Lab Half-Life Normal Mild Moderate Severe
Albumin (mg/dL) 21 days 3.5-5.0 2.8-3.5 2.1-2.7 <2.1
Transferrin (mg/dL) 8-9 days 200-400 150-200 100-150 <100
Prealbumin (mg/dL) 2 days 16-30 10-15 5-10 <5
Total Lymphcyte count       <1,500/mm3  
Zinc       <95 μg/dL  

BMI <18; BMI is calculated using the equation Wt (kg)/ht (m2).


  • transferrin levels less than 200 mg/dL, albumin less than 3.5 g/dL, or a total lymphocyte count less than 1500 cells/mm3.
  • Patients that are malnourished have a 5-7x higher risk of major wound complications.
  • Obese patients are also commonly defienct in Vitamin D (92.9%) and iron (36.2% to 56.9%).
  • Mordidly obese (BMI) and IDDM patients are at high risk of being malnourished @10% (Schneider AM, JAAOS2021;29:673-680)
  • Dietary protein has been the primary modifiable intervention.  Nutition intervention with high protein, antiinflammatory diet has demonstrated shoterf hospital stay, lower initial and readmission costs and lower 90-day total charges. (Schroer WC, Bone oint J 2019;101-B(7-supple-C):17-21)
  • Vitamin A, C, and D, zinc, and copper supplementation has also been associated with improved outcomes.

Serum albumin

  • <3.5 g/dL associated with poor surgical outcome, unfavorable prognosis, increased cost
    <2.5 g/dL associated with increased rates of morbidity and mortality.
Malnutrition References
  • Wagner ER, Kamath AF, Fruth KM, Harmsen WS, Berry DJ. Effect of Body Mass Index on Complications and Reoperations After Total Hip Arthroplasty. JBJS 2016.
  • Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle, CJ. Evaluation of Malnutrition in Orthopaedic Surgery. J Am Acad Orthop Surg 2014.
  • Huang R, Greenky M, Kerr GJ, Austin MS, Parvizi J. The Effect of Malnutrition on Patients Undergoing Elective Joint Arthroplasty. J of Arthroplasty 2013.