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  • Serum albumin <3.0 g/dl and total lymphocyte count (TLC) <1500 both correlate with poor healing. (Dickhaut SC, JBJS 1984; 66A:71)
  • Markers of malnutrition: albumin (lhalf-life=21days, transferrin(half-life 8days), prealbumin(half-life 2 days.)
  • Patients with poor nutritional status should be evaluated for dietary supplementation before surgery to maximize healing.
  • Cachetic apperance, temproal wasting, ascities, poor dentition indicated severe malnutrition.


  • Recommended fluid intake should begin 4 hours before training, with a goal of drinking 5to7 mL per kg of body weight of either water or a sports beverage. (Sawka MN, Med Sci Sports Exerc 2007;39(2): 377).
  • Current recommended caloric intake by  US Department of Health and Human Services:  2,000 calories per day (a minimum of 1,200 cal/day for women and 1,800 cal/day for men). For athletes, the caloric intake is much higher; men=up to 4,000 to 5,000 cal/day, women= up to 2,000 to 3,000 cal/day.
  • Dietary Guidelines see
  • Banned supplements can be identified by the World Anti-Doping Agency at http://www.wada-


  • naturally occurring substance; stimulates the central nervous system
  • may decrease the perception of effort
  • NCAA will ban any athlete with a caffeine level in urine higher than 15 μg/mL. 


  • Improves performance in high-intensity activities, such as sprinting and weight lifting. (Baird MF,  J Nutr Metab 2012).
  • Adverse effects include fluid gain, cramps, nausea, and diarrhea. 
  • Currently considered safe for healthy adults.
  • Patients treated for fractures and dislocations with any sign of malnutrition according to the MUST score were more than twice as likely to acquire some combination of infection, venous thromboembolism, respiratory failure, or other reason for readmission than those of normal nutritional status. (Lee, James, JOT, 2015:29;8 373–378)