Malnutrition Essentials for Neurologists and Neurosurgeons: A Review of the Literature

Abstract

Malnutrition still causes deaths in the world today and protein energy malnutrition (PEM) is characterized by increased oxidative stress, immune deficiency, and development of various infections. Even today, however, it is an underrecognized and undertreated entity in neurology and neurosurgery. In this article, we therefore seek to review the available literature regarding various factors affecting surgical outcome of children with malnutrition undergoing some neurosurgical interventions including shunt surgery and traumatic brain injury in intensive care unit, in addition to its effects upon oxidative stress status and immunity. Furthermore, we attempt to provide essential knowledge of malnutrition affecting surgical outcome of patients with PEM. Based on available evidence in the published literature, it is concluded that it is a serious public health problem characterized by increased oxidative stress, immune deficiency, and development of various infections.

Keywords

immunity - infection - oxidative stress - outcome - protein energy malnutrition - surgery

Publikationsverlauf

Eingereicht: 12. August 2020

Angenommen: 13. November 2020

Artikel online veröffentlicht:
13. Januar 2021

• References

• 1 World Health Organization, Neurological Disorders: Public Health Challenges. Geneva, Switzerland: World Health Organization; 2006
• 2 Pelletier DL, Frongillo Jr EA, Schroeder DG, Habicht J-P. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ 1995; 73 (04) 443-448
• 3 Ravasco P. Nutrition in cancer patients. J Clin Med 2019; 8 (08) 1211
• 4 Schofield C, Ashworth A. Why have mortality rates for severe malnutrition remained so high?. Bull World Health Organ 1996; 74 (02) 223-229
• 5 World Health Organization, The World Health Report 2002: Reducing Risks, Promoting Healthy Life. Geneva, Switzerland: World Health Organization; 2002
• 6 Savino W. The thymus gland is a target in malnutrition. Eur J Clin Nutr 2002; 56 (3, Suppl 3): S46-S49
• 7 Schmidt SB, Boltzmann M, Rollnik JD. Nutritional situation of enterally fed patients in neurological early rehabilitation and impact of nutritional status on functional outcome. Clin Nutr 2020; 39 (02) 425-432
• 8 Pelletier DL. The potentiating effects of malnutrition on child mortality: epidemiologic evidence and policy implications. Nutr Rev 1994; 52 (12) 409-415
• 9 Pelletier DL, Frongillo EA. Changes in child survival are strongly associated with changes in malnutrition in developing countries. J Nutr 2003; 133 (01) 107-119
• 10 Rodríguez L, Cervantes E, Ortiz R. Malnutrition and gastrointestinal and respiratory infections in children: a public health problem. Int J Environ Res Public Health 2011; 8 (04) 1174-1205
• 11 Schaible UE, Kaufmann SH. Malnutrition and infection: complex mechanisms and global impacts. PLoS Med 2007; 4 (05) e115
• 12 Hafsteinsdóttir TB, Mosselman M, Schoneveld C, Riedstra YD, Kruitwagen CL. Malnutrition in hospitalised neurological patients approximately doubles in 10 days of hospitalisation. J Clin Nurs 2010; 19 (5-6): 639-648
• 13 Gomez F, Ramos G, Frenk S, Cravioto M, Chavez R, Vazquez J. Mortality in second and third degree malnutrition. J Trop Pediatr 1956; 2 (02) 77-83
• 14 Müller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ 2005; 173 (03) 279-286
• 15 Daradkeh G, Essa MM, Al-Mashaani A, Al-Adawi S, Arabawi S. Malnutrition indicators which is more predictive? Nutrition risk index (NRI) or malnutrition universal screening tool (MUST). J Clin Nutr Metab 2018; 2: 2
• 16 Requena JR, Chao C-C, Levine RL, Stadtman ER. Glutamic and aminoadipic semialdehydes are the main carbonyl products of metal-catalyzed oxidation of proteins. Proc Natl Acad Sci USA 2001; 98 (01) 69-74
• 17 Woodward B. Protein, calories, and immune defenses. Nutr Rev 1998; 56 (1 Pt 2): S84-S92
• 18 Bhaskaram P. Nutritional modulation of immunity to infection. Indian J Pathol Microbiol 1992; 35 (04) 392-400
• 19 Rodríguez L, González C, Flores L, Jiménez-Zamudio L, Graniel J, Ortiz R. Assessment by flow cytometry of cytokine production in malnourished children. Clin Diagn Lab Immunol 2005; 12 (04) 502-507
• 20 Franca T, Ishikawa L, Zorzella-Pezavento S, Chiuso-Minicucci F, da Cunha M, Sartori A. Impact of malnutrition on immunity and infection. J Venom Anim Toxins Incl Trop Dis 2009; 15 (03) 374-390
• 21 Sakai T, Mitsuya K, Kogiso M, Ono K, Komatsu T, Yamamoto S. Protein deficiency impairs DNA vaccine-induced antigen-specific T cell but not B cell response in C57BL/6 mice. J Nutr Sci Vitaminol (Tokyo) 2006; 52 (05) 376-382
• 22 Mellman I, Steinman RM. Dendritic cells: specialized and regulated antigen processing machines. Cell 2001; 106 (03) 255-258
• 23 Abe M, Akbar F, Matsuura B, Horiike N, Onji M. Defective antigen-presenting capacity of murine dendritic cells during starvation. Nutrition 2003; 19 (03) 265-269
• 24 Honda M, Kamiyama Y, Kawamura K. et al. Growth, development and nutritional status in Japanese children under 2 years on continuous ambulatory peritoneal dialysis. Pediatr Nephrol 1995; 9 (05) 543-548
• 25 Petro TM, Schwartz KM, Chen S-SA. Production of IL2 and IL3 in syngeneic mixed lymphocyte reactions of BALB/c mice are elevated during a period of moderate dietary protein deficiency. Immunol Invest 1994; 23 (02) 143-152
• 26 Redmond HP, Shou J, Kelly CJ. et al. Immunosuppressive mechanisms in protein-calorie malnutrition. Surgery 1991; 110 (02) 311-317
• 27 Reid M, Badaloo A, Forrester T, Morlese JF, Heird WC, Jahoor F. The acute-phase protein response to infection in edematous and nonedematous protein-energy malnutrition. Am J Clin Nutr 2002; 76 (06) 1409-1415
• 28 Keusch GT. The history of nutrition: malnutrition, infection and immunity. J Nutr 2003; 133 (01) 336S-340S
• 29 Fantuzzi G, Faggioni R. Leptin in the regulation of immunity, inflammation, and hematopoiesis. J Leukoc Biol 2000; 68 (04) 437-446
• 30 Palacio A, Lopez M, Perez-Bravo F, Monkeberg F, Schlesinger L. Leptin levels are associated with immune response in malnourished infants. J Clin Endocrinol Metab 2002; 87 (07) 3040-3046
• 31 Rodríguez L, Graniel J, Ortiz R. Effect of leptin on activation and cytokine synthesis in peripheral blood lymphocytes of malnourished infected children. Clin Exp Immunol 2007; 148 (03) 478-485
• 32 Bourre J-M. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging 2006; 10 (05) 377-385
• 33 Román GC. Nutritional disorders in tropical neurology. In: Handbook of Clinical Neurology. Amsterdam, Netherlands: Elsevier; 2013: 381-404
• 34 Benton D. Neurodevelopment and neurodegeneration: are there critical stages for nutritional intervention?. Nutr Rev 2010; 68 (1, Suppl 1): S6-S10
• 35 Oliveira Assis AM, Barreto ML, Magalhães de Oliveira LP. et al. Determinants of mild-to-moderate malnutrition in preschoolers in an urban area of Northeastern Brazil: a hierarchical approach. Public Health Nutr 2008; 11 (04) 387-394
• 36 Morgane PJ, Austin-LaFrance R, Bronzino J. et al. Prenatal malnutrition and development of the brain. Neurosci Biobehav Rev 1993; 17 (01) 91-128
• 37 Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 2002; 359 (9306): 564-571
• 38 Heijmans BT, Tobi EW, Stein AD. et al. Persistent epigenetic differences associated with prenatal exposure to famine in humans. Proc Natl Acad Sci U S A 2008; 105 (44) 17046-17049
• 39 Peter CJ, Fischer LK, Kundakovic M. et al. DNA methylation signatures of early childhood malnutrition associated with impairments in attention and cognition. Biol Psychiatry 2016; 80 (10) 765-774
• 40 Taboada-Crispi A, Bringas-Vega ML, Bosch-Bayard J. et al. Quantitative EEG tomography of early childhood malnutrition. Front Neurosci 2018; 12: 595
• 41 Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R. The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 1977; 47 (04) 491-502
• 42 Hammers R, Anzalone S, Sinacore J, Origitano TC. Neurosurgical mortality rates: what variables affect mortality within a single institution and within a national database?. J Neurosurg 2010; 112 (02) 257-264
• 43 Bandlish D, Attry S, Ghosh S, Das H. Assessment of nutritional status of critically ill neurosurgical patients and parameters predicting the outcome: an institutional observational study. Int J Nutr Pharmacol Neurol Dis 2014; 4 (03) 179
• 44 Pirlich M, Schütz T, Norman K. et al. The German hospital malnutrition study. Clin Nutr 2006; 25 (04) 563-572
• 45 Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27 (01) 5-15
• 46 Dávalos A, Ricart W, Gonzalez-Huix F. et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996; 27 (06) 1028-1032
• 47 FOOD Trial Collaboration. Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke 2003; 34 (06) 1450-1456
• 48 Gariballa SE, Parker SG, Taub N, Castleden CM. Influence of nutritional status on clinical outcome after acute stroke. Am J Clin Nutr 1998; 68 (02) 275-281
• 49 Löser C. Malnutrition in hospital: the clinical and economic implications. Dtsch Arztebl Int 2010; 107 (51-52): 911-917
• 50 Sabbouh T, Torbey MT. Malnutrition in stroke patients: risk factors, assessment, and management. Neurocrit Care 2018; 29 (03) 374-384
• 51 Volpe SL, Schall JI, Gallagher PR, Stallings VA, Bergqvist AG. Nutrient intake of children with intractable epilepsy compared with healthy children. J Am Diet Assoc 2007; 107 (06) 1014-1018
• 52 Neal EG, Zupec-Kania B, Pfeifer HH. Carnitine, nutritional supplementation and discontinuation of ketogenic diet therapies. Epilepsy Res 2012; 100 (03) 267-271
• 53 Vaid N, Fekadu S, Alemu S. et al. Epilepsy, poverty and early under-nutrition in rural Ethiopia. Seizure 2012; 21 (09) 734-739
• 54 Atsuta N, Watanabe H, Ito M. et al; Research Committee on the Neurodegenerative Diseases of Japan. Age at onset influences on wide-ranged clinical features of sporadic amyotrophic lateral sclerosis. J Neurol Sci 2009; 276 (1-2): 163-169
• 55 Muscaritoli M, Kushta I, Molfino A, Inghilleri M, Sabatelli M, Rossi Fanelli F. Nutritional and metabolic support in patients with amyotrophic lateral sclerosis. Nutrition 2012; 28 (10) 959-966
• 56 Ghajar J. Traumatic brain injury. Lancet 2000; 356 (9233): 923-929
• 57 Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 2002; 24 (01) 24-28
• 58 Clifton GL, Robertson CS, Grossman RG, Hodge S, Foltz R, Garza C. The metabolic response to severe head injury. J Neurosurg 1984; 60 (04) 687-696
• 59 Deutschman CS, Konstantinides FN, Raup S, Thienprasit P, Cerra FB. Physiological and metabolic response to isolated closed-head injury. Part 1: basal metabolic state: correlations of metabolic and physiological parameters with fasting and stressed controls. J Neurosurg 1986; 64 (01) 89-98
• 60 Charrueau C, Belabed L, Besson V, Chaumeil J-C, Cynober L, Moinard C. Metabolic response and nutritional support in traumatic brain injury: evidence for resistance to renutrition. J Neurotrauma 2009; 26 (11) 1911-1920
• 61 Brandi LS, Santini L, Bertolini R, Malacarne P, Casagli S, Baraglia AM. Energy expenditure and severity of injury and illness indices in multiple trauma patients. Crit Care Med 1999; 27 (12) 2684-2689
• 62 Clifton GL, Robertson CS, Choi SC. Assessment of nutritional requirements of head-injured patients. J Neurosurg 1986; 64 (06) 895-901
• 63 Faisy C, Guerot E, Diehl J-L, Labrousse J, Fagon J-Y. Assessment of resting energy expenditure in mechanically ventilated patients. Am J Clin Nutr 2003; 78 (02) 241-249
• 64 Jain G, Mukerji G, Dixit A, Manshani N, Yadav YR. The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery. Br J Nutr 2007; 98 (05) 944-949