The acute-phase protein response to infection in edematous and nonedematous protein-energy malnutrition

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Abstract
Background: Immune structure and function are more compromised in edematous protein-energy malnutrition (PEM) than in nonedematous PEM. Whether the positive acute-phase protein (APP) response to infection is affected remains unknown. Objective: We assessed whether children with edematous PEM can mount a general APP response and compared the kinetic mechanisms of the response in children with edematous PEM with those in children with nonedematous PEM. Design: Plasma C-reactive protein, α1-acid glycoprotein, α1-antitrypsin, haptoglobin, and fibrinogen concentrations and the fractional and absolute synthesis rates of α1-antitrypsin, haptoglobin, and fibrinogen were measured in 14 children with edematous PEM, aged 11.4 ± 2 mo, and 9 children with nonedematous PEM, aged 10.1 ± 1.4 mo, at 3 times: ≈2 d after hospital admission (period 1), when they were malnourished and infected; ≈8 d after admission (period 2), when they were malnourished but free of infection; and ≈54 d after admission (period 3), when they had recovered. Results: Children with edematous and nonedematous PEM had higher plasma concentrations of 4 of 5 APPs in period 1 than in period 3. The magnitude of the difference in concentration and in the rate of synthesis of the individual APPs was less in the children with edematous PEM than in those with nonedematous PEM. The kinetic data show that the characteristics of the APP response were different in the 2 groups. Conclusions: These results suggest that severely malnourished children can mount only a partial APP response to the stress of infection and that the magnitude of this response is less in those with edema.