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Review Article |
1 From the Departments of Geriatric Medicine at Karolinska Hospital and Huddinge University Hospital, Stockholm.
Protein-energy malnutrition (PEM) is common in connection with chronic disease and is associated with increased morbidity and mortality. Because the risk of PEM is related to the degree of illness, the causal connections between malnutrition and a poorer prognosis are complex. It cannot auto matically be inferred that nutritional support will improve the clinical course of patients with wasting disorders. We reviewed studies of the treatment of PEM in cases of chronic obstructive pulmonary disease, chronic heart failure, stroke, dementia, reha-bilitation after hip fracture, chronic renal failure, rheumatoid arthritis, and multiple disorders in the elderly. Several method-ologic problems are associated with nutrition treatment studies in chronically ill patients. These problems include no generally accepted definition of PEM, uncertain patient compliance with supplementation, and a wide range of outcome variables. Avail-able treatment studies indicate that dietary supplements, either alone or in combination with hormonal treatment, may have positive effects when given to patients with manifest PEM or to patients at risk of developing PEM. In chronic obstructive pul-monary disease, nutritional treatment may improve respiratory function. Nutritional therapy of elderly women after hip fractures may speed up the rehabilitation process. When administered to elderly patients with multiple disorders, diet therapy may improve functional capacity. The data regarding nutritional treatment of the conditions mentioned above is still inconclusive. There is still a great need for randomized controlled long-term studies of the effects of defined nutritional intervention programs in chroni-cally ill and frail elderly with a focus on determining clinically relevant outcomes.
Key Words: Protein-energy malnutrition • chronic obstructive pulmonary disease • chronic heart failure • stroke • dementia • hip fracture • chronic renal failure • rheumatoid arthritis • elderly • nutritional support
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