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Acute-phase protein response is impaired in severely malnourished children
J F Doherty1, M H Golden, J G Raynes
1Tropical Metabolism Research Unit, University of the West Indies, Kingston, Jamaica.
Insights
Malnourished children show impaired acute-phase protein responses, affecting healing. Their C-reactive protein and serum amyloid A levels do not adequately increase after vaccination, indicating a compromised immune response.
Area of Science:
- Immunology
- Nutritional Science
- Pediatrics
Background:
- Malnutrition significantly impacts immune function and inflammatory responses.
- Acute-phase proteins like C-reactive protein (CRP) and serum amyloid A (SAA) are crucial in infection and healing.
Purpose of the Study:
- To assess the acute-phase protein response to vaccination in malnourished children.
- To compare these responses between severely and mildly malnourished children, and across different recovery stages.
Main Methods:
- Measured plasma CRP and SAA levels in severely malnourished children at admission and during recovery.
- Administered diphtheria-pertussis-tetanus (DPT) vaccine to assess immune response.
- Included a control group of mildly malnourished children.
Main Results:
- Severely malnourished children often had normal CRP and SAA levels despite infection.
- Vaccine-induced CRP and SAA responses were significantly lower in early recovery compared to post-nutritional rehabilitation.
- Mildly malnourished children showed a similar impaired response in early recovery compared to severely malnourished children.
Conclusions:
- The acute-phase protein response to vaccination is impaired in malnourished children.
- This impairment may have prognostic implications for healing and recovery.
- Nutritional status critically influences the ability to mount an effective acute-phase protein response.
Abstract:
1. The responses of plasma levels of C-reactive protein and serum amyloid A were assessed in two groups of malnourished children. 2. Sixty-six severely malnourished children were studied at admission. Fifty of these had clinical and/or laboratory evidence of infection. C-reactive protein was not elevated in 23 (46%) and serum amyloid A was not raised in 29 (58%) of these 50 children. 3. Surviving children (n = 62) received two doses of diphtheria-pertussis-tetanus vaccine, to which the C-reactive protein and serum amyloid A responses were measured. The first was given early in recovery, the second after nutritional rehabilitation. Ten mildly malnourished children acted as controls, receiving a single dose of diphtheria-pertussis-tetanus vaccine. 4. The responses of both C-reactive protein and serum amyloid A to diphtheria-pertussis-tetanus vaccine were significantly less in early recovery than after nutritional recovery. The response of the mildly malnourished group was no different from that of the severely malnourished group in early recovery, but was less than their response on discharge. 5. The acute-phase protein response of malnourished children is impaired. This may have prognostic implications as the response plays a central role in promoting healing.