PROGRAMME SCIENTIFIQUE - Oxygen Club of California

Neopterin - New Bioindicator of Malnutrition and Inflammation in the Elderly
Zadak 1 Zdenek; Hrnciarikova 2 Dana
1 University Hospital Hradec Kralove, Department of Research Development; 2 University Hospital
Hradec Kralove, Department of Metabolic Care and Gerontology
OP28
At present there are varying views on the interpretation of biochemical markers of malnutrition, and there
is ongoing research on the mutual influence of nutritional indicators during a concurrent inflammatory
reaction. The levels of serum proteins can also be reduced during an inflammatory reaction (negative
acute phase proteins) with a concurrent rise in inflammatory markers, such as C-reactive protein (positive
acute phase protein).
This phenomenon is prioritization of inflammation and malnutrition of the organism. Studies have shown
a statistically significant relationship between age, plasma proteins, and positive reactants of
inflammation. Revising the interpretation of malnutrition and inflammation, bioindicators reveal the
necessity of not using only absolute values of plasma proteins, lipoproteins and other components, but
rather the indices that integrate bioindicators of malnutrition, inflammation, sex and age.
Determination of serum proteins still ranks among principal examinations in malnutrition diagnostics, but
at present the view of serum proteins as only malnutrition markers is being changed, as their values are
affected also during inflammatory process.
The levels of serum proteins are, however, also decreased in the course of an inflammatory reaction
(negative proteins of the acute phase) by the transfer of plasma proteins to the reactants of the acute
phase, such as C-reactive protein (CRP). It is therefore suitable for the examination of the changes in
serum proteins to determine simultaneously also CRP, the value of which is increased in inflammation
(positive protein of the acute phase), and to compare the obtained values with each other. A decrease in
serum proteins can be also due to transcapillary leak to interstitial fluid (albumin level is particularly
influenced).
Since positive reactants of inflammation (CRP, lipoprotein (a), orosomucoid, fibrinogen) and biondicators
of malnutrition (albumin, prealbumin, transferin etc.) are reciprocally dependent, there is non-protein and
independent biomarker of inflammation essential for reliable discrimination of both processes. Neopterin
produced by human macrophages after stimulation with interferon gamma is secreted by activated T-
lymphocytes and is therefore a suitable indicator to monitor inflammation and immunity activation.
Tab.1.
Bioindicators of malnutrition
Indices of inflammation
albumin
C-reactive protein
prealbumin
fibrinogen
transferin
orosomucoid
cholinesterase
α 1 -antitrypsin
protein-binding retinol
neopterin in urine
total protein
sedimentation of erythrocytes
lipids – cholesterol, HDL, LDL and leptin lipoprotein (a)
some hematological an immunological
examinations
– absolute number of lymphocytes, skin tests etc.
Table 1: Bioindicators of malnutrition and indices of inflammation
Supported by Research Project MZO 00179906.
References