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Cellular Immunity in Adult Marasmus

Cellular Immunity in Adult Marasmus Abstract Twelve patients with recent weight loss to less than 85% of standard weightheight ratio and a serum albumin level of at least 3 gm/100 ml were considered to have the adult equivalent of marasmus. Cellular immune function was assessed by delayed hypersensitivity skin testing to Monilia and streptokinase-streptodornase, peripheral lymphocyte count, proportion of T and B cells, whole blood and isolated lymphocyte transformation to phytohemagglutinin, pokeweed mitogen, concanavalin A, Monilia, and streptokinase-streptodornase. Significant impairment of skin test reactivity while in vitro responsiveness remained intact was noted in the marasmic patients. No impairment was found in 12 individuals with recent weight loss who remained at a weight greater than the 85% weight-height ratio. In four marasmic individuals in whom weight loss was arrested by nutritional repletion, skin reactivity returned without substantial change in weight. In this type of marasmus, both depleted nutritional status and weight loss must be present for impairment of skin test responsiveness. These findings confirm relative sparing of more vital functions dependent on protein metabolism in adult marasmus compared to the kwashiorkorlike syndrome of hypoalbuminemic malnutrition seen in adults. (Arch Intern Med 137:1408-1411, 1977) References 1. Bistrian BR, Blackburn GL, Scrimshaw NS, et al: Cellular immunity in semi-starved states in hospitalized adults . Am J Clin Nutr 28:1148-1155, 1975. 2. Law DK, Dudrick SJ, Abdou NI: Immunocompetence of patients with protein calorie malnutrition . Ann Intern Med 79:545-550, 1973.Crossref 3. Smythe P, Schonland M, Brereton-Stiles GG, et al: Thymolymphatic deficiency and depression of cell-mediated immunity in protein calorie malnutrition . Lancet 2:939-947, 1974. 4. Geefhuysen J, Rosen EV, Katz J, et al: Impaired cellular immunity in kwashiorkor with improvement after therapy . Br Med J 4:527-529, 1974.Crossref 5. Schlesinger L, Stekel A: Impaired cellular immunity in marasmic infants . Am J Clin Nutr 27:615-620, 1974. 6. Jelliffe DB: The Assessment of the Nutritional Status of the Community , series 53. Geneva, World Health Organization, 1966. 7. Bistrian BR, Blackburn GL, Vitale J, et al: Prevalence of malnutrition in general medical patients . JAMA 235:1567-1570, 1976.Crossref 8. Build and Blood Pressure Study . Chicago Society of Actuaries, 1959. 9. Bistrian BR, Blackburn GL, Sherman M, et al: Therapeutic index of nutritional depletion in hospitalized adults . Surg Gynecol Obstet 141:512-516, 1975. 10. Boyum A: Separation of leukocytes from blood and bone marrow: Introduction . Scand J Clin Lab Invest 21( (suppl 97) ):7, 1968.Crossref 11. Weiner MS, Bianco C, Nussenzweig V: Enhanced binding of neuraminidase-treated sheep erythrocytes to human T lymphocytes . Blood 42:939-946, 1973. 12. Bianco C, Patrick R, Nussenzweig V: A population of lymphocytes bearing a membrane receptor for antigen-antibody-complement complexes: I. Separation and characterization . J Exp Med 132:702-720, 1970.Crossref 13. Ross GD, Rabellino EM, Polley MJ, et al: Combined studies of complement receptor and surface immunoglobulin-bearing cells and sheep erythrocyte rosette-forming cells in normal and leukemic human lymphocytes . J Clin Invest 52:377-385, 1973.Crossref 14. Pauly JL, Sokal JE, Han T: Whole blood culture technique for functional studies of lymphocyte reactivity to mitogens, antigens, and homologous lymphocytes . J Lab Clin Med 82:500-512, 1973. 15. Rocklin R: Clinical Immunology Seminar Proceedings . Boston, Harvard Medical School, 1974. 16. Ferguson A, Lawlor GJ, Neumann CG, et al: Decreased rosette-forming lymphocytes in malnutrition and intrauterine retardation . J Pediatr 85:717-723, 1974.Crossref 17. Coovadia HM, Parent MA, Loening WEK, et al: An evaluation of factors associated with the depression of immunity in malnutrition and in measles . Am J Clin Nutr 28:89-104, 1974. 18. Neumann CG, Lawlor GJ, Stiehm ER, et al: Immunologic responses in malnourished children . Am J Clin Nutr 28:89-104, 1975. 19. Hersch EM, Gutterman JD, Mavligit GM, et al: Serial studies of immunocompetence of patients undergoing chemotherapy for acute leukemia . J Clin Invest 54:401-408, 1974.Crossref 20. Jefferson LS, Korner A: Influence of amino acid supply on ribosomes and protein synthesis of perfused rat liver . Biochem J 111:703-712, 1969. 21. Smith SR, Pozefsky T, Chhetri MK: Nitrogen and amino acid metabolism in adults with protein-calorie malnutrition . Metabolism 23:603-618, 1974.Crossref 22. Holt LE, Snyderman SE, Norton PM, et al: The plasma aminogram in kwashiorkor . Lancet 2:1343-1348, 1963.Crossref 23. Steffee WP, Goldsmith RS, Pencharz PB, et al: Dietary protein intake and dynamic aspects of whole body nitrogen metabolism in adult humans . Metabolism 25:287-291, 1976.Crossref 24. Gibbons G, Blackburn GL, Harken DE, et al: Pre- and post-operative hyperalimentation in the treatment of cardiac cachexia . J Surg Res 20:439-444, 1976.Crossref 25. Blackburn GL, Williams LF, Bistrian BR, et al: New approaches to the management of severe acute pancreatitis . Am J Surg 131:114-124, 1976.Crossref 26. Copeland EM, MacFayden BV, Rapp MA, et al: Hyperalimentation and immune competence in cancer . Surg Forum 26:138-140, 1975. 27. Bistrian BR, Blackburn GL, Hallowell E, et al: Protein status of general surgical patients . JAMA 230:858-860, 1974.Crossref 28. Blackburn GL, Bistrian BR: Careers in nutrition from a clinical viewpoint . Nutr Rev 34:97n-104, 1976.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cellular Immunity in Adult Marasmus

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1977.03630220050013
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Abstract

Abstract Twelve patients with recent weight loss to less than 85% of standard weightheight ratio and a serum albumin level of at least 3 gm/100 ml were considered to have the adult equivalent of marasmus. Cellular immune function was assessed by delayed hypersensitivity skin testing to Monilia and streptokinase-streptodornase, peripheral lymphocyte count, proportion of T and B cells, whole blood and isolated lymphocyte transformation to phytohemagglutinin, pokeweed mitogen, concanavalin A, Monilia, and streptokinase-streptodornase. Significant impairment of skin test reactivity while in vitro responsiveness remained intact was noted in the marasmic patients. No impairment was found in 12 individuals with recent weight loss who remained at a weight greater than the 85% weight-height ratio. In four marasmic individuals in whom weight loss was arrested by nutritional repletion, skin reactivity returned without substantial change in weight. In this type of marasmus, both depleted nutritional status and weight loss must be present for impairment of skin test responsiveness. These findings confirm relative sparing of more vital functions dependent on protein metabolism in adult marasmus compared to the kwashiorkorlike syndrome of hypoalbuminemic malnutrition seen in adults. (Arch Intern Med 137:1408-1411, 1977) References 1. Bistrian BR, Blackburn GL, Scrimshaw NS, et al: Cellular immunity in semi-starved states in hospitalized adults . Am J Clin Nutr 28:1148-1155, 1975. 2. Law DK, Dudrick SJ, Abdou NI: Immunocompetence of patients with protein calorie malnutrition . Ann Intern Med 79:545-550, 1973.Crossref 3. Smythe P, Schonland M, Brereton-Stiles GG, et al: Thymolymphatic deficiency and depression of cell-mediated immunity in protein calorie malnutrition . Lancet 2:939-947, 1974. 4. Geefhuysen J, Rosen EV, Katz J, et al: Impaired cellular immunity in kwashiorkor with improvement after therapy . Br Med J 4:527-529, 1974.Crossref 5. Schlesinger L, Stekel A: Impaired cellular immunity in marasmic infants . Am J Clin Nutr 27:615-620, 1974. 6. Jelliffe DB: The Assessment of the Nutritional Status of the Community , series 53. Geneva, World Health Organization, 1966. 7. Bistrian BR, Blackburn GL, Vitale J, et al: Prevalence of malnutrition in general medical patients . JAMA 235:1567-1570, 1976.Crossref 8. Build and Blood Pressure Study . Chicago Society of Actuaries, 1959. 9. Bistrian BR, Blackburn GL, Sherman M, et al: Therapeutic index of nutritional depletion in hospitalized adults . Surg Gynecol Obstet 141:512-516, 1975. 10. Boyum A: Separation of leukocytes from blood and bone marrow: Introduction . Scand J Clin Lab Invest 21( (suppl 97) ):7, 1968.Crossref 11. Weiner MS, Bianco C, Nussenzweig V: Enhanced binding of neuraminidase-treated sheep erythrocytes to human T lymphocytes . Blood 42:939-946, 1973. 12. Bianco C, Patrick R, Nussenzweig V: A population of lymphocytes bearing a membrane receptor for antigen-antibody-complement complexes: I. Separation and characterization . J Exp Med 132:702-720, 1970.Crossref 13. Ross GD, Rabellino EM, Polley MJ, et al: Combined studies of complement receptor and surface immunoglobulin-bearing cells and sheep erythrocyte rosette-forming cells in normal and leukemic human lymphocytes . J Clin Invest 52:377-385, 1973.Crossref 14. Pauly JL, Sokal JE, Han T: Whole blood culture technique for functional studies of lymphocyte reactivity to mitogens, antigens, and homologous lymphocytes . J Lab Clin Med 82:500-512, 1973. 15. Rocklin R: Clinical Immunology Seminar Proceedings . Boston, Harvard Medical School, 1974. 16. Ferguson A, Lawlor GJ, Neumann CG, et al: Decreased rosette-forming lymphocytes in malnutrition and intrauterine retardation . J Pediatr 85:717-723, 1974.Crossref 17. Coovadia HM, Parent MA, Loening WEK, et al: An evaluation of factors associated with the depression of immunity in malnutrition and in measles . Am J Clin Nutr 28:89-104, 1974. 18. Neumann CG, Lawlor GJ, Stiehm ER, et al: Immunologic responses in malnourished children . Am J Clin Nutr 28:89-104, 1975. 19. Hersch EM, Gutterman JD, Mavligit GM, et al: Serial studies of immunocompetence of patients undergoing chemotherapy for acute leukemia . J Clin Invest 54:401-408, 1974.Crossref 20. Jefferson LS, Korner A: Influence of amino acid supply on ribosomes and protein synthesis of perfused rat liver . Biochem J 111:703-712, 1969. 21. Smith SR, Pozefsky T, Chhetri MK: Nitrogen and amino acid metabolism in adults with protein-calorie malnutrition . Metabolism 23:603-618, 1974.Crossref 22. Holt LE, Snyderman SE, Norton PM, et al: The plasma aminogram in kwashiorkor . Lancet 2:1343-1348, 1963.Crossref 23. Steffee WP, Goldsmith RS, Pencharz PB, et al: Dietary protein intake and dynamic aspects of whole body nitrogen metabolism in adult humans . Metabolism 25:287-291, 1976.Crossref 24. Gibbons G, Blackburn GL, Harken DE, et al: Pre- and post-operative hyperalimentation in the treatment of cardiac cachexia . J Surg Res 20:439-444, 1976.Crossref 25. Blackburn GL, Williams LF, Bistrian BR, et al: New approaches to the management of severe acute pancreatitis . Am J Surg 131:114-124, 1976.Crossref 26. Copeland EM, MacFayden BV, Rapp MA, et al: Hyperalimentation and immune competence in cancer . Surg Forum 26:138-140, 1975. 27. Bistrian BR, Blackburn GL, Hallowell E, et al: Protein status of general surgical patients . JAMA 230:858-860, 1974.Crossref 28. Blackburn GL, Bistrian BR: Careers in nutrition from a clinical viewpoint . Nutr Rev 34:97n-104, 1976.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Oct 1, 1977

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