Protein-energy malnutrition and involuntary weight loss: nutritional and pharmacological strategies to enhance wound healing

Clinically significant involuntary weight loss (IWL) is defined as a loss of 4.5 kg or > 5% of the usual body weight over a period of 6 - 12 months, especially when progressive. Weight loss of > 10% of normal body weight is considered to represent protein-energy malnutrition (PEM). Despite progress in our understanding of the aetiology and pathophysiology of IWL and PEM, these conditions remain frequent and serious problems in several high-risk populations in both acute and long-term care facilities. In patients with IWL and PEM, nonhealing wounds signal a catabolic process that requires prompt nutritional intervention. Aggressive nutritional therapy that provides adequate protein, calories and micronutrients, combined with an anabolic agent such as oxandrolone, may provide the most optimal environment for restoration of lean body mass and body weight and in turn, promote wound healing. More research, however, is needed to define optimal nutritional and anabolic therapies for these patients given the associated high morbidity and cost of care.