Nutritional assessment in a rehabilitation unit.

Forty-nine consecutive patient admissions to a rehabilitation unit were evaluated by a nutritional assessment team. Measured parameters included serum albumin, height, weight, 24-hour protein and calorie intake, and response to 4 antigens (purified protein derivative, streptokinase/streptodornase, trichophyton, candida) administered by intradermal injections. Patients were classified normal (albumin greater than or equal to 3.5 gm%, positive skin tests, normal weight), Kwashiorkor (albumin less than 3.5gm%, anergic skin tests, no weight loss), marasmus (albumin greater than or equal to 3.5gm%, anergic skin tests, weight loss greater than 101lb (4.54kg) or obesity (greater than 130% ideal body weight). Protein-calories malnutrition (marasmus or kwashiorkor) was found in 34 (67%) of the patients. Only 15 patients (33%) satisfied criteria for normal nutritional status at the time of admission. Four subjects satisfied the criteria for both obesity and kwashiorkor. Because of the increased morbidity and mortality associated with protein-calorie malnutrition, all patients admitted to a rehabilitation unit should have a nutritional assessment. If the assessment demonstrates malnutrition, a program of metabolic support should be initiated to increase protein levels and restore immune competence.