Malnutrition refers to the clinical condition in which there is a dysequilibrium between nutrient intake and requirements as a result of insufficient intake, exaggerated loss of nutrients, or increased catabolism. Traditionally, malnutrition is divided into kwashiorkor, associated with edema resulting from low protein intake, or marasmus, in which protein and calorie intakes are deficient and there is no edema.<sup>43 Hill G.L. Understanding protein energy malnutrition Disorders of Nutrition and Metabolism in Clinical Surgery: Understanding and Management London: Churchill Livingstone (1992).  71-83

Cliccare qui per andare alla sezione Riferimenti</sup> The malnutrition that is encountered in hospitalized patients is usually due to a deficiency of carbohydrates, proteins, and fats referred to as protein-energy malnutrition. Deficiencies in vitamins, minerals, and trace elements often accompany the protein-energy deficits.<sup>43 Hill G.L. Understanding protein energy malnutrition Disorders of Nutrition and Metabolism in Clinical Surgery: Understanding and Management London: Churchill Livingstone (1992).  71-83

Cliccare qui per andare alla sezione Riferimenti, 80 Mora R.J.F. Malnutrition: Organic and functional consequences World J Surg 1999 ;  23 : 530-535  [cross-ref]

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The prevalence of malnutrition in hospitalized patients is estimated to be greater than 25% in academic hospitals in the United States.<sup>11 Bistrian B.R., Blackburn G.L., Vitale J. , e al. Prevalence of malnutrition in general medical patients JAMA 1976 ;  235 : 1567-1570

Cliccare qui per andare alla sezione Riferimenti, 16 Butterworth C.W., Blackburn G.L. Hospital malnutrition and how to assess the nutritional status of a patient Nutr Today 1975 ;  10 : 10-18

Cliccare qui per andare alla sezione Riferimenti</sup> Other studies show that 50% of hospitalized patients have moderate malnutrition, with 5% to 10% being severely malnourished.<sup>11 Bistrian B.R., Blackburn G.L., Vitale J. , e al. Prevalence of malnutrition in general medical patients JAMA 1976 ;  235 : 1567-1570

Cliccare qui per andare alla sezione Riferimenti, 15 Bristian B.R., Blackburn G.L., Hallowell E. , e al. Protein status of general surgical patients JAMA 1974 ;  230 : 858-860

Cliccare qui per andare alla sezione Riferimenti, 23 Coats K.G., Morgan S.L., Bartolucci A.A. , e al. Hospital associated malnutrition: A reevaluation 12 years later J Am Diet Assoc 1989 ;  93 : 27-33

Cliccare qui per andare alla sezione Riferimenti</sup> Nutritional status worsens during the course of hospitalization in multiple patient populations.<sup>44 Hill G.L., Pickford I., Young G.A. , e al. Malnutrition in surgical patients: An unrecognized problem Lancet 1977 ;  1 : 689-692  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 88 Pinchcofsky G.D., Kalminski M.V. Increasing malnutrition during hospitalization: Documentation by a nutritional screening program J Am Coll Nutr 1985 ;  4 : 471-479

Cliccare qui per andare alla sezione Riferimenti, 108 Weinsier R.L., Hunker E.M., Krumdieck C.L. , e al. Hospital malnutrition: A prospective evaluation of general medical patients during the course of hospitalization Am J Clin Nutr 1979 ;  32 : 418-426

Cliccare qui per andare alla sezione Riferimenti</sup> Malnutrition affects clinical status, morbidity, and mortality. Weight loss of 10 to 20 lb associated with illness adversely affects muscle, respiratory, and cardiovascular functions and decreases resistance to infection.<sup>7 Arora N.S., Rochester D.F. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients Am Rev Respir Dis 1982 ;  126 : 5-8

Cliccare qui per andare alla sezione Riferimenti, 98 Russell D.M., Leiter L.A., Whitewell J. , e al. Skeletal muscle function during hypocaloric dieting and fasting: A comparison with standard nutritional assessment parameters Am J Clin Nutr 1983 ;  37 : 133-138  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 112 Hunger Disease: Studies by the Jewish Physicians in the Warsaw Ghetto New York: Wiley (1979). 

Cliccare qui per andare alla sezione Riferimenti</sup> Malnutrition increases hospital cost by prolonging patient stay, and it ultimately can increase mortality.<sup>94 Reilly J.J., Hull S.F., Albert N. , e al. Economic impact of malnutrition: A model system for hospitalized patients JPEN 1988 ;  12 : 371-376

Cliccare qui per andare alla sezione Riferimenti, 103 Seltzer M.H., Slocum B.A., Cataldi-Betcher , e al. Instant nutritional assessment: Absolute weight loss and surgical mortality JPEN J Parenter Enteral Nutr 1982 ;  6 : 218-221

Cliccare qui per andare alla sezione Riferimenti, 111 Windsor J.L., Hill G. Weight loss with physiologic impairment: A basic indicator of surgical risk Ann Surg 1988 ;  207 : 290-296  [cross-ref]

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With increasing knowledge of the adverse effects of malnutrition on clinical outcome, the use of nutritional support in hospitalized and in home patients has grown. In 1993, it was estimated that greater than 5 million patients per year receive some form of nutritional therapy.<sup>8 AS.P.E.N. Board of Directors Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients JPEN J Parenter Enteral Nutr 1993 ; 1SA-52SA

Cliccare qui per andare alla sezione Riferimenti</sup> There has been a 10-fold increase in the annual rate of enteral and parenteral nutrition–related publications since the 1980s.<sup>56 Klein S., Kinney J., Jeejeebhoy K. , e al. Nutrition support in clinical practice: Review of published data and recommendations for future research directions JPEN J Parenter Enteral Nutr 1997 ;  21 : 133-155

Cliccare qui per andare alla sezione Riferimenti</sup> Despite the increased use of and scientific investigation of nutritional therapy, decisions regarding the use of nutritional therapy in the medical patient are often difficult. The clinician must be able to assess properly the patient potentially in need of nutritional therapy, determine the amounts and route of delivery of nutrients, and identify the most efficacious monitoring techniques. A lack of physician knowledge and the paucity of well-performed clinical trials in the use of nutritional therapy in medical patients presents additional problems when providing such therapy.