Malnutrition moderate

Preoperative nutrition support in patients with moderate to severe malnutrition who cannot tolerate enteral nutrition and in whom surgery can be delayed safely for at least 7 days... 

Lactoferrin, a protein found in secondary granules of polymorphonuclear cells, was observed to be mildly to moderately elevated in the stools of children with endemic cryptosporidiosis [91] and healthy adult volunteers with experimental infection [92], Indeed, in another study of malnourished children in Haiti, cryptosporidiosis was noted to stimulate an inflammatory response, as evidenced by elevated IL-8, TNF-a, lactoferrin, IL-13 and IL-10 [93]. Further studies are needed to elucidate the role of inflammatory mediators in the development of prolonged diarrhea, malabsorption and malnutrition in immunocompromised hosts and children in endemic areas. 

Alcohol-induced ketoacidosis must be differentiated from a similar metabolic complication in diabetes melli-tUS (E.S. Dillon et al., 1940 D.W. Jenkins et al., 1971). With chronic alcohol consumption and concurrent malnutrition, metabolic acidosis is caused by a still unclear multifaceted pathogenesis (hypoinsulinaemia, lipolysis, extreme increase in free fatty acids, rise in ketone bodies). The clinical picture shows nausea, vomiting, dehydration, hyperventilation, fruity odour on breath, aceton-uria and acetonaemia as well as a moderate form of hyperglycaemia. This syndrome probably occurs more often than has been hitherto assumed. (54)... 

Kinney, J. M. (1987). kidiiect calorimetiy in malnutrition Nutritional assessment or thcra-preutic reference /. Parenteral Enteral Nutr. 11, 90S-94S-Pellet, P L. (1990). Food eneigy requirements in humans. Am.. Clin, Nutr. 51,711-722. Ravussin, E., Bumand, B., hutz, ., and Jaquier, E- (1962). Twenty-foulabour eneigy expenditure and resting metabolic rate in obese, moderately obese, and control subjects. Am.. Clin. Nutr. 35,36 573. 

A deficiency purely in pantothenic acid has probably never occurred, except in controlled studies. Persons suffering from severe malnutrition would be expected to be deficient in the vitamin. Studies with animals have shown that consumption of a diet deficient in the vitamin results in a loss of appetite, slow growth, skin lesions, ulceration of the intestines, weakness, and eventually death. Pantothenic acid deficiency also results in the production of gray fur in animals whose fur is colored. Biochemical studies with deficient animals have revealed severe decreases in pantothenic acid levels in a variety of tissues, but only moderate declines in the levels of coenzyme A in liver and kidney and maintenance of coenz)nne A levels in the brain (Smith et ah, 1987). Some striking defects in glycogen and ketone body metabolism have been noted in pantothenic acid-deficient animals. 

Albumin Liver M.W. 66,000 15-19 days N 3.5-5.0g/dl Mild 2.8-3.5 g/dl Moderate 2.1-2.7 g/dl Severe <2.1 g/dl Transports many endogenous and exogenous ligands, major determinant of plasma oncotic pressure. Large body pool and long half-life makes it a poor index of acute malnutrition... 

ALB was one of the first identified biochemical markers of malnutrition and has long been used in population studies. ALB is a relatively insensitive index of early protein malnutrition because there is a large amount normally found in the body (4 to 5 g/kg of body weight), it is highly distributed in the extravascular compartment (60%), and it has a long half-life (18 to 20 days). However, chronic protein deficiency in the setting of adequate nonprotein calorie intake leads to marked hypoalbuminemia because of a net ALB loss from the intravascular and extravascular compartments (kwashiorkor). Serum ALB concentrations also are affected by moderate-to-severe calorie deficiency hepatic, renal, and GI disease and infection, tramna, stress, and burns. In many cases, interpretation of serum ALB concentrations relative to nutrition status is difficult however, a positive correlation between decreased serum ALB concentrations and poor clinical outcome has been demonstrated in a variety of settings. Additionally, serum ALB concentrations of 2.5 g/dL or less can be expected to exacerbate ascites and peripheral, pulmonary, and GI mucosal edema due to decreased colloid oncotic pressure. 

Jean Ann Tonich developed a folate deficiency and is on the verge of devel-j oping a cobalamin (vitamin B12) deficiency as a consequence of prolonged moderately severe malnutrition related to chronic alcoholism. Before folate therapy is started, the physician must ascertain that the megaloblastic anemia is not caused by a pure B12 deficiency or a combined deficiency of folate and B12. 

In mild and moderate ID, the prevalence rate of circulating thyroid autoantibodies in the population is also high (Laurberg et ai, 1998 Pedersen et aL, 2003). In such areas, non toxic and toxic multinodular goiters are prevalent and overall hyperthyroidism is more common than hypothyroidism (Laurberg et ai, 1999). Results from areas with severe ID are fimited and might, in some cases, be influenced by the general immunosuppressive effect of malnutrition, which may occur simultaneously (Salabe et al., 1982). 

It is partly owing to adaptation of the remaining small intestine to reabsorb bile acids that the length of ileal resection is not correlated with fecal bile acid excretion (64,101). In addition, accompanying malnutrition may limit the capacity of the liver to enhance its bile acid synthesis, so that in patients with extensive intestinal resections fecal bile acid excretion may be only moderately increased (64,101). In these cases, serum cholesterol is usually very low and depletion of body cholesterol in the presence of insufficiently enhanced cholesterol synthesis may be one factor for limited bile salt production. 

Cultural and genetic factors limit the applicability of these studies to health care in the United States. Though the effects of mild to moderate malnutrition are more subtle, they may also be more prevalent than previously assumed. These considerations apply to micronutrient status, such as for iron in children, and to a spectrum of adult deficiencies, primarily... 

IgA responses are nutritionally sensitive, and it seems likely that this is due to the strong T cell dependence of these functions. Even moderate malnutrition impairs secretory immunity (McMurray et al., 1977 Sirisinha et al., 1977 Faulk et al., 1977), one of the primary barriers against infection. These studies indicate that secretory IgA may be deficient even though serum immunoglobulin levels are normal or above normal. 

EFFECTS OF MODERATE MALNUTRITION AND CONTROLLED DIETARY RESTRICTION... 

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