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We have followed for 40 days seven hospitalized, young (age, mean SD : 33 +/- 8 yrs), and moderately obese (W/H : 35 +/- 3.92) women. During the first 5 days (DO to D5) they received a diet similar to their customary home-diet; from D6 to D40, their daily caloric intake was adjusted to 3,41 +/- 0.13 MJ (816 +/- 30 kcal). This diet comprised 21 p. 100 of sugars, 35 p. 100 of lipids, 1.57 +/- 0.09 g proteins per kg ideal body weight. Five seven-day periods have been studied. On the first day of each period, we recorded body weight and measured plasma albumin, pre albumin, retinol binding protein, complement (CH50 and C3) C peptide (in the fasting state and after glucagon stimulation), and thyroid hormones (T3 and rT3). On each of the 35 days of this study, total nitrogen was measured (Kjeldahl's method) in food, urine and faeces. On D0 and D41 lean and fat body masses were evaluated through measurements of total water (dilution of tritiated water) and of skin fold thickness respectively. From D0 to D40, the average weight loss was 8.76 +/- 1.86 kg; the cumulated nitrogen balances were negative in 6 patients and positive in one, with variations from one period to another and from one patient to another. Plasma proteins and hormones did not vary significantly. Changes in lean mass were comprised between + 0,7 and -- 1,6 kg in spite of the fact that all patients received the same caloric and protein intake.

Changes in nutritional status at the initial phase of treatment of cancers and malignant blood diseases were evaluated in 32 male patients (mean age 58 +/- 18 years) examined during three 4-day stays in hospital (T0, T1, T2) at 2 months' interval. On the first day of each stay the following parameters were measured: food intake (kcal/day), weight (kg), squared height (m), fat mass (kg) obtained by measuring 4 skin folds and using Durnin's tables, brachial muscle area (cm2) and total skeletal muscle mass (kg) calculated from Heymsfield's equations. On the third and fourth days, after 48 hours of meat-free and fish-free diet, 3-methylhistidine (mmol/g creatininuria) and creatinine (mg) were measured in urine, and the urinary creatinine/height ratio (mg/cm/day) was calculated. Full anthropomorphic measurements were performed on 19/32 patients and complete measurements of 3-methylhistidine and the urinary creatinine/height ratio in 9/32 patients. Subsequent examinations revealed a decrease in brachial muscle area, total skeletal muscle mass and urinary creatinine/height ratio which, together with an increase in baseline 3-methylhistidine, confirmed the loss of muscle mass. Mean losses of muscle and fat were 6 p. 100 between T1 and T0 and 7 p. 100 between T2 and T0 for the muscle mass, and 9 p. 100 between T2 and T0 for the fat mass. These losses of body mass occurred very early, with significant differences between T1 and T0 and between T2 and T0. They suggest that protein-calorie malnutrition develops at a very early stage in patients treated for cancer or malignant blood disease.

In industrial countries protein-calorie malnutrition (PCM) is a frequent cause of hospital morbidity and mortality. In this study, 88 hospital patients were evaluated: 44 (25 men and 19 women) aged from 20 to 80 years) with PCM, and 44 without malnutrition; the two groups were matched with regard to sex, age and height. The following parameters were determined: arm muscle surface, whole-body muscle mass, proportion of body fat, serum albumin (Alb), prealbumin (PA), retinol-binding protein (RBP), transferrin, thyroxine-binding protein, thyroxine, triiodothyronine, reverse triiodothyronine and total complement. Anthropometric measurements were validated by planimetry of a computerized tomographic section of the arm in 60 patients. There were significant differences between the two sexes in anthropometric values. Alb, PA and RBP values were different in men and RBP only in women; all other biochemical parameters were the same in both sexes. Thus, the group with PCM could be distinguished from the control group by anthropometric values and RBP values. Anthropometric parameters have been reported as being more specific of PCM than biochemical parameters, but since the latter are considered more sensitive, both complement each other and must be taken into account.