Malnutrition and Associated Sarcopenia - Episode 2

Nutrition, Muscle Mass, and Patient Outcomes

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Peter A. McCullough, MD: It’s my estimate that malnutrition and sarcopenia are under-recognized in the general physician and specialty physician segments of healthcare. Now, the physician nutrition scientist, which is an established training route and established certification, has largely been focused on two extremes. One has been total parenteral nutrition for patients who simply can take no oral intake. That’s critically-ill patients in the hospital who are on a variety of supportive measures, many times, mechanical ventilators. And, then the other area that they focused on is obesity and changes in the body after bariatric surgery. But, that middle ground of patients who are chronically ill, they don’t need total parenteral nutrition.

In fact, they are on oral diets but they’re chronically malnourished. That segment oftentimes isn’t recognized by physicians, as well as other care providers. And that’s a key segment that we can target. It’s important for all doctors to realize we don’t have enough dieticians to see and review all of our patients hospitalized. And, in fact, many of us don’t even have access to dietitians in the office place. So, it’s up to the physicians and, in particular, the nurses. One of the most helpful things a nurse can do is recognize a patient with malnutrition, and then assist the doctor in providing what really is a benign recommendation of oral nutrition supplementation.

It is of value to hold as a special topic, in terms of our review of various illnesses and the disciplines, the broad disciplines of internal medicine, family medicine, and surgery. It is important to focus on nutrition—and particularly malnutrition and sarcopenia—and review the data with respect to the relationships of sarcopenia, and malnutrition, and hospitalization. Once hospitalized, the development of skin breakdown, including decubitus ulcers—which is clearly related in a progressive way to malnutrition and sarcopenia—is related to infectious complications, so higher rates of infection, indicating an impaired immune response.

In the area of the outpatient world—very importantly, falls and fractures, motor vehicle accidents, and rehospitalization, and all-cause mortality—there’s probably no factor that cuts across all these different disease areas and is so strongly related to all-cause mortality. The chain of logic is that if one has a normal nutritional status, normal or even an increased muscle mass, one is more resilient to a complication if it occurs.

We’d be more resilient to a traumatic episode like a motor vehicle accident or a fall, we’d be more resilient to an infection like pneumonia, and we would be more resilient to acute respiratory failure in the hospital. If we did require mechanical ventilation, we’d be much better off if we had our full complement of respiratory musculature to help us through that intercurrent illness. So, there’s a chain of logic that lean muscle mass is critically related to survival through those mechanisms.