The journal of nutrition, health & aging

, Volume 22, Issue 1, pp 26–29 | Cite as

Why is the Skeleton Still in the Hospital Closet? A Look at the Complex Aetiology of Protein-Energy Malnutrition and its Implications for the Nutrition Care Team

  • S. MarshallEmail author


The acknowledgement of protein-energy malnutrition (PEM) as one of “…the most serious nutritional problems of our time” was actually made by Dr Butterworth Jr in 1974 in his seminal article, “the skeleton in the hospital closet” (1). In most cases, major health problems prevalent in the 1970s have been addressed and improved, such as vast improvements in vaccination rates, pain management and contraception efficacy (2-4). But when it comes to PEM, the continuing high prevalence across all settings (10 – 65% in our home-dwelling, hospitalised and institutionalised elderly) (5-8) and hefty economic burden (>USD$156 billion per annum) (9-11) at first appears to suggest that medicine and medical nutrition therapy may have failed to achieve any significant improvement in the past 40 years. However, PEM (the unintentional loss of lean tissues caused by inadequate energy, protein and nutrient intake) is unique compared with many other medical and nutritional problems, due to not...


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Copyright information

© Serdi and Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of Health Sciences and MedicineBond UniversityRobinaAustralia
  2. 2.Bond Institute of Health and SportRobinaAustralia

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