Abstract
BackgroundThe aim of this study was to evaluate markers of inflammation, oxidative stress and endothelial function in a disease-related malnutrition (DRM) outpatient population.MethodsFor this cross-sectional study, a total of 83 subjects were included and clustered in 3 groups: 34 with normonutrition (NN), 21 with DRM without inflammation (DRM-I) and 28 with DRM and inflammation (DRM + I). Nutritional diagnosis was conducted for all subjects according to ASPEN. Biochemical parameters, proinflammatory cytokines, reactive oxygen species production, glutathione, mitochondrial membrane potential, oxygen consumption, adhesion molecules and leukocyte-endothelium interactions were evaluated.ResultsDRM + I patients showed lower albumin, prealbumin, transferrin, and retinol-binding protein levels with respect to the NN group (p < 0.05), differences that were less noticeable in the DRM-I group. DRM + I was associated with a significant increase in hsCRP and IL6 vs the NN and DRM-I groups, and TNFα was increased in both DRM vs NN. DRM was characterised by increased oxidative stress, which was marked by a significant increase in ROS levels and a decrease in mitochondrial membrane potential in the DRM + I group. An evident reduction in mitochondrial oxygen consumption and glutathione concentration was observed in both DRM groups, and was accompanied by increased leukocyte adhesion and adhesion molecules and decreased rolling velocity in the DRM + I group. Furthermore, percentage of weight loss was negatively correlated with albumin, prealbumin, transferrin, O2 consumption, glutathione and leukocyte rolling velocity, and positively correlated with hsCRP, IL6, TNFα, ROS, leukocyte adhesion, and VCAM-1.ConclusionsOur results show that DRM is associated with oxidative stress and an inflammatory state, with a deterioration of endothelial dysfunction in the DRM + I population.
Highlights
The aim of this study was to evaluate markers of inflammation, oxidative stress and endothelial function in a disease-related malnutrition (DRM) outpatient population
Patients were categorized based on the recent diagnostic consensus of malnutrition, employing the following etiology- based terminology: malnutrition without inflammation or DRM without inflammation (DRM-I); patients with anorexia; mechanic or neurologic dysphagia, in which inflammation was not the main cause of malnutrition; malnutrition with inflammation or DRM + I; and patients with chronic disease-related malnutrition and acute disease or injuryrelated malnutrition, neoplasm, inflammatory bowel disease or chronic obstructive pulmonary disease (COPD), in which the disease and the chronic underlying inflammation played an active role in their nutritional status [18]
The DRM + I group was comprised of patients with neoplasm, chronic obstructive pulmonary disease, ulcerative colitis, pneumonia, chronic renal disease and Crohn disease, while the DRM-I group included the rest of the patients
Summary
The aim of this study was to evaluate markers of inflammation, oxidative stress and endothelial function in a disease-related malnutrition (DRM) outpatient population. It has been demonstrated that malnutrition per se and DRM may involve insufficient intake of antioxidants and trace elements that are cofactors of antioxidant systems, as well as low levels of glutathione (GSH) [7, 8]. In this context, the malnutrition present during anorexia nervosa is characterised by mitochondrial dysfunction and oxidative stress in peripheral blood leukocytes at the level of the mitochondrial complex I [9]. Regarding the relationship between ROS and nutrition, it has been determined that there is a higher level of free radicals and lower antioxidant levels in protein-undernourished patients than in an adequately nourished population [7]
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