Malnutrition

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).

Malnutrition:  

• 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.