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PubMed1998

Induction and modulation of acute-phase response by protein malnutrition in rats: comparative effect of systemic and localized inflammation on interleukin-6 and acute-phase protein synthesis.

The acute-phase protein (APP) response is regulated by cytokines such as interleukin-6 (IL-6), interleukin-1 (IL-1) and tumor necrosis factor (TNF), but may also be influenced by malnutrition. The aims of this study were as follows: 1) to determine in rats the effect of a protein-deficient diet on IL-6 mRNA expression in intestine, liver and peripheral blood mononuclear cells (PBMC), and on alpha-1 acid glycoprotein (AGP) and alpha-2 macroglobulin (A2M) serum levels and hepatic mRNA expression; 2) to compare, in protein-deficient rats, the IL-6 and APP responses after a turpentine (TO)- or a lipopolysaccharide (LPS)-induced inflammation; and 3) to determine the effect of a protein malnutrition on IL-6 mRNA expression in rat PBMC treated ex vivo with LPS. Interleukin-6 mRNA was present in intestine and PBMC but not in the liver of malnourished rats, and was absent in any tissue or cells of controls. A2M was present in the serum from malnourished rats but not after refeeding. AGP mRNA expression was not influenced by protein malnutrition. In malnourished rats, IL-6 serum level peaked later than in controls after TO and LPS treatment. In malnourished TO-treated rats, A2M mRNA increased earlier than in controls and remained detectable later than in controls. AGP mRNA expression after TO was not influenced by protein malnutrition. In PBMC of malnourished rats, LPS-induced IL-6 mRNA expression occurred earlier and lasted longer than in controls. Our results indicate that protein malnutrition by itself induces IL-6 and A2M expression, and that it modulates the APP response to inflammation.

Acute-Phase Proteins↗
PubMed1990

Effects of postweaning protein malnutrition on intestinal inositol phosphatase activities in normally weaned and neonatally undernourished rats.

Postweaning protein malnutrition imposed on normally weaned or neonatally undernourished rats fed a low-protein diet induced retardation of body and small intestinal growth. A sparing effect on intestinal growth as compared to body growth was observed during protein malnutrition. Postweaning protein malnutrition in normally weaned rats resulted in a significant elevation of specific activities of inositol triphosphatase and phytase in duodenum and jejunum without affecting the activity in ileum. On the other hand, protein malnutrition imposed on neonatally undernourished rats resulted in a significant decrease of enzyme activities in small intestinal segments. These results suggest altered activity of intestinal inositol phosphatase in postweaning protein malnutrition with the direction of effects dependent on the neonatal nutritional status.

6-Phytase↗
PubMed1984

Malnutrition and immunocompetence in older and younger outpatients.

To determine the relationship between malnutrition and immune status in older and younger outpatients, we assessed 179 outpatient men according to nine markers of malnutrition and assigned them to a well nourished or a malnourished group. Immune status was measured by mixed lymphocyte culture, lymphocyte response to three mitogens, neutrophil chemotaxis, and immunoglobulin levels. Each group was further divided into those 65 years and older (28%) and those younger than 65 years (72%). Malnutrition was present in 29% of the younger group and 38% of the older. Malnourished patients had less lymphocyte response to allogeneic cells and to phytohemagglutinin, but more response to pokeweed and higher IgA levels. In the younger group chemotaxis results showed that malnourished persons had higher responses than well nourished; the trend was opposite in the older group. More differences in immune status were found between malnourished and well nourished than between old and young, but more unfavorable responses were found in the older malnourished than in any other group. The study suggests that malnutrition is common among outpatients and that depressed immune responses associated with malnutrition can lead to disease, particularly in the elderly.

Age Factors↗
PubMed2006

The effect of childhood malnutrition on externalizing behavior.

PURPOSE OF REVIEW: Childhood externalizing behavior (aggression, hyperactivity, and conduct disorder) has been increasingly viewed as a public health problem because of its etiology and outcome. The association between malnutrition and externalizing behavior has begun to receive attention. This review summarizes recent empirical findings on malnutrition as a risk factor for the development of externalizing behavior, with an emphasis on micronutrient deficiency, and explores brain dysfunction as a possible mechanism. RECENT FINDINGS: Externalizing behavior is associated with both macromalnutrition (e.g. protein) and micromalnutrition (e.g. iron and zinc). Both prenatal and postnatal malnutrition is implicated. The long-term effects of malnutrition on behavior could be reversible. The effects of docosahexaenoic acid/omega-3 long-chain essential fatty acid on externalizing behavior are more mixed. From animal and human findings, it is hypothesized that malnutrition impairs neurocognitive functioning by reducing neurons, alternating neurotransmitter functioning, and increasing neurotoxicity, and that such neurocognitive impairments predispose to externalizing behavior. SUMMARY: Different lines of evidence support the view that poor nutrition contributes to the development of child behavior problems. More randomized, controlled trials that manipulate nutritional intake and evaluate behavior in children are needed to evaluate the etiological role of nutrition in externalizing behavior in order to inform intervention and prevention efforts.

Child↗
PubMed2006

Critical appraisal of the management of severe malnutrition: 3. Complications.

The high case-fatality of severe malnutrition is due to infections, dehydration, electrolyte disturbances and heart failure. We focus on the evidence about managing these complications of severe malnutrition. Signs of circulatory collapse in severely malnourished children should be treated with intravenous or bone marrow infusion of Ringer's lactate with additional dextrose and potassium at a rate 20-40 mL/kg fast with close monitoring of vital signs. Recommendations for slow or restricted fluids in the face of shock are unsafe, and hypotonic or maintenance solutions must be avoided to prevent hyponatraemia. However, the evidence that severely malnourished children do not tolerate excessive fluid administration is good, so caution must be exercised with regards to fluids in the initial phase of treatment. There is also good evidence that wide spectrum antibiotics need to be given empirically for severe malnutrition to prevent the otherwise unavoidable early mortality. There is a need for improved protocols for tuberculosis diagnosis, HIV management and treatment of infants under 6 months with severe malnutrition. The contribution of environmental enteropathy to poor growth and nutrition during the weaning period means that there should be more priority on improving environmental health, particularly better hygiene and less overcrowding. A T-cell mediated enteropathy contributes to growth failure and malnutrition, and it is related to environmental contamination of enteric organisms in the weaning period rather than allergic responses.

Child↗
PubMed2006

The impact of malnutrition on survival and the CD4 count response in HIV-infected patients starting antiretroviral therapy.

BACKGROUND: The impact that malnutrition at the time of starting antiretroviral therapy (ART) has on survival and the CD4 count response is not known. METHODS: A retrospective cohort study of patients attending the national HIV referral centre in Singapore who had a CD4 count less than 250 cells/microL and a measurement of body weight performed at the time of starting ART was carried out. Demographic and clinical variables were extracted from an existing database. Body mass index (BMI) was calculated from the weight in kilograms divided by the square of the height in metres. Moderate to severe malnutrition was defined as BMI less than 17 kg/m(2). Intent-to-treat Cox models were used to determine the predictors of survival. RESULTS: A total of 394 patients were included in the analysis, of whom 79 died during a median study follow-up of 2.4 years. Moderate to severe malnutrition was present in 16% of patients at the time of starting ART, and was found to be a significant independent predictor of death [hazard ratio (HR) 2.19, 95% confidence interval (CI) 1.29-3.73, P=0.004 for those with BMI<17 compared with those with BMI>18.5] as were stage of disease (HR 2.47, 95% CI 1.20-5.07, P=0.014 for those who were at stage C compared with those at stage A) and the type of ART [HR 0.50, 95% CI 0.27-0.93, P=0.03 for highly active antiretroviral therapy (HAART) compared with non-HAART treatment]. Malnutrition did not impair the magnitude of the increase in CD4 count at 6 or 12 months. CONCLUSIONS: Malnutrition at the time of starting ART was significantly associated with decreased survival, but the effect appeared not to be mediated by impaired immune reconstitution. Given the increasing access to ART in developing countries and the high frequency of HIV-associated wasting, studies of nutritional therapy as an adjunct to the initiation of HAART are urgently needed.

Adult↗
PubMed1990

Malnutrition in patients with AIDS.

Malnutrition is a frequent problem in persons infected with the human immunodeficiency virus. The origin of malnutrition in patients with AIDS may be multifactorial. The primary mechanisms include disorders of food intake, alterations in intermediary metabolism, and nutrient malabsorption. Attention to the problems of malnutrition in patients with AIDS is of paramount importance because the timing of death in these patients may be more closely related to degree of body cell mass depletion than to any specific underlying infection. Nutritional support can improve nutritional status in selected patients, and repletion of body cell mass may be associated with functional improvement. Early assessment, attention to nutritional requirements, and prompt intervention can minimize wasting and replete body cell mass. This article examines the evidence for malnutrition in patients with AIDS, reviews the studies of nutritional support, and presents an approach to the management of malnutrition in AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Malnutrition impairs alveolar fluid clearance in rat lungs.

Inadequate nutrition complicates the clinical course of critically ill patients, and many of these patients develop pulmonary edema. However, little is known about the effect of malnutrition on the mechanisms that resolve alveolar edema. Therefore, we studied the mechanisms responsible for the decrease in alveolar fluid clearance in rats exposed to malnutrition. Rats were allowed access to water, but not to food, for 120 h. Then, the left and right lungs were isolated for the measurement of lung water volume and alveolar fluid clearance, respectively. The rate of alveolar fluid clearance was measured by the progressive increase in the concentration of Evans blue dye that was instilled into the distal air spaces with an isosmolar 5% albumin solution over 1 h. Malnutrition decreased alveolar fluid clearance by 38% compared with controls. Amiloride (10(-3) M) abolished alveolar fluid clearance in malnourished rats. Either refeeding for 120 h following nutritional deprivation for 120 h or an oral supply of sodium glutamate during nutritional deprivation for 120 h restored alveolar fluid clearance to 91 and 86% of normal, respectively. Dibutyryl-cGMP, a cyclic nucleotide-gated cation channel agonist, increased alveolar fluid clearance in malnourished rats supplied with sodium glutamate. Terbutaline, a beta(2)-adrenergic agonist, increased alveolar fluid clearance in rats under all conditions (control, malnutrition, refeeding, and glutamate-treated). These results indicate that malnutrition impairs primarily amiloride-insensitive and dibutyryl-cGMP-sensitive alveolar fluid clearance, but this effect is partially reversible by refeeding, treatment with sodium glutamate, or beta-adrenergic agonist therapy.

Adenosine Triphosphate↗
PubMed2006

[Heart failure, malnutrition and inflammation. Prevalence and relevant aspects in its assessment].

UNLABELLED: Heart failure is associated to alterations in the nutritional status that contributes to a worse prognosis of the disease. OBJECTIVE: To study protein-calorie malnutrition (PEM) prevalence, micronutrient deficits and increase of inflammatory parameters in patients with cardiac failure (CF). MATERIAL AND METHODS: Cross-sectional, observational study in 98 heart failure patients of Internal Medicine Service have been evaluated. We have analyzed biomedical, anthropometric variables (weight, size, BMI, tricipital fold), search of treatments, echocardiogram valuation and determination of albumin, pre-albumin, A and E group vitamins, ESR and C-reactive protein. We have defined protein malnutrition (PN) as albumin values RESULTS: Average age was 76.6 +/- 7.5. A total of 77.7% showed a functional class II-III/IV. Prevalence of PEM was 40%. Low albumin and prealbumin was found in 12.8% and 38.3% respectively (p < 0.05). Using BMI, 5.3% of patients had malnutrition. Nevertheless, if tricipital fold is used, EM was found in the 25.3% of the cases (p < 0.05). Iron iron, vitamin A and C-reactive protein levels were different in heart failure patients with PM (p < 0.05). The percentage of protein malnutrition in patients with LVEF < 45% was 16.4% versus 5.5% in diastolic dysfunction (p = 0.01). Treatment with ACE-inhibitors was 42.2%; in this group the malnutrition for any criterion was 13% vs 26% in the group of patients without ACE-inhibitors (p = 0.08). CONCLUSIONS: There is a high prevalence of nutritional and inflammatory disturbances (low in diastolic dysfunction) in patients with moderate status of heart failure. Treatment with an ACE-inhibitor improves the nutritional parameters.

Aged↗
PubMed2000

Hyperleptinemia is not correlated with markers of protein malnutrition in chronic renal failure. A cross-sectional study in predialysis, peritoneal dialysis and hemodialysis patients.

BACKGROUND: Serum leptin levels are increased in chronic renal failure (CRF) and may potentially contribute to protein malnutrition in this disorder. METHOD: Following a cross-sectional design, we performed a nutritional survey in a wide sample of uremic patients treated conservatively (n = 87), with peritoneal dialysis (n = 71) and with hemodialysis (n = 53). Then, we analyzed the correlation between serum leptin levels and markers of protein malnutrition. We used a multivariate approach, taking into consideration the confounding effect of other factors on the correlation between hyperleptinemia and protein malnutrition. MAIN RESULTS: Both univariate and multivariate analysis disclosed a poor correlation between hyperleptinemia and markers of protein malnutrition. In fact, there were trends to a positive correlation between leptinemia and body protein stores, as estimated from the scrutinized markers. Persistence of the basic correlation between general intake, fat mass and leptin in CRF could partially explain these findings, but neither a negative correlation between leptin levels nor protein nutritional state could be disclosed after controlling for this factor. CONCLUSIONS: Our results do not support a first-line role for hyperleptinemia in the genesis of protein malnutrition of uremia.

Adult↗
PubMed1992

Salivary flow and dental caries in Indian children suffering from chronic malnutrition.

Chronic protein-energy malnutrition during the period of growth and development causes permanent disturbances of salivary gland function and tooth structure. Moderate protein-energy deficiency also causes impaired saliva secretion rate and composition in the adult rat. These impairments have been shown to coincide with an increased incidence of dental caries. In the present investigation we studied the effect of chronic malnutrition on saliva secretion rate and susceptibility to dental caries in Indian children. It was found that chronic malnutrition reduced the secretion rate of stimulated saliva, but not that of unstimulated saliva. The salivary buffer capacity was continuously decreased as the secretion rate decreased with the level of malnutrition in the Indian children. The malnourished children developed increased caries. Thus, it could be concluded that chronic malnutrition in growing children enhances the cariogenic potential stemming from fermentable carbohydrates.

Body Height↗
PubMed1998

Prenatal malnutrition-induced changes in blood pressure: dissociation of stress and nonstress responses using radiotelemetry.

A link between prenatal malnutrition and hypertension in human populations has recently been proposed. Rat models of prenatal malnutrition have provided major support for this theory on the basis of tail-cuff measurements. However, this technique requires restraint and elevated temperature, both potential sources of stress. To determine the effect of prenatal protein malnutrition on blood pressure under nonstress conditions, 24-hour radiotelemetric measurements were taken in the home cage. Male rats born to dams fed a 6% casein diet for 5 weeks before mating and throughout pregnancy were studied in early adulthood (from 96 days of age). During the waking phase of their cycle but not the sleep phase, prenatal malnutrition gave rise to small but significant elevations of diastolic blood pressure and heart rate compared with well-nourished controls. Direct effects of stress on blood pressure responses were determined in a second experiment using an olfactory stressor. Prenatally malnourished rats showed a greater increase in both systolic and diastolic pressures compared with well-nourished controls during the first exposure to ammonia. A different pattern of change of cardiovascular responses was also observed during subsequent presentations of the stressor. These findings of a small baseline increase in diastolic pressure consequent to prenatal malnutrition, but an augmented elevation of both systolic and diastolic pressures after first exposure to stress, suggest the need to reevaluate interpretation of the large elevations in blood pressure previously observed in malnourished animals using the stressful tail-cuff procedure.

Age Factors↗
PubMedDate not supplied

Interaction of protein and zinc malnutrition with the murine response to infection.

Malnutrition increases the host's susceptibility to infection. However, the mechanisms are not well understood. This study examined the interaction of protein and zinc underfeeding in mice before challenge with an intracellular pathogen, Salmonella typhimurium. C3H/HeN mice (n = 68) were weighted and placed on one of four diets: 20% ovalbumin with adequate zinc (20% NL), 20% ovalbumin without zinc (20% LO), 1% ovalbumin with zinc (1% NL), and 1% ovalbumin without zinc (1% LO). At the end of 6 weeks they were again weighed and then challenged with 10(4) S. typhimurium intraperitoneally. Mortality was recorded over the next 2 weeks. Although weight loss was markedly affected by protein malnutrition (two-way analysis of variance: p = .0001), there was no independent effect by zinc (p = .3459). Similarly, protein malnutrition alone affected mortality rates (chi 2: p = .0001), whereas zinc had no independent effect (p = .7166). However, both protein and zinc underfeeding shortened the length of survival (Mann-Whitney U test: p less than .001). We conclude that protein malnutrition is the dominant factor influencing weight loss and mortality in this model. However, zinc malnutrition does shorten the length of survival and may contribute to the global immunosuppression noted in malnourished subjects.

Animals↗
PubMedDate not supplied

Malnutrition in hospital: detection and consequences.

Malnutrition in hospital is not a new concept. Studies carried out over 20 years ago identified that 50% of surgical patients (Hill et al, 1977) and 44% of medical patients (Bistrian et al, 1976) showed evidence of malnutrition. A more recent study demonstrated that the problem still exists (McWhirter and Pennington, 1994). This research showed that 40% of patients were undernourished on admission to hospital and 78% of these suffered further deterioration in their nutritional status during their hospital stay. This article, the first in the series, aims to identify patient groups which are likely to become malnourished during hospitalization and outlines how nurses and doctors can detect malnutrition and/or potential malnutrition in patients. The consequences of malnutrition and the current issues surrounding the reported problems of patients who do not receive enough food and drink while in hospital (Association of Community Health Councils, 1997) are discussed. The article also explores what measures can be taken to improve patients nutritional intake while in hospital. It describes the way forward in terms of clinical practice, current projects and the information and training available to nurses and other members of the multidisciplinary team. The author's overall aim is to improve healthcare professionals' knowledge within this field and to raise the profile of nutritional care.

Hospitalization↗
PubMedDate not supplied

Serum thyroid hormone and thyroid gland weight measurements in protein-energy malnutrition.

Protein-energy malnutrition (PEM) is a problem which concerns about half the world's children. We investigated the effects of malnutrition on thyroid gland weight and thyroid hormone levels. 22 children suffering from malnutrition (14 children suffering from marasmus and 8 children suffering from kwashiorkor) and 7 healthy controls were studied. Malnutrition was confirmed clinically and according to the Wellcome classification definition of malnutrition. Serum thyroid hormone concentrations were measured by radioimmunoassay and the weights of the thyroid gland were evaluated scintigraphically. In the groups with marasmus and kwashiorkor the mean TT4, TT3 and FT3 levels were significantly lower, and TSH levels were significantly higher, compared to controls. FT4 was not influenced by PEM. The mean thyroid gland weights of the groups with marasmus and kwashiorkor were higher than that of the control group. We found no significant differences in all these parameters between groups with marasmus and kwashiorkor. In each of the three groups, the most marked positive correlation was between thyroid gland weight and ratio of thyroid gland weight to body surface area.

Body Surface Area↗
PubMed1991

Tissue and serum insulin-like growth factor I (IGF I) concentrations in rats subjected to temporary protein-energy malnutrition early in life.

Rats subjected to temporary protein-energy malnutrition and subsequent nutritional rehabilitation remain smaller than adequately fed animals, have a subnormal insulin secretion and persisting cellular hypoplasia in several tissues. This investigation studies whether impaired production of insulin-like growth factor I (IGF I) is another persisting consequence of malnutrition. Rats were subjected to severe protein-energy malnutrition between 3 and 6 weeks of age and subsequently fed adequate diet up to 12 weeks of age. Serum and tissue samples for analysis of IGF I were obtained at 12 weeks of age. IGF I concentrations were similar in serum, heart, liver and lung of previously malnourished and control rats. In the kidneys of previously-malnourished rats the IGF I concentration was twice that of control rats. Results suggest that during protein-energy malnutrition and subsequent nutritional rehabilitation IGF I tissue concentrations are primarily regulated by the prevailing plane of nutrition. It is speculated that the temporary protein-energy malnutrition blunts the cellular capacity for IGF I production and, except in the kidney, prevents increased IGF I tissue concentrations and associated compensatory growth.

Aging↗
PubMed1979

Seasonal changes in malnutrition and diarrheal disease among preschool children in El Salvador.

The nutritional status of preschool children in a rural El Salvadoran population was assessed quarterly for 1 year using height, weight and arm circumference measurements in order to define seasonal changes in malnutrition. Seasonal patterns in the incidence of reported malnutrition and diarrheal disease from the local clinic serving the study population and on the national level for EL Salvador were also assessed and were compared with field measurements. Results indicated a similar seasonal increase in both measured malnutrition and in the reported incidence of malnutrition and diarrheal disease occurring at the onset of the rainy season. The results confirm the existence and indicate the magnitude of seasonal changes in malnutrition and diarrheal disease in a preschool population.

Body Height↗
PubMed2006

Increased susceptibility to metabolic alterations in young adult females exposed to early malnutrition.

Early malnutrition during gestation and lactation modifies growth and metabolism permanently. Follow up studies using a nutritional rehabilitation protocol have reported that early malnourished rats exhibit hyperglycemia and/or hyperinsulinemia, suggesting that the effects of early malnutrition are permanent and produce a "programming" effect on metabolism. Deleterious effects have mainly been observed when early-malnutrition is followed by a high-carbohydrate or a high-fat diet. The aim of this study was to evaluate whether following a balanced diet subsequent to malnutrition can deter the expression of metabolic disease and lead rats to exhibit metabolic responses, similar to those of well-nourished controls. Young rats, born from dams malnourished during gestation and lactation with a low protein diet, were provided with a regular balanced chow diet upon weaning. At 90 days of age, the effects of rehabilitation were determined under three different feeding conditions: ad libitum, fasting or fasting-reefed satiated.Early-malnourished rats showed an increased rate of body weight gain. Males under ad libitum conditions showed an elevated concentration of hepatic glycogen and low values of insulin. In the fasting-reefed satiated condition, only early-malnourished females showed an alteration in glucose response and glucagon level, compared with their well-nourished controls. Data indicate that a balanced diet along life after early malnutrition can mask the expression of metabolic disorders and that a metabolic challenges due to a prolonged fasting and reefed state unmask metabolic deficiencies in early-malnourished females.

Animals↗