THE EFFECT OF NUTRITIONAL-STATUS ON THE CYTOKINE AND ACUTE-PHASE PROTEIN RESPONSES TO ELECTIVE SURGERY

Weight loss and impaired nutritional status are associated with increa sed complications following surgery This study aimed to assess the eff ect of nutritional status on the magnitude of the acute phase protein response, and determine if this is associated,vith changes in the magn itude of the related cytokine responses. Nineteen patients (10 well no urished, 9 malnourished on the basis of body composition) undergoing m ajor abdominal surgery were studied by frequent blood sampling in the early postoperative period. There was a significant reduction iu the p lasma C- reactive protein response in the malnourished group, but no d ifference between the groups in the responses of alpha(1)-antitrypsin, alpha(1)-acid glycoprotein, or in the trace elements iron or zinc, wh ich reflect induction of ferritin and metallothionein. There was an ea rly increase in IL-6, soluble receptors of TNF, and in IL-1 receptor a ntagonist in both groups, but no detectable increase in plasma IL-1 or TMF. There was no difference between the wellnourished and malnourish ed group for any of these markers of activation of the cytokine networ k. Weight loss is therefore associated with a reduction in aspects of the acute phase response, but this is due to impaired effectiveness ra ther than reduced magnitude of the cytokine response.