In Vitro Leukocyte Endogenous Mediator Production Is Not Impaired following Surgical Stress in Moderately Malnourished Patients

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Abstract
Leukocyte endogenous mediator (LEM), a protein produced by phagocytizing cells, plays a critical role in the metabolic response to injury and infection. There is an important interaction between protein-calorie malnutrition and the capacity of cells to produce LEM, since severely malnourished or severely stressed individuals, have a reduced capacity to produce LEM. The leukocytes of 10 mildly to moderately malnourished patients undergoing elective major surgery, a moderate stress, had an intact ability to produce LEM on preoperative assessment. This ability was not affected by a 5-day postoperative period of hypocaloric nutrient intake despite a significant loss of body protein in one-half of the patients and a significant fall in serum protein concentrations. These results suggest a high biologic priority for LEM production during the metabolic response to injury and for infection. (Journal of Parenteral and Enteral Nutrition 8:174–177, 1984)