[Assessment of nutritional status--a part of routine clinical diagnosis: cholinesterase activity as a nutritional...

Nutritional assessment has not yet been established as integral part of basic clinical diagnostic procedures everywhere, eventhough the prognostic relevance of malnutrition is well known. One of the reasons is the lack of nutritional indicators, which are specific of and sensitive for changes of the nutritional status on the one hand, and routinely analyzed on the other. We report on the utility of serum cholinesterase, which has the shortest half-life of all plasma proteins, to identify malnourished patients. 54 internal inpatients with malignant diseases or in septic state were followed up prospectively with respect to courses of cholinesterase (CHE), albumin (ALB), transferrin (TRA), and body weight over periods of 4 weeks. A correct correlation to malnutrition was defined as plasma concentrations less than reference ranges or continuous concentr. fall greater than 10%. Based on 132 observations (65 with continuous weight loss, mean: -5.5% of original w.; 54 w. gain, mean +4.6%, 13 constant w.), changes of CHE had the highest correlation to weight changes (r = 0.79, p less than 0.001), compared to the courses of TRA- or ALB-levels (r = 0.65/0.68). Incorrect positive results (conc. fall or conc. less than ref. range without weight loss): absolute levels - CHE 4%, ALB 4%, TRA 22%; conc. courses - CHE 0%, ALB 0%, TRA 6%. Incorrect negative: absolute c. - CHE 63%, ALB 30%, TRA 28%; courses - CHE 15%, ALB 19%, TRA 17%. The common determination of CHE and ALB-courses allowed a correct identification of malnutrition in 96% of all observations, with the same result as the courses of ALB + TRA.(ABSTRACT TRUNCATED AT 250 WORDS)