Undernutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism?

On the basis of triceps skinfold thickness and arm muscle circumference measurements, 744 elderly women with fractured neck of femur were divided into three groups--well nourished, thin, and very thin. The mortality in the three groups was 4.4%, 8%, and 18%, respectively. Differences were not explained by age, associated disease, dementia, or marital status. Food intake after injury was related to initial nutritional state. There was a midwinter peak in fracture incidence and also a pronounced seasonal variation in the type of patient admitted; a much higher proportion of thin patients presented in winter after accidents indoors. The hypothesis that thinness or under-nutrition may impair thermoregulation and predispose to hypothermia, lack of coordination, and accident was supported by core temperature measurements on admission: those in most very thin patients were less than 35 degrees C, whereas in most well-nourished patients they were greater than 36 degrees C.