Populations at Risk for Malnutrition and Sarcopenia

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Nicolaas Deutz, MD, PhD: Malnutrition in the clinic, which means that people don’t eat enough for the requirements of the body, is rather prevalent. And the reason for that is if people are admitted to the hospital, they have been ill already for some time. Then they usually stop eating and feel sick, and then they start to lose weight. They also will be doing some moving, and that will also reduce their muscle mass. So, principle malnutrition and loss of muscle mass—which we call sarcopenia—are two things that describe the same disease. The sarcopenia, the muscle loss, is a real critical thing. Because, it will reduce the strength of people and make them worse to recover in the clinic.

Malnutrition is very prevalent in older people, because the older adults usually have a lot of diseases that can cause the malnutrition. Sometimes, there are social reasons why people eat less at home. Older people sometimes have low blood glucose levels, so older adults are way more prone to become malnourished than, for instance, middle-aged people.

Malnutrition can be very common, depending on the groups that we study. For instance, people that are admitted to the hospital, about half of them can be malnourished. Also, when people are in the hospital, some of them become malnourished in the hospital. Older adults in nursing homes usually have 80% to 90% malnutrition because it’s so difficult. So, the range is very wide, and even in the community, 10% to 15% of malnourishment has been defined.

Peter A. McCullough, MD: There are two special comorbidities that really cut across so many diagnoses that we really need to consider. One is diabetes mellitus. So, patients who have diabetes have a much higher rate of sarcopenia. In fact, they have a common problem called sarcopenic obesity. Ninety percent of diabetics have type 2 diabetes, which means their fat mass has been too high for too long. They’ve exhausted pancreatic endocrine function. And here, we have a situation where there is a gross metabolic disturbance in their body, which leads to progressive amounts of fat mass and decreased muscle mass. Diabetes is really a special condition to be considered. It cuts across all the common illnesses that are associated with sarcopenia and lean muscle mass, including cancer, cardiovascular disease, autoimmune disease, and neurodegenerative disease.