Download PDF by C. L. Kervran: Biological Transmutations

By C. L. Kervran

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Not only are a significant number of patients malnourished on admission, a considerable number deteriorates over their hospital course [5–6, 17–18]. Thus, the question arises whether there is an iatrogenic cause to the worsening documented malnutrition, or is it simply the interrelatedness of malnutrition and disease progression? The etiology of malnutrition is complex. At-risk patients are among the most ill, and their poor nutritional status is due in part to prolonged stress responses to underlying chronic disease or hospitalization, to inadequate dietary intake, especially in elderly patients [19], or to a combination of these factors.

Selection bias is likely responsible for much of the inconclusiveness regarding the benefits of nutritional support in the perioperative setting [118, 119]. In addition, evidence is lacking that nutritional support affects outcomes favorably, partly because of difficulty finding 48 Butsch and Heimburger accurate measures of nutritional outcome. Thus, some authors argue that a lack of clear-cut benefits exists in groups other than selected groups [120]. This has prompted investigators to carefully select the most beneficial candidates, including patients with major trauma, severely malnourished patients undergoing elective surgery, and wellnourished minimally stressed patients unable to eat for 7 to 10 days postoperatively.

9. Heymsfield SM, McMannus C, Stevens V, et al. Muscle mass: reliable indicator of protein-energy malnutrition severity and outcome. Am J Clin Nutr 1982;35:1192–1199. 10. Jones JM. The methodology of nutritional screening and assessment tools. J Hum Nutr Diet 2002;15:59–71. 11. Simmons SF, Reuben D. National intake monitoring for nursing home residents: a comparison of staff documentation, direct observation and photography models. J Am Geriat Soc 2000;48:209–213. 12. Leonard Jones-JE, Arrowsmith H, Davidons C, et al.

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