In many chronic diseases such as hypertension, diabetes, obesity, atherosclerotic heart disease, cerebral vascular disease, metabolic bone disease and alcoholism, deteriorated nutritional status may contribute to the etiology of the disease process and may prevent effective recovery unless it is corrected in the course of a therapeutic regimen.
In still other conditions such as malignancies, arthritis and chronic gastrointestinal disease, malnutrition my result as a consequence of the underlying pathology and must be diagnosed and treated as part of the total care of the patient.
Protein-calorie malnutrition produces progressive weight loss, weakness and apathy.
The metabolic effects of protein-calorie malnutrition can become superimposed on any underlying disease process, preventing recovery from infection, surgery and injury, even in a previously healthy person.
The result of protein-calorie malnutrition may be the impairment of wound healing, exacerbation of decubitus ulcers at pressure points, increased wound disruption and increased fistula formation following bowel surgery.
Fluid and electrolyte imbalances become more difficult to correct as a result of imbalances in protein distribution.
Endocrine imbalances may result as a consequence of the impairment of synthesis of polypeptide hormones when protein deficiency is present.
A long-standing protein deficiency can lead to impairment of immune mechanisms. This impairment of immune mechanisms results in increased wound infections, increased incidence of pneumonia and of urinary tract infections and cancer.
The social consequences of malnutrition are equally important in these days of increasing concern with the cost of medical delivery systems.