual wasting process that passes through stages of underweight then mild moderate and severe cachexia. Table 72-1 Comparison of Marasmus and Kwashiorkor Marasmus Kwashiorkor Clinical setting Energy intake Protein intake during stress state Marasmus Kwashiorkor Time course to develop Months or years Weeks Clinical features Starved appearance Well-nourished appearance Weight 80 standard for height Easy hair pluckability0 Triceps skinfold 3 mm Edema Mid-arm muscle circumference 15 cm Laboratory Creatinine-height Serum albumin .
