Malnutrition body mass index

The obvious symptom of starvation is a loss of weight, which is most easily assessed by a decrease in the body mass index (BMI). Indeed, it is an excellent predictor of death from starvation. A value of BMI below about 13 in men and about 12 in women is not compatible with life. These values coincide with a loss of about 50% of lean body mass. The major causes of death from malnutrition in developed countries are pneumonia, other infections or heart failure. 

While low serum cholesterol levels have been observed in malnourished patients, largely as a result of decreased synthesis of lipoproteins in the liver, hypocholesterolemia occurs later in the course of malnutrition and is therefore not useful as a screening test. PEM usually results in low serum urea nitrogen (BUN), urinary urea, and total nitrogen. Estimation of 24-h urine creatinine excretion is also a valuable biochemical index of muscle mass (when there is no impairment in renal function). The urinary CHI is correlated to lean body mass and anthropometric measurements. In edematous patients, for whom the extracellular fluids contribute to body weight and spuriously high body mass index values, the decreased CHI values are especially useful in diagnosing malnutrition. 

In addition to supplemental oxygen, adjunctive therapies to consider as part of a pulmonary rehabilitation program are psychoeducational care and nutritional support. Psychoeducational care (such as relaxation) has been associated with improvement in the functioning and well-being of adults with COPD."" The role of nutritional support in patients with COPD is controversial. Several studies have shown an association between malnutrition, low body mass index (BMI), and impaired pulmonary status among patients with COPD. However, in... 

Body mass index (weight in kg divided by the height squared in metres) is a reasonable indicator of nutritional state, except when the patient is oedematous. Arm circumference is an indicator of skeletal muscle mass, while skin fold thickness is proportional to body fat levels. In addition, general physical examination may reveal signs of malnutrition in the skin, nails, hair, teeth and mucous membranes. 

Table 8.1 Classification of protein-energy malnutrition by body mass index...

The severity of protein—energy malnutrition in adults can be assessed from the body mass index (the ratio of weight (in kg)/height (in m) section 6.1.1), as shown in Table 8.1. 

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