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Malnutrition affects on average 20–50% of hospital inpatients and its negative repercussions in terms of morbi-mortality have been fully documented. Although this state of affairs is well known, there is little screening for malnutrition in hospitals. There is no single parameter indicating malnutrition, which instead has to be diagnosed based on anthropometric and biological data, and by multi-factorial indices of nutritional risk. Screening adapted to each of the four main classes of hospital care, acute medicine and surgery, intensive care, geriatrics and paediatrics needs to be systematically performed for every inpatient. To make malnutrition screening a natural part of the practice of care, we need to design training courses, which highlight the benefits in terms of length of stay, morbi-mortality and cost. [Copyright &y& Elsevier]

Epidemiology: Protein-calorie malnutrition (PCM) is highly prevalent among elderly persons living in the community (4%), hospitalized in acute care units or geriatric rehabilitation units (50%), or in long-term care facilities (30-40%). PCM is the first predictor of poor prognosis in the elderly., Diagnosis: Parameters used to establish the diagnosis of PCM and identify its pathophysiology are both simple and inexpensive: body mass index, plasma albumin and CRP, arm circumference and skin fold thickness., Consequences: Because of its frequency and consequences on morbidity and mortality in the elderly, PCM is an important public health problem in industrialized countries.

The authors propose to study parathyroid hormone receptors in humans by means of a test "inspired by the Ellsworth-Howard test" using the active synthetic 1-34 fragment of the hormone PTH-1-34. The use of this test in 44 patients (29 healthy subjects, 7 patients with idiopathic hypercalciuria 5 cases of Paget's disease, 1 patient with idiopathic hypoparathyroidism, 2 cases of basal cell nevus syndrome) who received different doses of this substance intravenously, revealed a marked dose-dependent stimulation of adenyl-cyclase as objectified by an increase in urinary excretion of cyclic AMP (AMPcU). Distal tubular calcium reabsorption was also significantly affected as demonstrated by a decrease in urinary calcium in the first hours following administration of the 1-34 fragment even in the case of idiopathic hypercalciuria. In comparison to the "classical" Ellsworth-Howard test, however, no significant urinary phosphate response was observed during the present test. Similarly, urinary hydroxyproline and phosphate and calcium blood levels remained stable. As the results obtained for the case of hypoparathyroidism demonstrate, this easily performed test is useful for valuating parathormone receptors in kidney by means of two sensitive parameters (AMPcU and the ratio of fractional urinary calcium to urinary creatinine). In addition to its action, synthetic fragment h PTH-1-34 offers the advantage of being totally innocuous.