Abstract

The adverse effect of excessive weight loss on clinical outcomes was documented over 80 years ago when Hiram Studley showed that, in patients undergoing surgery for perforated duodenal ulcer, postoperative mortality was ten times greater in those who had lost more than 20% of their bodyweight preoperatively, compared with those who had lost less. Similarly, less pronounced results were shown in medical (not undergoing surgical treatment) patients. The potential importance of these observations was emphasised by a study from the 1990s showing that 30% of 500 patients admitted to hospital for treatment had moderate-to-severe malnutrition on admission.2 Of the patients who stayed in hospital for more than one week, 65% continued to lose weight, with only a few of the malnourished patients being referred for nutritional intervention.