Protein-Energy Malnutrition and Infectious Disease

Synergistic Interactions


The immune system plays a leading role in fighting off the constant bombardment of our bodies by invading pathogenic organisms, such as bacteria, fungi, viruses, toxins, and allergic compounds. Also, the immune system is intimately linked to the quality and quantity of nutrient intake (1,2). The host is defense-regulated and maintained by two branches of the immune system. One is cell-mediated immunity, carried out primarily by the CD4+ Th-1 and CD8+ T lymphocytes, which plays a pivotal role in cytotoxic responses against malignant cells and cells infected with intracellular bacteria and viruses. The other branch is humoral (antibody-mediated) immunity, of which the B lymphocyte plays a dominant role, to ward off and/or destroy extracellular pathogens. The T lymphocytes may also influence humoral immunity, as the Th-2 CD4+ T lymphocyte subset secretes a wide variety of antibody-inducing cytokines. The Th-1 CD4+ T lymphocyte produces primarily interleukin-2 (IL-2) and interferon gamma (IFN-y) and the Th-2 population produces primarily IL-4, -5, -6, and -10. Antibody isotype production (IgA, IgE, IgG, etc.) is dependent on the kind of cytokine produced to fight invading antigen assaults. Unfortunately, this vast array of defense mechanisms is not impregnable. Primary causes of a breakdown in these lines of defense (i.e., serious breakdown of our immune system) is either chronic or acute under nutrition and malnutrition.


Zinc Deficiency Atrophic Gastritis Weanling Mouse Inadequate Food Intake Biotin Deficiency 
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  1. 1.
    The state of the world’s children 1998: A UNICEF report. Malnutrition: causes, consequences and solutions. Nutr Rev 1998; 56: 115–23.Google Scholar
  2. 2.
    Fernandes G. Nutrition and immunity. Encycl Hum Biol 1991; 5: 503–16.Google Scholar
  3. 3.
    Chandra RK. Nutrition and the immune system: an introduction. Am J Clin Nutr 1997; 66: 460S - 3S.Google Scholar
  4. 4.
    Williams SR. Nutritional deficiency diseases. In: Williams SR, ed, Nutrition and Diet Therapy, pp. 327–50. CRC, Boca Raton, FL, 1985.Google Scholar
  5. 5.
    Lesourd B. Protein undernutrition as the major cause of decreased immune function in the elderly: clinical and functional implications. Nutr Rev 1995; 53: S86 - S94.CrossRefGoogle Scholar
  6. 6.
    Cederholm T, Wretlind B, Hellstrom K, Anderson B, et al. Enhanced generation of interleukins 113 and 6 may contribute to the cachexia of chronic disease. Am J Clin Nutr 1997; 65: 876–82.Google Scholar
  7. 7.
    Myrvik QN. Immunology and nutrition. In: Shils ME, Olson JA, Shike M, eds, Modem Nutrition in Health and Disease, pp. 623–62. Lea & Febiger, Philadelphia, 1994.Google Scholar
  8. 8.
    Woods JW, Woodward BD. Enhancement of primary systemic acquired immunity by exogenous triiodothyronine in wasted, protein-energy malnourished weanling mice. J Nutr 1991; 121: 1425–32.Google Scholar
  9. 9.
    Sauerwein RW, Mulder JA, Mulder L, Lowe B et al. Inflammatory mediators in children with protein-energy malnutrition. Am J Clin Nutr 1997; 65: 1534–9.Google Scholar
  10. 10.
    Doherty JF, Golden MHN, Remick DG, Griffin GE. Production of interleukin-6 and tumour necrosis factor-a in vitro is reduced in whole blood of severely malnourished children. Clin Sci 1994; 86: 347–51.Google Scholar
  11. 11.
    Deitch EA, Winterton J, Li M, Berg R. The gut as a portal of entry for bacteremia. Ann Surg 1987; 205: 681–92.CrossRefGoogle Scholar
  12. 12.
    Chandra RK. 1990 McCollum award lecture. Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr 1991; 53: 1087–101.Google Scholar
  13. 13.
    Sakamoto M, Fujisawa Y, Nishioka K. Physiologic role of the complement system in host defense, disease, and malnutrition. Nutrition 1998; 14: 391–8.CrossRefGoogle Scholar
  14. 14.
    McMurray DN, Rey H, Casazza LJ, Watson RR. Effect of moderate malnutrition on concentrations of immunoglobulins and enzymes in tears and saliva of young Colombian children. Am J Clin Nutr 1977; 30: 1944–8.Google Scholar
  15. 15.
    Woodward BD, Woods JW, Crouch DA. Direct evidence that primary acquired cell-mediated immunity is less resistant than is primary thymus-dependent humoral immunity to the depressive influence of wasting protein-energy malnutrition in weanling mice. Am J Clin Nutr 1992; 55: 1180–5.Google Scholar
  16. 16.
    Ha CL, Paulino-Racine LE, Woodward BD. Expansion of the humoral effector cell compartment of both systemic and mucosal immune systems in a weanling murine model which duplicates critical features of human protein-energy malnutrition. Br J Nutr 1996; 75: 445–60.CrossRefGoogle Scholar
  17. 17.
    Ha CL, Woodward B. Reduction in the quantity of the polymeric immunoglobulin receptor is sufficient to account for the low concentration of intestinal secretory immunoglobulin A in a weanling mouse model of wasting protein-energy malnutrition. J Nutr 1997; 127: 427–35.Google Scholar
  18. 18.
    McGee DW, McMurray DN. The effect of protein malnutrition on the IgA immune response in mice. Immunology 1988; 63: 25–9.Google Scholar
  19. 19.
    Lipschitz DA, Uduj KB. Influence of aging and protein deficiency on neutrophil function. J Gerontol 1986; 41: 690–4.CrossRefGoogle Scholar
  20. 20.
    Skerrett SJ, Henderson WR, Martin TR. Alveolar macrophage function in rats with severe protein calorie malnutrition. J Immunol 1990; 144: 1052–61.Google Scholar
  21. 21.
    Lesourd BM. Nutrition and immunity in the elderly: modification of immune responses with nutritional treatments. Am J Clin Nutr 1997; 66: 478S - 84S.Google Scholar
  22. 22.
    Lesourd BM, Meaume S. Cell mediated immunity changes in aging, relative importance of cell subpopulation switches and of nutritional factors. Immunol Lett 1994; 40: 235–42.CrossRefGoogle Scholar
  23. 23.
    Verdery RB. The role of malnutrition in the failure to thrive syndrome. In: Watson RR, ed, Handbook of Nutrition in the Aged, pp. 304–8. CRC, Boca Raton, FL, 1985.Google Scholar
  24. 24.
    Ausman LM, Russell RM. Nutrition in the elderly. In: Shils ME, Olson JA, Shike M, eds, Modem Nutrition in Health and Disease, pp. 770–80. Lea & Febiger, Philadelphia, 1994.Google Scholar
  25. 25.
    Sullivan DH, Walls RC, Bopp MM. Protein-energy undernutrition and the risk of mortality within one year of hospital discharge: a follow-up study. J Am Geriatr Soc 1995; 43: 507–12.Google Scholar
  26. 26.
    Cederholm T, Jagren C, Hellstrom K. Outcome of protein-energy malnutrition in elderly medical patients. Am J Med 1995; 98: 67–74.CrossRefGoogle Scholar
  27. 27.
    Cederholm TE, Hellstrom KH. Reversibility of protein-energy malnutrition in a group of chronically-ill elderly outpatients. Clin Nutr 1995; 14: 81–7.CrossRefGoogle Scholar
  28. 28.
    Morley JE. Anorexia of aging: physiologic and pathologic. Am J Clin Nutr 1997; 66: 760–73.Google Scholar
  29. 29.
    Taylor CG, Potter AJ, Rabinovitch PS. Splenocyte glutathione and CD3-mediated cell proliferation are reduced in mice fed a protein-deficient diet. J Nutr 1997; 127: 44–50.Google Scholar
  30. 30.
    Woodward BD, Miller RG. Depression of thymus-dependent immunity in wasting protein-energy malnutrition does not depend on an altered ratio of helper (CD4+) to suppressor (CD8+) T cells or on a disproportionately large atrophy of the T-cell relative to the B-cell pool. Am J Clin Nutr 1991; 53: 1329–35.Google Scholar
  31. 31.
    Sullivan DA, Vaerman JP, Soo C. Influence of severe protein malnu trition on rat lacrimal, salivary and gastrointestinal immune expression during development adulthood and aging. Immunology 1993; 78: 308–17.Google Scholar
  32. 32.
    Bradley SF, Vibhagool A, Kunkel SL, Kauffman CA. Monokine secretion in aging and protein malnutrition. J Leuk Biol 1989; 45: 510–4.Google Scholar
  33. 33.
    Kuvibidila S, Lolie Y, Ode D, Warier RP. The immune response in protein-energy malnutrition and single nutrient deficiencies. In: Klurfeld DM, ed, Human Nutrition: A Comprehensive Treatise, pp. 121–55. Plenum, New York, 1993.Google Scholar
  34. 34.
    Fraker PJ, Haas SM, Leucke RW. Effect of zinc deficiency on the immune response of the young adult A/J mouse. J Nutr 1977; 107: 1889–95.Google Scholar
  35. 35.
    Fraker PJ, King LE, Garvey BA, Medina CA. The immunopathology of zinc deficiency in humans and rodents. A possible role for pro- grammed cell death. In: Klurfeld DM, ed, Human Nutrition: A Com-prehensive Treatise, pp. 267–83. Plenum, New York, 1993.Google Scholar
  36. 36.
    Fernandes G, Nair M, Onoe K, Tanaka T, Floyd R, Good RA. Impair-ment of cell-mediated immunity functions by dietary zinc deficiency in mice. Proc Natl Acad Sci USA 1979; 76: 457–61.CrossRefGoogle Scholar
  37. 37.
    Prasad AS, Fitzgerald JT, Hess JW, Kaplan J, Peleu F, Dardenne M. Zinc deficiency in elderly patients. Nutrition 1993; 9: 218–24.Google Scholar
  38. 38.
    Sazawal S, Black RE, Bhan MK, Bhandali N, Sinha A, Jolla S. Zinc supplementation in young children with acute diarrhea in India. N Engl J Med 1995; 333: 839–44.CrossRefGoogle Scholar
  39. 39.
    Prasad AS. Zinc deficiency in women, infants and children. J Am Coll Nutr 1996; 15: 113–20.Google Scholar
  40. 40.
    Folwaezy C. Zinc and diarrhea in infants. J Trace Element Med Biol 1997; 11: 116–22.CrossRefGoogle Scholar
  41. 41.
    Tracey KJ. TNF and other cytokines in the metabolism of septic shock and cachexia. Clin Nutr 1992; 11: 1–11.CrossRefGoogle Scholar

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