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Cellular immune competence and diarrheal morbidity in malnourished Bangladeshi children: a prospective field study
Insights
Cellular immune incompetence in malnourished children, indicated by skin test anergy, significantly increases diarrheal disease attack rates and duration. This immune defect may perpetuate a cycle of infection and malnutrition.
Area of Science:
- Nutrition and Immunology
- Pediatric Infectious Diseases
Background:
- Protein-calorie malnutrition is prevalent in developing countries, impacting child health.
- Nutritional status is linked to immune function and susceptibility to infections.
- Cellular immune defects can exacerbate morbidity in malnourished children.
Purpose of the Study:
- To investigate the relationship between nutritional status, cellular immunity, and morbidity in Bangladeshi children.
- To determine if cellular immune defects, specifically anergy, are associated with increased risk of diarrheal, respiratory, and febrile diseases.
Main Methods:
- A year-long prospective study of 152 Bangladeshi children with mild to moderate protein-calorie malnutrition.
- Assessed nutritional status, cellular immune function (skin test anergy to recall antigens and dinitrochlorobenzene sensitization).
- Correlated immune status and nutritional status with morbidity from diarrheal, respiratory, and febrile diseases.
Main Results:
- In children over 36 months, wasting correlated with skin test anergy and impaired hypersensitivity.
- Anergy was associated with a 58% increased attack rate and 83% increased duration of diarrheal diseases.
- Ninety-three percent of prolonged diarrheal illnesses (≥14 days) occurred in anergic children, independent of nutritional status.
Conclusions:
- Cellular immune incompetence, indicated by anergy, is linked to increased diarrheal morbidity in malnourished children.
- This immune deficiency may contribute to a cycle of recurrent infections and worsening nutritional status.
- Targeting immune function alongside nutritional support could be crucial for managing childhood malnutrition and infections.
Abstract:
A year-long prospective study of 152 Bangladeshi children with mild to moderate protein-calorie malnutrition related nutritional status and cellular immune defects to morbidity due to diarrheal, respiratory, and febrile diseases. In children older than 36 mo, wasting correlated with skin test anergy to three recall antigens and with inability to initiate hypersensitivity to dinitrochlorobenzene. In this older age group, anergy was associated with a 58% increased attack rate and an 83% increased duration of diarrheal diseases but not with febrile or respiratory infections. In stepwise regression analysis, this anergy effect was independent of the small negative impact of poorer nutritional status on morbidity. Ninety-three percent of diarrheal illnesses lasting at least 14 d were among anergic children. Cellular immune incompetence, indicated by anergy of unknown etiology, is associated with increased diarrheal morbidity and may promote the vicious cycle of repeated infections and deteriorating nutritional status.