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.     

The bound carbohydrates of fractionated serum proteins in protein-calorie malnutrition.

Alterations in the carbohydrate composition of serum protein fractions have been determined in pooled sera from 35 children with protein-calorie malnutrition (PCM), 30 children treated for PCM, and 24 age- and social status-matched controls. Total protein-bound hexose (PBH), protein-bound sialic acid (PBSA), and protein-bound fucose (PBF) were elevated in PCM, but only PBF returned to control levels with treatment. Ratios of bound carbohydrate to protein in the unfractioned serum were elevated in PCM but PBH and PBF protein or globulin ratios returned to normal with treatment. The most marked change in carbohydrate composition occurred in the alpha1-globulin fraction. Molar ratios in the individual globulin fractions indicated an increase in carbohydrate moieties as follows: PBSA greater than PBH greater than PBF.     

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.     

Serum proteinase inhibitors and other serum proteins in protein-energy malnutrition.

1. The concentrations of serum protein albumin, prealbumin and transferrin were determined in twenty-eight cases of protein-energy malnutrition (PEM) with infection, together with the levels of serum proteinase inhibitors (PI), alpha1-antitrypsin (AT), alpha1-antichymotrypsin (Ach), alpha2-macroglobulin (alpha2M) and inter-alpha-trypsin inhibitor (IalphaI). 2. Albumin, prealbumin and transferrin concentrations, as well as the levels of PI, IalphaI and alpha2M were found to be lower in cases of PEM associated with infection than the corresponding values for a group of healthy Thai preschool children and a group of newborn Thai children, but despite starvation AT and Ach values generally were increased. 3. The results provide support for the hypothesis that PI, especially AT and Ach might limit the synthesis of albumin, prealbumin and transferrin in PEM associated with infection, via the inhibition of the mobilization of body's own protein.     

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.     

Cardiac beta-adrenergic responsiveness is well preserved in moderate protein calorie malnutrition from semistarvation

Twenty-one dogs underwent instrumentation of the left ventricle with ultrasonic dimension to study the effects of acute protein-calorie malnutrition on the adrenergic responsiveness of the heart. This study allowed a chronic and dynamic measurement of the major cardiac axes and the ventricular wall thickness, which in turn can be used to derive sophisticated measurements of global and intrinsic left ventricular function. Of the 21 dogs, 11 received a protein- and calorie-deficient diet designed to achieve a mean weight loss from a baseline of 20-25% over a 4-week period. The other 10 dogs received a normal diet. Dogs were also randomized to receive either acute propranolol beta-receptor blockade (n = 9) or acute isoproterenol beta-receptor stimulation (n = 12) during their baseline studies. Of the nine dogs given propranolol, five were subsequently malnourished and four served as controls. Of the 12 given isoproterenol, six were rendered malnourished and six were controls. All dogs were studied at both baseline and 4 weeks and received drugs in an identical fashion during both studies. The significant changes with malnutrition consisted of decreases in heart rate, cardiac mass, and left ventricular wall thickness. The degree of change in stroke volume, ejection fraction, cardiac output, dp/dt, and Emax (index of left ventricular contractility), with the administration of propranolol or isoproterenol was unaltered by malnutrition. These data support the contention that moderate protein-calorie malnutrition is well tolerated in instrumented, unstessed dogs and that the left ventricle's capacity to respond to beta-stimulation and to tolerate beta-blockade is largely unimpaired.     

The influence of nutritional supplement drinks on providing adequate calorie and protein intake in older adults with dementia

Objectives

Investigate the impact of the provision of ONS on protein and energy intake from food and ability to meet protein and calorie requirements in people with dementia.

Design

After consent by proxy was obtained, participants took part in a cross over study comparing oral intake on an intervention day to an adjacent control day.

Setting

The study occurred in Nursing homes and hospitalised settings.

Participants

Older adults with dementia over the age of 65 were recruited. 26 participants (aged 83.98.4years, MMSE 13.088.13) took part.

Intervention (if any)

On the intervention day nutritional supplement drinks were provided three times. Each drink provided 283.341.8 Kcal of energy and 13.84.7g of protein. Supplements were removed approximately 1 hour before meals were served and weighed waste (g) was obtained.

Measurements

Intake of food consumed was determined on intervention and control days using the quartile method (none, quarter, half, three quarters, all) for each meal component.

Results

More people achieved their energy and protein requirements with the supplement drink intervention with no sufficient impact on habitual food consumption.

Conclusion

Findings from these 26 participants with dementia indicate that supplement drinks may be beneficial in reducing the prevalence of malnutrition within the group as more people meet their nutritional requirements. As the provision of supplement drinks is also demonstrated to have an additive effect to consumption of habitual foods these can be used alongside other measures to also improve oral intake.     

Studies on the significance of hair root protein and DNA in protein-calorie malnutrition.

Hair root protein and DNA, serum nonessential amino acid/essential amino acid ratio, serum total protein, albumin, globulin and albumin/globulin ratio were estimated in children suffering from portein-calorie malnutrition (PCM) and the values compared to those obtained from healthy children. The data were presented in two ways: 1) classified as early malnutrition, marasmus, marasmic kwashiorkor, or kwasiorkor and the parameters compared 2) all the malnourished children were divided into four groups on the basis of percentage of body weight for age and the parameters compared. There was a progressive decrease in the content of hair root DNA and protein with the severity of PCM with these values decreasing to less than half of the normal values. In all types of PCM the serum albumin decreased significantly and the globulin increased while the total protein was altered only in the more severe stages. Differences in the serum consituents between groups were more pronounced when classified clinically than when grouped as percentage of normal body weight. Since hair root changes are progressive and of greater magnitude than those in the serum, hair root DNA and proteins might be useful chemical criteria in detectinc various stages of PCM, and further to help understand the pathogenesis of the condition.     

The influence of restricted calorie intake on peritoneal macrophage function

Malnutrition leads to immune dysfunction with greatly increased morbidity. However, restrictive dietary regimens are also known to preserve immune function in autoimmune-susceptible mice. The macrophage (M?) is central to both immune effector and autoregulatory functions and is critical to host-defense mechanisms. The aim of this study was to investigate the effect of calorie restriction on M? functions in mice. Female, 6- to 8-wk-old, Swiss Webster mice were randomized to ad libitum feeding for 7 or 21 d (n = 10 mice/group), restricted feeding (13.5 to 14.0 g/cage/d; n = 10) for 7 d, or restricted feeding (16.5 to 17.0 g/cage/d; n = 10) for 21 d. These restrictions were equivalent to a decrease in calorie intake of 21.9% and 5.1%, respectively, over 7 and 21 d. All mice were allowed free access to water. On days 8 and 22, respectively, the mice were killed, and peritoneal M?s were isolated by lavage and adhered to 96-well polystyrene tissue-culture-treated plates. After stimulation with lipopolysaccharide, supernatant prostaglandin E2 and interleukin-6 levels were measured by enzyme-linked immunosorbent assay. Supernatant NO2- in response to stimulation with lipopolysaccharide and interferon-gamma was determined by the Greiss reaction. Prostaglandin E2 production was significantly elevated in peritoneal M?s from the calorie-restricted mice compared with the ad-libitum-fed mice after 7 d. After 21 d, production of both prostaglandin E2 and nitric oxide was significantly increased (P < 0.05) in peritoneal M?s from the restricted mice compared with the ad-libitum-fed mice. These results indicate that calorie restriction influences immune function by altering prostaglandin E2 and nitric oxide generation by M?s.     

The activity of serum ribonuclease in protein-energy malnutrition.

Serum alkaline ribonuclease activity and serum albumin concentration were determined in 25 normal children and 59 children with protein-energy malnutrition. The increase in serum ribonuclease was marked in marasmus and marasmic kwashiorkor. The ribonuclease activity dropped significantly after two weeks of treatment and returned to normal by four weeks. In kwashiorkor, serum ribonuclease activity was significantly lower than control and returned to normal after four weeks of treatment. These findings support previous observations that the serum ribonuclease is a good criterion of the nutritional status and indicates that the enzyme activity, particularly when related to serum albumin, is a good prognostic index in this respect.