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

Objective. Protein-energy malnutrition (PEM), often occurring in patients w ith chronic disease, is associated with a decreased capacity to combat infe ctions. In this study we assessed polymorphonuclear neutrophil (PMN) supero xide anion ( O-2(-),) formation in elderly PEM patients with various chroni c diseases. Design and subjects. Nineteen patients (75 ii 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 . Setting. A service of internal medicine at a university-affiliated hospit al. Interventions. Eight patients were prescribed a dietary liquid suppleme ntation during the observation period, Main outcome measures. Superoxide pr oduction in PMN induced by fMLP (a receptor ligand) and phorbol myristate a cetate (PMA), which acts directly on protein Kinase C, Results. fMLP-induce d 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 O-2(-),- production levels were 48 +/- 8 a nd 73 +/- 13% (P = 0.12) of those of controls at the start and after 3 mont hs, respectively. Corresponding figures in those who were not prescribed su pplementation were 57 +/- 8 and 64 +/- 4% (P = 0.55). Conclusion. Possibly contributing to reduced host defence, receptor ligand-induced PMN generatio n of O-2(-) is significantly lower in chronically ill, elderly patients wit h PEM than in age-matched healthy controls.