Reply to Friedman

Abstract

To the Editor:—Dr. Friedman is correct in stating that severe protein calorie malnutrition is consistantly mirrored in an abnormal arm muscle area. Unfortunately, when malnutrition is so advanced, nutritional intervention is unlikely to succeed, as Dr. Friedman himself and his colleagues have demonstrated.1 In our article we state (page 224) that “anthropometric measurements are reliable indices of moderate malnutrition but are not sensitive enough to indentify early states of malnutrition when nutritional support may be quite effective”.2 The problem of diagnosing early malnutrition in the elderly is complicated by the wide range of variation in anthropometric indices in healthy elderly, reported by many studies quoted in our review (references 71–76). Thus, we cannot see any contradiction between Dr. Friedman's position and ours. We believe, however, that nutritional support may be more effective especially in the elderly if instituted early,3 and we do not believe anthropometric indices a sensitive enough detector of malnutrition to allow prompt initiation of nutritional therapy.