title: Causes of death in forensic autopsy cases of malnourished persons.
abstract: OBJECTIVE
  Medical examiners and forensic pathologists often encounter emaciated bodies in postmortem examinations. However, the main disease that caused death is often not clear and measures to prevent the unexpected death of malnourished persons have not been established. In this study, we examined the underlying causes of death among a large number of forensic autopsy cases that showed emaciation to clarify the features of sudden, unexpected death in malnourished persons.
  
  
  METHODS
  Documents of autopsy cases without putrefaction handled during 2007-2010 by the Tokyo Medical Examiner's Office were reviewed (n=7227). The body mass index (BMI) was calculated for each case. The causes of death for cases with severe malnutrition (BMI<16; n=885) were closely examined.
  
  
  RESULTS
  About 70% of all deaths in malnourished cases (BMI<16) was due to disease, and the causative diseases are more varied than in those with less severe malnutrition and those without malnutrition (BMI⩾16). A higher proportion of malnutrition as the cause of death was observed in younger persons for both sexes, and a higher proportion of having a history of psychiatric diseases was observed in younger deceased women. In addition, a higher proportion of alcohol-related digestive diseases was observed especially in younger men, some of whom had a history of alcohol dependence. On the other hand, the proportion of organic diseases, such as neoplasms and gastroduodenal ulcer, was higher in older deceased persons, especially among men. Around 70% of all respiratory diseases comprised pneumonia in both sexes. Among non-disease-related causes of death, poisoning was the most frequent cause in women under 55years old (35.3%), with the majority having had a history of psychiatric disease.
  
  
  CONCLUSIONS
  Because autopsy cases of malnourished persons show various causes of death, physicians have to pay more attention in making death diagnosis in such cases. From a preventative point of view, early detection of organic diseases, a better approach toward managing psychiatric diseases, and implementation of vaccination for pneumonia will contribute to reduction of future unexpected deaths among malnourished persons.
authors.affiliation: Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, 4-21-18 Otsuka, Bunkyo-ku, Tokyo, Japan. hideto-@qk9.so-net.ne.jp
authors.forename: Hideto
authors.initials: H
authors.lastname: Suzuki
authors.forename: Takanobu
authors.initials: T
authors.lastname: Tanifuji
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Abe
authors.forename: Tatsushige
authors.initials: T
authors.lastname: Fukunaga
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D015992:Body Mass Index; D002423:Cause of Death; D015897:Comorbidity; D004614:Emaciation / Q000150:complications / Q000209:etiology / Q000401:mortality*; D005260:Female; D049429:Forensic Pathology / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000209:etiology / Q000401:mortality*; D008875:Middle Aged; D017678:Sex Distribution; D055815:Young Adult