Severe arm-muscle wasting: sign of lethal malnutrition in sick elderly men

During a 3-yr period, I detected 29 sick men with severe muscle wasting defined by corrected arm-muscle area less than or equal to 16.9 cm2. Almost invariably, these men had weight and body mass index below the 3rd percentile. All had marked depletion of total-body muscle and protein mass, as evidenced by low urinary creatinine-height ratio and total-body nitrogen from neutron-activation analysis. Median survival was only 1.2 mo. Subjects were divided according to survival at 3 mo. The 8 survivors differed from the 21 who died in that they had higher energy intake and a greater chance of restoring muscle mass (5/8 vs. 0/21, P less than 0.001). Treatment of this lethal wasting state remains unsatisfactory. Hence, the most sensible approach is prevention.