Protein Energy Malnutrition Patients Research Articles

Impaired granulocyte formylpeptide-induced superoxide generation in chronically ill, malnourished, elderly patients.

Protein-energy malnutrition (PEM), often occurring in patients with chronic disease, is associated with a decreased capacity to combat infections. In this study we assessed polymorphonuclear neutrophil (PMN) superoxide anion (*O2-) formation in elderly PEM patients with various chronic diseases. Nineteen patients (75+/-1 years), with body mass index 17.1+/-0.4, and 19 age-matched healthy controls were included. Fourteen patients and 14 controls were re-examined in a 3 month follow-up. A service of internal medicine at a university-affiliated hospital. Eight patients were prescribed a dietary liquid supplementation during the observation period. Superoxide production in PMN induced by fMLP (a receptor ligand) and phorbol myristate acetate (PMA), which acts directly on protein kinase C. fMLP-induced superoxide generation in the malnourished patients was 55+/-5% of that of the controls. However, the patients retained their capacity, 108+/-6% of control PMN generation, to respond to PMA. In those who received formula supplementation, fMLP-generated *O2- production levels were 48+/-8 and 73+/-13% (P = 0.12) of those of controls at the start and after 3 months, respectively. Corresponding figures in those who were not prescribed supplementation were 57+/-8 and 64+/-4% (P = 0.55). Possibly contributing to reduced host defence, receptor ligand-induced PMN generation of *O2 is significantly lower in chronically ill, elderly patients with PEM than in age-matched healthy controls.

Adenosine deaminase activity in protein-energy malnutrition.

Cell-mediated immunity (CMI) was evaluated in 69 children with protein-energy malnutrition (PEM) and 20 healthy controls. Significantly decreased responses to purified protein derivative (PPD) (p < 0.02) and absolute lymphocyte count (ALC) (p < 0.01) and increased serum adenosine deaminase (ADA) activity (p < 0.001) were observed in PEM cases compared with the controls. The mean values of ALC and ADA activity in PEM patients were 85.9% and 158.7% of the normal mean, respectively. A significant negative correlation was observed between the two parameters (r=- 0.2765, p < 0.01). The CMI tests were abnormal in all three grades of PEM, except for the response to PPD in grade I, when compared with the controls. No significant differences were found between infected and uninfected PEM cases. Thus, impaired CMI was observed not only in grades II and III but also in grade I PEM patients and the concomitant infection did not affect its status. However, ADA activity demonstrated a more pronounced change than the other tests.

Adenosine deaminase activity in protein‐energy malnutrition

Cell‐mediated immunity (CMI) was evaluated in 69 children with protein‐energy malnutrition (PEM) and 20 healthy controls. Significantly decreased responses to purified protein derivative (PPD) (p &lt; 0.02) and absolute lymphocyte count (ALC) (p &lt; 0.01) and increased serum adenosine deaminase (ADA) activity (p &lt; 0.001) were observed in PEM cases compared with the controls. The mean values of ALC and ADA activity in PEM patients were 85.9% and 158.7% of the normal mean, respectively. A significant negative correlation was observed between the two parameters (r =−0.2765, p &lt; 0.01). The CMI tests were abnormal in all three grades of PEM, except for the response to PPD in grade I, when compared with the controls. No significant differences were found between infected and uninfected PEM cases. Thus, impaired CMI was observed not only in grades II and III but also in grade I PEM patients and the concomitant infection did not affect its status. However, ADA activity demonstrated a more pronounced change than the other tests

Blood sugar and serum insulin response in protein-energy malnutrition.

Blood sugar and serum insulin levels in the fasting state and following an oral glucose load in children with protein-energy malnutrition (PEM) were studied. Twenty-nine children with PEM (15 marasmus, 7 kwashiorkor, and 7 marasmic kwashiorkor) and eight healthy children aged between 6 and 60 months were the subjects of the study. Fasting samples were collected after a 6 h fast. Post-glucose samples were collected after an oral glucose load of 1.75 g/kg. Serum insulin was estimated by radioimmunoassay and glucose by the glucose oxidase method. In malnourished children, the mean fasting blood glucose levels were significantly lower. Two hours following an oral glucose load, only marasmus and marasmic kwashiorkor patients showed significantly higher blood glucose levels. Similarly, the fasting serum insulin levels were significantly lower in malnourished children. Two hours after the oral glucose load, serum insulin levels increased significantly in malnourished children but fell well short of the control values. The insulin:glucose ratio was consistently low in all cases but was more marked in PEM patients, both in the basal state as well as oral glucose loading

Plasma Vitamin A Levels in Measles and Malnourished Pediatric Patients and Their Implications in Therapeutics

Measles and protein energy malnutrition (PEM) in children have been associated with low serum retinol levels. Vitamin A supplementation has reduced mortality and morbidity significantly. The purpose of this study was to determine the effect of vitamin A supplementation on plasma retinol levels in children with these conditions. Black, African children, admitted to Ga-Rankuwa Hospital with measles or PEM, were randomly allocated to either a study or a control group. The study group received, in addition to routine treatment, 150,000 units of vitamin A palmitate IM on day 1 followed by 15,000 units orally for 7 days. The patients in the control group received routine appropriate treatment, which may have included 3000 units vitamin A per day. Retinol plasma concentrations of all patients were measured on days 1, 2, and 8. The mean baseline plasma retinol levels (day 1) of both the measles and PEM patients were lower than 11 micrograms/dl. There was a statistically significant increase in plasma levels in the study and control groups for both conditions by day 8 with the mean plasma retinol levels > 30 micrograms/dl. There was no statistically significant difference between study and control groups. This study has shown that there is a high incidence of baseline hyporetinaemia in these patients. The mean retinol plasma levels return to within normal limits after 8 days of either routine treatment or vitamin A supplementation.

The protein-energy malnourished child in a Nigerian teaching hospital.

Over a 5 year period January 1972 to December 1976 a total of 4624 patients were admitted to the pediatric wards of the University College Hospital Ibadan Nigeria. 203 of these patients were suffering from Protein Energy Malnutrition (PEM) 146 with kwashiorkor 33 with marasmic-kwashiorkor and 24 with marasmus. PEM patients have significantly lower electrolyte values than healthy Nigerian children. Their packed cell volumes were within the lower limits of normal values for health Nigerian children and a low immunization rate for communicable diseases was also observed. 28.3% gave a history of measles attack while 19.4% had chronic diarrhea during the period immediately before presentation with PEM. Hypothermia hypoglycemia and sepsis were not adequately documented on these patients an indication that they were less rigorously looked for than they ought to have been and are presumed to have contributed to the high mortality rate of 28%. Improved management of these patients while on the ward should include use of a low reading thermometer for detection of hypothermia use of dextrostix for quick bedside blood sugar estimation monitoring of packed cell volume or haemoglobin levels to watch for anemias and thorough screening for infection in addition to chest radiographs and tuberculin tests. Urine stool and blood cultures were incompletely carried out on the children in this study. (authors modified)

Transcobalamin II in protein-energy malnutrition among residents of the Kivu area.

Transcobalamin II, the crucial transport protein for vitamin B12, was measured in protein-energy malnutrition patients and healthy controls. No significant difference between these two groups was observed. Treated patients showed higher concentrations than those on admission. The striking observation was, however, that all African subjects studied in Lwiro, Zaïre, had very high transcobalamin II levels compared to Europeans living either in Brussels or in Lwiro, and compared to Africans living in Brussels. This observation seems therefore not simply related to genetic or to environmental factors. No evident explanation is yet available.

Oxidative haemolysis in protein malnutrition

A study of the haemolytic anaemia observed in protein-energy malnutrition (PEM) in Kivu disclosed the following results. The in vitro resistance to oxidative aggressions of PEM patients' erythrocytes was decreased: when incubated with acetylphenylhydrazine, a higher percentage of the cells showed Heinz bodies, as compared with erythrocytes of local controls. Normal or increased activities were found for certain erythrocyte enzymes involved in the detoxification of activated oxygen: glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase and glutathione reductase. The level of reduced glutathione was not decreased. Reduced activities were observed for two enzymes containing trace elements: glutathione peroxidase and Superoxide dismutase. It is suggested that the shortened erythrocyte lifespan observed in PEM patients corresponds to an oxidative process which results from the decrease of both enzyme activities. The hypothesis that depletion of trace elements could be responsible for the decreased activity of those enzymes is discussed.