Effects of Wasting Malnutrition in Male and Female Elderly

To the Editor: — Morley and colleagues1 have aptly reported the fatal effect of severe muscle wasting on a sick elderly man. However, nowhere in their paper is a statement suggesting that the lethal consequences of wasting are confined to sick elderly men with severe muscle wasting. Instead the authors imply that women are equally susceptible to death from wasting, and that mild degrees of wasting such as a 10% weight loss from an initially normal body size are themselves dangerous. Three prospective studies2-4 have shown that severe muscle wasting, as defined by corrected arm muscle area below 16.9 cm2, is lethal to sick elderly men. The latter study demonstrated that controls matched by age, sex, disease type and severity (as assessed by an expert panel) survived significantly longer than severely wasted cases. All three studies failed to uncover any lethal effect of wasting upon sick women. Although Morley and colleagues did not supply arm muscle measurements for their reported case, a man of that height (170 cm) and weight (40 kg) would almost certainly have corrected arm muscle area below 16.9 cm2, the cutoff for lethal wasting in sick old men. Perhaps the author could report his arm anthropometric values? Paul J. Friedman, MD, FRACP Chairman of Geriatric Department Waikato Hospital Hamilton, New Zealand