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Malnutrition & Sarcopenia

ABOUT MALNUTRITION

Malnutrition results from inadequate nutrient intake and utilization, leading to the breakdown of skeletal muscle and other aspects of lean body mass. This can result from many factors, including illness, injury, and insufficient or erratic food intake.

Regardless of BMI or body type, malnutrition causes adverse effects on body function and clinical outcomes.1

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6 CLINICAL CHARACTERISTICS OF MALNUTRITION.6,7

  • Insufficient food intake compared with nutrition requirements
  • Weight loss over time
  • Loss of muscle mass
  • Loss of fat mass
  • Fluid accumulation
  • Diminished functional status as measured by hand grip strength

Patients only need to exhibit two to be considered malnourished.

DISEASE-RELATED MALNUTRITION

Malnutrition is often present in patients suffering from a wide variety of disease states, including various types of cancer, chronic obstructive pulmonary disease (COPD), and other conditions, like diabetes.

  • 50% of patients with cancer have some nutritional deficit prior to being diagnosed8
  • 85% of patients experience malnutrition and weight loss at some point during cancer treatment9,10
  • 20% of cancer deaths may be attributed to cancer-induced cachexia11
  • Approximately 23% of outpatients with COPD have disease-related malnutrition12, while an additional 45% of outpatients with COPD are at risk for disease-related malnutrition13
  • Approximately 50% of patients with COPD admitted to the hospital suffer from disease-related malnutrition14-18
SARCOPENIA AND MALNUTRITION

Sarcopenia often overlaps with malnutrition, especially in older patients.19 Different stages of sarcopenia may be used to help identify the severity of the condition, such as:

  • Pre-sarcopenia: Characterized by reduced muscle mass. No reduction in muscle strength or physical performance
  • Sarcopenia: Characterized by the presence of low muscle mass and low muscle function (strength OR performance)
  • Severe sarcopenia: Characterized by reduced muscle mass and reduction in muscle strength20

Knowing and responding to the signs of malnutrition and/or sarcopenia are critical to patients receiving proper care in both inpatient and outpatient settings.

Sarcopenia has a pervasive, negative impact on patients’ quality of life and often leads to:

  • Increased inpatient length of stay21
  • A decline in daily activities and ambulatory function21
  • Reduced day-to-day activities21,22
  • Increased risk of illness and infection22,23
  • Reduced recovery from surgery, illness, and injury22,23
  • Poor wound healing23
  • Increased mortality23
ECONOMIC IMPACT

Sarcopenia impacts more than patients. It is also associated with higher healthcare costs.24

  • The estimated direct healthcare cost attributable to sarcopenia in the United States in 2000 was $18.5 billion, representing 1.5% of total healthcare expenditures for that year.25
  • Healthcare expenditures due to sarcopenia cost roughly $900 per person per year.26

More than 2 in 3 patients experience further nutritional decline once admitted.
Malnourishment:

  • Prolongs recovery

    Malnourished patients are hospitalized an average of 2 days longer than those screened and treated early.27,28
  • Increases complications

    Patients with malnutrition and weight loss have 3 times the risk for surgical site infection29
  • Raises Readmissions

    Malnourished patients are more likely to be readmitted within 15 days of discharge30
  • Inflates costs

    3.2% of all US hospital discharges (2010) had a malnutrition diagnosis. These patients had a significantly longer length of stay (LOS) and higher costs.31

1Elia M, ed. Guidelines for Detection and Management of Malnutrition: A Report of the Malnutrition Advisory Group. Maidenhead, UK: British Association for Parenteral and Enteral Nutrition (Bapen); 2000.

2Coats KG, et al. J Am Diet Assoc. 1993;93:27-33

3Giner M, et al. Nutrition. 1996;12:23-29

4Thomas DR, et al. Am J Clin Nutr. 2002; 75:308-312

5Davidson W, et al. Oncol Nurs Forum. 2012;39:E340-E345.

6White et al., JAND 2012;112:730-738.

7White et al., JPEN 2012;36:275-283.

8Halpurn-Silveira D, et al. Support Care Cancer. 2010;18:617-625.

9Dewys WD, et al. Am J Med. 1980;69(4):491-497.

10Laviano A, et al. Nutrition. 1996;12:358-371.

11Tisdale MJ. Nat Rev Cancer. 2002;2:862-871.

12Cochrane EJ, et al. J Hum Nutr Diet. 2004;17:3-11.

13Collins PF, et al. Respirology. 2013;18:616-629.

14Laaban JP, et al. Chest. 1993;103:1362-1368.

15Thorsdottir I, et al. J Am Diet Assoc. 2001;101:648-654.

16Thorsdottir I, et al. J Am Diet Assoc. 2002;102:247-249.

17Gupta B, et al. Int J Tuberc Lung Dis. 2010;14:500-505.

18Gupta SS, et al. Lung India. 2014;31:29-34.

19Vandewoude MFJ et al. Malnutrition-Sarcopenia Syndrome: Is This the Future of Nutrition Screening and Assessment for Older Adults? J Aging Research. 2012:1-8.

20Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39(4):412-423.

21Pitchard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, Unger P. Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr. 2004;79:613-618.

22Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84(3):475-482.

23Demling RH. Nutrition, anabolism, and the wound healing process: an overview. Eplasty. 2009;9:65-94.

24Tappenden KS, Quatrara B, Parkhurst ML. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. JPEN J Parenter Enteral Nutr. 2013;37:482-497.

25Janssen I, Shepard DS, Katznarzyk PT, Roubenoff R. The Healthcare Costs of Sarcopenia in the United States. Journal of the American Geriatric Society 52:80-85, 2004.

26Marcell. Sarcopenia: Causes, consequences, and preventions. The Journals of Gerontology 2003;58:M911-M916.

27Brugler L, et al. J Qual Improv. 1999;25:191-206.

28Smith PE, et al. Health Financ Manage. 1997;51:66-69.

29Bauer JD, et al. J Hum Nutr Diet. 2007;20:558-564.

30Lim SL, et al. Clin Nutr. 2012;31:345-350.

31Corkins MR, et al. JPEN. 2014;38:186-195.