Incidence of protein calorie malnutrition in the nursing home population

That nutritional parameters change with age is a well-known phenomenon. Physical activity, lean body mass, and metabolic rate all decline with increasing age. There has been little work regarding the nutritional assessment of geriatric nursing home patients to determine their nutritional status and to focus attention on their nutritional needs. The purpose of this study was to assess the nutritional status of the residents of two urban nursing homes. The nutritional status of 227 nursing home residents (mean age 72.2 years) was evaluated using biochemical and anthropometric measurements. Midarm muscle circumference, triceps skinfold thickness, weight, height, serum albumin, serum pre-albumin, serum retinol binding protein, and a complete blood count with differential were obtained. The evaluation of this data indicated that there was a 52% incidence of malnutrition. This can be broken down to: 24% hypoalbuminemic malnutrition, 19% Kwashiokor-Marasmus mix, and 9% Marasmus. Twenty-eight percent of all patients were anergic, and 76% of the patients were anemic. In conclusion, there appears to be far more documentable malnutrition than anticipated or previously reported in this population.     

Determination of thiamin status during protein calorie malnutrition in rats

To clarify the influence of protein calorie malnutrition (PCM) on thiamin metabolism in rats, the effects of three diets containing different amounts of protein and sucrose were evaluated by three tests in 20 young male Wistar rats equally divided into four groups. Three of the groups, the controls (group 1), those fed high protein (group 2), and one of the two groups fed a low protein diet (group 3), were fed ad libitum. A second group (group 4) on the same low protein diet was fed 40% less than that consumed by group 3, which consumed less than the controls or high protein rats because of poor appetite. The sucrose contents of the experimental diets were inversely related to the protein contents. Thiamin concentrations were determined in blood, brain, heart, liver, kidney and spleen, and in 24-hr urine and stools. Tissue transketolase activity (TTKA) was measured in brain and liver and in erythrocytes (ETKA), the latter in association with the thiamin pyrophosphate (TPP) effect. Malnutrition caused decreased 24-hr urinary thiamin excretion, decreased ETKA, with corresponding increased TPP effect and decreased TKA of brain. As tissue thiamin concentrations were not decreased, the results suggest that malnutrition causes functional thiamin deficiency.     

The effect of nutritional support on T-lymphocyte subpopulations in protein calorie malnutrition

T-lymphocyte subpopulations were measured in the two major types of adult malnutrition, adult marasmus and kwashiorkor-like hypoalbuminemic malnutrition. The population of T-cells (T3) and the percentage of both helper (T4) and suppressor (T8) T-cells were significantly (P less than .05) decreased in patients with kwashiorkor-like hypoalbuminemic malnutrition, but did not differ from control values in patients with adult marasmus. The ratio of helper T-cell (T4), to suppressor T-cells (T8) (range 1.2-1.6) did not vary from control values in either type of malnutrition. One week of nutritional support was not associated with a significant increase in any of the T lymphocyte subpopulations in either type of malnutrition. These T-cell subpopulation changes are consistent with the greater depression of cellular immune function seen in patients with metabolic stresses associated with kwashiorkor-like hypoalbuminemic malnutrition. With the increasing frequency in which abnormalities of T-cell subpopulations are being reported in various diseases, the coexistence of kwashiorkor-like hypoalbuminemic malnutrition should be noted for its potentially confounding effect.     

The effect of nutritional support on T-lymphocyte subpopulations in protein calorie malnutrition.

T-lymphocyte subpopulations were measured in the two major types of adult malnutrition, adult marasmus and kwashiorkor-like hypoalbuminemic malnutrition. The population of T-cells (T3) and the percentage of both helper (T4) and suppressor (T8) T-cells were significantly (P less than .05) decreased in patients with kwashiorkor-like hypoalbuminemic malnutrition, but did not differ from control values in patients with adult marasmus. The ratio of helper T-cell (T4), to suppressor T-cells (T8) (range 1.2-1.6) did not vary from control values in either type of malnutrition. One week of nutritional support was not associated with a significant increase in any of the T lymphocyte subpopulations in either type of malnutrition. These T-cell subpopulation changes are consistent with the greater depression of cellular immune function seen in patients with metabolic stresses associated with kwashiorkor-like hypoalbuminemic malnutrition. With the increasing frequency in which abnormalities of T-cell subpopulations are being reported in various diseases, the coexistence of kwashiorkor-like hypoalbuminemic malnutrition should be noted for its potentially confounding effect.     

Evaluation of various methods in the detection of protein calorie malnutrition (PCM) of early childhood

3 different anthropometric methods and clinical assessment were carried out on 82 children aged 1–5 years, to diagnose protein calorie malnutrition.The anthropometric methods used include measurements of weight-for-age, weight-for-height, mid-arm circumference and the use of a Quac stick. The results obtained showed close agreement between two methods, namely weight-for-height and mid-arm circumference measurements.The mid-arm circumference measurement proved to be the easiest, simplest and fastest method to employ in detecting protein calorie malnutrition among a population of children below the age of 5 years. A combination of mid-arm circumference and weight-for-height measurements is recommended for better and more accurate results.     

Subclinical protein malnutrition is a determinant of hyperhomocysteinemia

OBJECTIVES: Hyperhomocysteinemia is regarded as a public health problem of increasing importance likely to contribute to vascular disorders and premature mortality. Folate, cobalamin, pyridoxine, and riboflavin dietary deficiencies are currently regarded as causative factors. However, several investigations have indicated that the theory of vitamin B deprivation provides only a partial explanation for the observed abnormalities of sulfur-containing amino acids. We investigated the potential contributory role played by protein malnutrition. METHODS: For that purpose, three cohorts of 20 adult patients presenting stage I, II, and III goiter underwent careful medical history, dietary inquiry, and clinical examination. Their overall health and nutrition states were assessed with classic anthropometry, measurement of vitamin B blood parameters, visceral protein markers, essential amino acids, total homocysteine, and cystathionine. RESULTS: The concentrations of transthyretin, seven essential amino acids, and cystathionine progressively decreased as the thyroid gland increased. Methionine was the sole essential amino acid whose values did not change; total homocysteine was unique in that increased levels correlated negatively with transthyretin values. Taken together, the data point to a progressive deterioration of protein nutrition status impairing the transsulfuration pathway and is best explained by an acquired defect of cystathionine-beta-synthase activity. CONCLUSIONS: Hyperhomocysteinemia may arise from the shrinking of endogenous nitrogen pools as a result of decreased protein intake or stress-induced increased losses. Raised total homocysteine may result from the attempt of the malnourished and/or stressed body to preserve methionine homeostasis.     

Protein-calorie malnutrition in squirrel monkeys: adaptive response to calorie deficiency

Control, low-protein, low-calorie, and low-protein-plus-low-calorie diets were fed to 37, 14, 8, and 16 infant squirrel monkeys, respectively, from ages 2-8 wk. The deficient diets were planned to prevent growth and were designed to examine the short- and long-term effects of defined nutritional restrictions on body weight, food intake, hematocrit, plasma albumin, growth hormone, and cortisol concentrations. During the restriction period, plasma albumin levels were significantly decreased in both groups with a protein restriction component: plasma cortisol levels were significantly increased only in the low protein and low calorie groups. No significant group differences were observed for hematocrit or plasma growth hormone. Results of this study indicate that 1) energy restriction did not seem to modify the protein requirement for weight maintenance and 2) animals fed low-protein diets, even in the face of growth failure, have a mechanism for wasting energy.     

Detection of moderate protein-energy malnutrition in pre-school children

Several biochemical and anthropometric tests were used to define the states of mild or moderate protein-energy malnutrition among 810 children aged under five years in the forest region of Southern Cameroon. The results show that the percentage and the identity of children classified as undernourished may be different according to the anthropometric test employed. The mean values of most of the biochemical variables assayed decrease in the groups affected with moderate weight and arm deficiencies. A system is proposed for the evaluation of the nutritional status based on the simultaneous use of four anthropometric tests. Some biochemical parameters may be useful for establishing a diagnosis.     

The correctability of the nutritional,immune, and hematopoietic manifestations of protein calorie malnutrition in the elderly.

Protein calorie malnutrition is being recognized with greater frequency in the hospitalized patient. This report describes the clinical presentation and response to nutritional therapy in nine elderly malnourished patients ranging from 73 to 95 years. Clinical features of malnutrition include weight loss, confusion, hypoalbuminemia (mean 2.8 gm/dl), a low total iron binding capacity (TIBC) (mean 192 micrograms/dl), anergy, lymphocytopenia (mean 1 × 10(3) cells/microliter) and an anemia (mean 9.0 gm/dl). Our subjects were followed for 42 days. In two, hyperalimentation was achieved by voluntary food intake and polymeric dietary supplements. In seven, feeding for 21 days via nasogastric tube was required. After three weeks, weight gain, decreased confusion, improved appetite and mobility, and significant increases in serum albumin and TIBC were seen. At that time, no subject was anergic and lymphocyte counts increased significantly. Increase in the serum iron and percent saturation was noted, and by day 42, a significant elevation in the hemoglobin occurred. As a measure of stem cell function, the committed granulocyte/macrophage progenitor cell (CFU-C) was quantitated in four subjects prior to and following 21 days of nutritional support. A marked increase in CFU-C number from a mean of 0.1 × 10(7) cells/kg to a normal value of 0.85 × 10(7) cells/kg was seen. Thus in addition to correcting the nutritional deficit, hyperalimentation returned immune and hematopoietic abnormalities to near normal levels. While improvement could reflect recovery from an associated disease, it is just as likely that correction of malnutrition, a well-recognized cause of these immunologic and hematopoietic abnormalities, accounted for the response. These observations emphasize the importance of recognizing malnutrition in the elderly and highlight the need for a careful nutritional assessment prior to ascribing hematologic and immunologic abnormalities to the aging process.     

m-RNA translatability in the liver,brain and kidney of rats: Effect of protein calorie malnutrition in early life

The m-RNA level and its translational capacity were determined in the liver, brain and kidney of rats which had been exposed to under nutrition early in life. To achieve this objective, lactating females were divided into 2 groups 1 week after they gave birth to offspring. These control and experimental groups were made to suckle 8–11 and 13–16 pups, respectively, for a period of 2 weeks. The young of both groups were then killed and their livers, brains and kidneys were isolated. Polyadenylated RNA (poly A⁺ RNA) was fractionated by affinity chromatography on an oligo-dT-cellulose column. Poly A⁺ RNA content as well as the percentage of poly A⁺ RNA in relation to total RNA were both lower in the malnourished pups in comparison to the controls. Analysis of the in vitro translation product primed by poly A⁺ RNA of the liver, brain and kidney revealed a decrease of ³⁵S-methionine-incorporation in the liver and brain of the dietary-insulted offspring, the reduction being greater in the liver than in the brain. No significant variation was noted in the kidney of the control and PCM groups. Sodium dodecyl sulfatepolyacrylamide gel electrophoresis, autoradiography and densitometric autoradiographic tracings confirmed these findings and demonstrated that proteins were synthesized at a lower rate in the livers and brains of the malnourished rats than in the controls. These data indicate that malnutrition early in life modulates the metabolism of m-RNA and, consequently, protein synthesis in the liver, brain and kidney of rats.     

Parental history of moderate to severe infantile malnutrition is associated with cognitive deficits in their adult offspring

Objectives: We compared the IQ and academic achievement of the young adult offspring of parents malnourished in infancy and those of a healthy control group in order to test the hypothesis that the offspring of previously malnourished individuals would show IQ and academic deficits that could be related to reduced parental socioeconomic status.

Methods: We conducted a group comparison study based on a community sample in Barbados (Barbados Nutrition Study). Participants were adult children ≥16 years of age whose parents had been malnourished during the first year of life (n?=?64; Mean age 19.3 years; 42% male) or whose parents were healthy community controls (n?=?50; Mean age 19.7 years; 48% male). The primary outcome was estimated IQ (Wechsler Abbreviated Scale of Intelligence); a secondary outcome was academic achievement (Wide Range Achievement Test – Third Edition). Data were analyzed using PROC MIXED with and without adjusting for parental socioeconomic status (Hollingshead Index of Social Position).

Results: IQ was reduced in the offspring of previously malnourished parents relative to the offspring of controls (9.8 point deficit; P?Discussion: The deleterious impact of infant malnutrition on cognitive function may be transmitted to the next generation; however, this intergenerational effect does not appear to be explained by the reduced socioeconomic status or IQ of the parent generation.     

Prenatal protein malnutrition in rats enhances serotonin release from hippocampus.

The effect of prenatal protein malnutrition on central serotonin metabolism was assessed in 220- to 240-d-old male rats. The malnourished rats (denoted 6,25 group) were males born to dams fed a 6% casein diet during pregnancy and fostered at birth to dams fed a control (25% casein) diet. They were compared with males born to dams fed 25% casein diet. Tissue concentrations of serotonin, 5-hydroxyindoleacetic acid, 5-hydroxytryptophan, L-tryptophan and catecholamines in the hippocampal formation in the 6,25 group were similar to those of well-fed controls (25,25 group). However, a twofold greater basal serotonin efflux from hippocampal slices of 6,25 rats compared with slices from 25,25 rats was observed during a 20-min incubation period. Hippocampal [3H]paroxetine binding indicated that there was no alteration of apparent maximal binding and affinity of the serotonin transporter in the 6,25 rats. In addition, there was no difference in serotonin receptor binding in hippocampal membranes from 6,25 and 25,25 rats. The results indicate that prenatal protein malnutrition causes selective changes in central serotonin metabolism.     

The role of protein and calorie restriction in outcome from Salmonella infection in mice.

We studied the separate effects of protein and calorie restriction in mice challenged with Salmonella typhimurium, an intracellular pathogen eliminated by cell-mediated immunity. Female A/J mice (n = 73) were placed on one of eight solid diets for 3 weeks. Animals were weighed at the beginning and the end of the feeding period. Diets were adjusted by two factors. The total amount of protein in the diet was 1%, 5%, 20%, or 40% by weight. The diets were fed to half the mice in quantities of 3 g and to the other half at 1.5 g per mouse per day. At the end of 3 weeks, mice were injected intraperitoneally with bacteria and mortality was observed for 2 weeks. Mortality was related to protein intake and was significantly higher in the 1% and 5% groups (chi 2: p = .0021). However, mortality was lower in the calorie-restricted groups (chi 2: p = .0242). Although caloric intake did not affect cell-mediated immunity, the response to 2,4-dinitrofluorobenzene was greater in the low protein groups. Lymphoproliferative responses in the mixed lymphocyte response were not affected by either caloric or protein intake. Lymphoproliferative responses to both lipopolysaccharide and phytohemagglutinin were affected by dietary protein but not by caloric intake; proliferative responses were higher in the low-protein groups. We conclude that protein restriction can increase mortality in this model. On the other hand, short-term calorie restriction can improve survival.