Cellular immunity in semistarved states in hospitalized adults

Adult protein-calorie malnutrition, as reflected by decreased levels of serum albumin and transferrin, was studied in 21 hospitalized patients. This malnutrition state was a consequence of a catabolic response to stress and also use of standard parenteral fluid maintenance with 5% dextrose and water. Associated findings included a significant reduction in both total lymphocytes and cellular immunity, as measured by dinitrochlorobenzene and Candida skin testing. This state of visceral attrition, resembling kwashiorkor, occurs commonly in hospitalized patients, and may account for significant morbidity and mortality. Alternatives to the 5% dextrose and water in the nutritional support of the semistarved state may allow better preservation of visceral protein status and immune function.