Reversibility of protein-energy malnutrition in a group of chronically-ill elderly outpatients.

Nutritional status was studied in 23 elderly (74 +/- 1 years), malnourished outpatients with non-malignant diseases. The patients' recollections and medical records indicated a gradual weight loss of approximately 25% in the preceding 2-15 years; only a small amount (6%) was lost during the final 6 months. At a re-examination after 3 months, all patients were still malnourished but in general the depletion had decreased. An elevated level of serum orosomucoid (orosomucoid positive) was used as evidence of an on-going inflammatory process. The 14 orosomucoid negative patients displayed a more pronounced improvement in their nutritional status than those who were orosomucoid positive. 15 patients were prescribed a protein and energy enriched formula (40 g protein and 400/1.7 kcal/MJ per day). The orosomucoid positive and orosomucoid negative groups did not differ in number of subjects prescribed supplementation. During the follow-up period the patients that were recommended supplementation showed a more prominent improvement in their nutritional status than the 'non-supplemented' subjects. Discriminant analysis revealed that prescription of oral supplementation and, to a lesser extent, serum orosomucoid concentrations within the reference range favoured nutritional repletion. The most pronounced recovery was registered in orosomucoid negative patients who had been prescribed supplementation.

Low levels of essential fatty acids are related to impaired delayed skin hypersensitivity in malnourished chronically ill elderly people.

Essential fatty acid (FA) deficiency, which may accompany protein-energy malnutrition (PEM), has been associated with impaired inflammatory reactions. We evaluated this relationship by analysing FA profiles and delayed cutaneous hypersensitivity in 20 malnourished elderly non-cancer patients and in 20 age-matched control patients. As indicated by serum cholesterol and serum triglycerides, the lipid levels were decreased by about one-third in the subjects with PEM. In comparison with the controls, there was a reduction in the omega 3 FA (e.g. eicosapentanoate) in total serum lipids (mg l-1) and serum phospholipids (%) of 40% and 47%, respectively. Reductions in serum omega 6 FA (e.g. linoleate and arachidonate) levels corresponded to the drop in total FA concentrations (30%). The cutaneous hypersensitivity was impaired in 14 of the malnourished patients. The magnitude of the skin reaction was positively correlated (P < 0.05) to the concentrations of eicosapentanoate in serum lipids and serum phospholipids, as well as to the linoleate concentration in total serum lipids. Six of the malnourished patients took part in a nutritional intervention programme for 3 months. In parallel with an improvement in the nutritional status there was a 35% increase (P < 0.05) in the total omega 3 FA serum concentration. Negative skin tests became positive and the median skin induration enlarged threefold (P < 0.05). Thus, deficiency of omega 3 FA might be one factor contributing to cutaneous anergy in elderly malnourished patients.