Skip to main content
SpringerLink
Log in

Grenzen und Bedeutung der Labordiagnostik bei Mangelernährung im Alter

Limits and relevance of the laboratory diagnosis of malnutrition in the elderly

  • Themenschwerpunkt
  • Published:
Wiener Medizinische Wochenschrift Aims and scope Submit manuscript

Summary

Despite the widespread interest in malnutrition in the elderly, the utility of laboratory tests is limited. This is because their diagnostic significance can be impaired by undercurrent diseases, preanalytical effects and unsatisfactory standardization. This survey summarizes the most important parameters of malnutrition. Thus, "nitrogen balance" is considered the golden standard of nutrition status, while the diagnostic significance of serum proteins depends on their biological half-time. Albumin is seen as the most reliable malnutrition marker, but cholinesterase and cholesterol-decrease must also be mentioned. The so-called "low-T3-phenomenon" which is caused by the production of "reverse T3", seems to be the unique parameter for the "catabolic" state of metabolism. Of special interest are also prognostic markers of mortality, such as orosomucoid. Cytokines, other signal peptides, trace elements and vitamins are from the diagnostic point of view of rather limited significance. In sum, the diagnosis and monitoring of malnutrition in the elderly represents an important challenge for laboratory medicine.

Zusammenfassung

Trotz der breiten Aufmerksamkeit bezüglich "Mangelernährung im Alter" sind die Möglichkeiten der Labordiagnostik eher limitiert. So können diagnostische Aussagen einzelner Tests durch interkurrente Krankheiten, präanalytische Effekte sowie durch mangelnde Standardisierung beeinträchtigt werden. In der vorliegenden Übersicht wird auf die Bedeutung der wichtigsten diesbezüglichen Laborparameter eingegangen. Neben der Stickstoffbilanz, die als "goldener Standard" für Mangelernährung gilt, sind insbesondere Serumproteine zu nennen, deren Aussage sich nach der jeweiligen biologischen Halbwertszeit richtet. Als verlässlichster Marker gilt dabei Albumin, aber auch Cholinesterase sowie Cholesterin-Verminderung ist hier zu erwähnen. Das sog. "niedrig-T3-Phänomen", dem die Bildung von "reverse T3" zugrunde liegt, scheint als einziges die "katabole" Stoffwechsellage direkt wider zu spiegeln. Darüber hinaus sind prognostische Mortalitätsmarker, etwa Orosomukoid von besonderem Interesse. Zytokine und andere Signalpeptide sowie Spurenelemente und Vitamine scheinen als Diagnostikum eher eine begrenzte Bedeutung zu haben. Demnach stellt die Diagnose und das Monitoring der Mangelernährung im Alter für die Labordiagnostik eine wichtige Herausforderung dar.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  • Shenkin A, Cederbald G, Elia M, Isaksson B (1996) Laboratory assessment of protein-energy status. Clin Chim Acta 253: S5–S59

    Article  PubMed  CAS  Google Scholar 

  • Akner G, Cederholm T (2001) Treatment of protein-energy malnutrition in chronic nonmalignant disorders. Am J Clin Nutr 74: 6–24

    PubMed  CAS  Google Scholar 

  • Berner YN (2003) Nutrition and Aging. Geriatria (Slovakia) 9: 172–185

    Google Scholar 

  • Cicconetti P, Riolo N, Ettore E, Costarella M, Priami C, Marigliano V (2003) Demographic evolution, aging and frailty. Ricenti Prog Med 94: 309–313

    Google Scholar 

  • Böhmer F (2001) Responsibilities of prevention in gerontology. Wien Med Wochenschr 151: 468–471

    PubMed  Google Scholar 

  • Lapin A, Böhmer F (2005) Laboratory diagnosis and geriatrics: More than just reference intervals for the elderly. Wien Med Wochenschr 155: 30–35

    Article  PubMed  Google Scholar 

  • Roubenoff R (2000) Sarcopenia: a major modifiable cause of frailty in the elderly. J Nutr Health Aging 4: 140–142

    PubMed  CAS  Google Scholar 

  • Ferucci L, Cavazzini C, Corsi A, Bartali B, Russo CR, Lauretani F, Bandinelli S, Guralnik (2002) Biomarkers of frailty in older persons. J Endocrinol Invest 25: 10–15

    Google Scholar 

  • Potischman N (2003) Biologic and methodologic issues for nutritional biomarkers. J Nutrition 875S–80S

  • Young DS (1994) Pre-analytical variability in the elderly. In: Geriatric Clinical Chemistry: Reference values, Faulkner WR, Meites S (ed) 1994, AACC Press, Washington, pp 19–39

    Google Scholar 

  • Blank HM, Bowman BA, Cooper GR, Myers GL, Miller DT (2003) Laboratory issues: use of nutritional biomarkers. J Nutr 133(Suppl 3): 888S–S894

    Google Scholar 

  • Lapin A, Böhmer F (1999) Laborbefunde bei älteren Menschen: Ein vergessener Aspekt der Labormedizin? Z Gerontol Geriatr 32: 41–46

    Article  PubMed  CAS  Google Scholar 

  • Orman ML, Salem P (2002) Diagnosing undernutrition. Clin Geriat Med 18: 719–736

    Article  Google Scholar 

  • Issakson B (1993) A critical evaluation of the duplicateportion technique in dietary surveys [Review]. Eur J Clin Nutr 47: 457–460

    Google Scholar 

  • Konstantinides FN (1992) Nitrogen balance studies in clinical nutrition (Review). Nutr Clin Pract 7: 231–238

    PubMed  CAS  Google Scholar 

  • Finucane P, Rudra T, Hsu R, Tomlinson K, Hutton RD, Pathy MSJ (1998) Markers of the nutritional status in acutely ill elderly patients. Gerontology 34: 304–310

    Article  Google Scholar 

  • Böhmer F, Lapin A (2003) What are "normal" laboratory parameters in elderly patients when examined of first admission at a geriatric hospital? – A pilot study. Euro J Ger 2: 86–93

    Google Scholar 

  • Visser M, Kritchevsky SB, Newman AB, Goodpaster BH, Tylavsky FA, Nevitt MC, Harris TB (2005) Lower serum albumin concentration and change in muscle mass: The health, aging and body composition study. Am J Clin Nutr 82: 531–537

    PubMed  CAS  Google Scholar 

  • Campion EW, deLabry LO, Glynn RJ (1988) The effect of age on serum albumin in healthy males: Report from the normative aging study. J Gerontol 433: M18–M20

    Google Scholar 

  • O'Sullivan (2001) Biochemical markers of nutritional status. Clin Lab 25(5): 14–16

    Google Scholar 

  • Marcus EL, Sokoloff M, Nemanov L, Ebstein RP (2000) Determination of serum albumin in older adults. A need for specification of the assay method. J Am Med Dir Assoc 1: 261–266

    PubMed  CAS  Google Scholar 

  • Burrit MF, Anderson CF (1984) Laboratory assessment of nutritional status. Hum Pathol 15: 130–133

    Google Scholar 

  • Bernstein L (1995) Measurement of visceral protein status in assessing protein and energy malnutrition: Standard care (Prealbumin in Nutritional care Consensus Group). Nutrition 11: 169–171

    Google Scholar 

  • Caregaro L, Favaro A, Santonastaso P, Alberino F, Di Pascoli L, Nardi M, Favaro S, Gatta A (2001) Insulin-like growth factor 1 (IGF-1), a nutritional marker in patients with eating disorders. Clin Nutr 20: 251–257

    Article  PubMed  CAS  Google Scholar 

  • van den Beld AW, Blum WF, Pols HA, Grobbee DE, Lamberts SW (2003) Serum insulin-like growth factor binding protein as an IGF-2 as an indicator of functional ability in elderly man. Eur J Endocrinol 148: 627–634

    Article  PubMed  CAS  Google Scholar 

  • Raynaud-Simon A (2003) Level of plasma insulin-like growth factor I (IGF I), IGF II, IGF binding proteins, type 1 IGF receptor and growth hormone binding protein in community-dwelling elderly subjects with no malnutrition and no inflammation. J Nutr Health Aging 7: 267–273

    PubMed  CAS  Google Scholar 

  • Novacek G, Vogelsang H, Schmid B, Lochs H (1993) Are single measurements of pseudocholinesterase and albumin markers for inflammatory activity or nutritional status in Crohn's disease? Wien Klin Wochenschr 105: 111–115

    PubMed  CAS  Google Scholar 

  • Geriatric Clinical Chemistry: Reference values, Part II Analytes, Faulkner WR, Meites S (ed) 1994, AACC Press, Washington, pp 332–333

    Google Scholar 

  • Ibs KH, Rink L (2001) The immune system in ageing. Z Gerontol Geriat 34: 480–485

    Article  CAS  Google Scholar 

  • Herrmann J, Heinen E, Kroll HJ, Rudorff KH, Kruskemper HL (1981) Thyroid function and thyroid hormone metabolism in elderly people. Low T3-syndrome in old age? Klin Wochenschr 58: 315–323

    Article  Google Scholar 

  • Magri F, Muzzoni B, Carvello L, Fioravanti M, Busconi L, Camozzi D, Vignati G, Ferrrari E, (2002) Thyroid function in physiological aging and in centenarians: possible relationship with some nutritional markers. Metabolism 51: 105–109

    Article  PubMed  CAS  Google Scholar 

  • Bianco AC, Salvatore D, Gerben B, Berry MJ, Larsen PR (2002) Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronine selenodeiodinases. Endocrine Reviews 32: 38–89

    Article  Google Scholar 

  • Friberg L, Drvota V, Bjelak AH, Eggertsen G, Ahnve S (2001) Association between increased level of reverse triiodothyronine and mortality after acute myocardial infarction. Am J Med 111: 699–703

    Article  PubMed  CAS  Google Scholar 

  • Peeters RP, Wouters PJ, van Toor H, Kaptein E, Visser TJ, Van den Berghe G (2005) Serum 3,3',5'-triiodothyronine (rT3) and 3,5,3'-triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodinase activities. J Clin Endocrinol Metab 90: 4559–4565

    Article  PubMed  CAS  Google Scholar 

  • Onder G, Landi F, Volpato S, Felin R, Carbonin P, Gamassi G, Bernabei R (2003) Serum cholesterol level and inhospital mortality in the elderly. Am J Med 115: 265–271

    Article  PubMed  CAS  Google Scholar 

  • Schalk BW, Visser M, Deeg DJ, Bouter LM (2004) Lower levels of serum albumin and total cholesterol and future decline in functional performance in older persons: the longitudinal aging study Amsterdam. Age Ageing 33: 26–272

    Article  Google Scholar 

  • Haller J, Löwik MRH, Ferry M, Ferro-Luzzi A (1994) Nutritional status: Blood Vitamins A, E, B6, B12, folic acid and carotene. Euronut SENECA Study on nutrition and health of the elderly in Europe. In: Geriatric Clinical Chemistry: Reference values, Faulkner WR, Meites S (ed) 1994, AACC Press, Washington, pp 73–116

    Google Scholar 

  • Dörner K, Kruse-Jarres JD (1992) Spurenelemente In: Labor und Diagnose, 4.Aufl. Lothar Thomas Hrsg., Die Medizinische Verlagsgesellschaft Marburg, PP: 407–426

  • Stauder R, Lange S, Spizo G (2005) Anemia in the elderly – a literature review and development of a diagnostic and therapeutic algorithm. Euro J Ger 7: 176–181

    Google Scholar 

  • Mitrache C, Passweg JR, Libura J, Petrikkos L, Seiler WO, Gratwohl A, Stählin HB, Tichelli A (2001) Anemia: an indicator for malnutrition in the elderly. Ann Hematol 80: 295–298

    Article  PubMed  CAS  Google Scholar 

  • Keenan JM, Morris DH (1993) How to make sure your older patients are getting enough zinc. Geriatrics 48: 57–65

    PubMed  CAS  Google Scholar 

  • Bogden JD (2004) Influence of zinc on immunity in the elderly. J Nutr Health Aging 8: 48–54

    PubMed  CAS  Google Scholar 

  • Henry OF, Biacher J, Verdavaine J, Duviquet M, Safar ME (2003) Alpha 1-acid glycoprotein is a predictor of inhospital death in the elderly. Age Ageing 32: 37–42

    Article  PubMed  Google Scholar 

  • Goichot B, Schlienger JL, Grunenberger F, Pardignac A, Aby MA (1995) Low cholesterol concentrations in freeliving elderly subjects: relations with dietary intake and nutritional status. Am J Clin Nutr 62: 547–553

    PubMed  CAS  Google Scholar 

  • Rudman D, Mattson DE, Nagraj HS, Feller AG, Jackson DL, Caindec N, Rudman IW (1998) Prognostic significance of serum cholesterol in nursing home men. JPEN J Parenteral Enteral Nutr 12: 155–158

    Article  Google Scholar 

  • Reunanen A, Knekt P, Marniemi J, Mäki J, Maatela J, Aromaa A (1996) Serum calcium, magnesium, copper and zinc and risk of cardiovascular death. Eur J Clin Nutr 50: 431–437

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sozialmedizinisches Zentrum Sophienspital, Wien, Austria

    Alexander Lapin

Authors
  1. Alexander Lapin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Lapin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lapin, A. Grenzen und Bedeutung der Labordiagnostik bei Mangelernährung im Alter. Wien Med Wochenschr 156, 142–148 (2006). https://doi.org/10.1007/s10354-006-0268-7

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10354-006-0268-7

Keywords

Schlüsselwörter

Search

Navigation