Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1977 Apr;185(4):467–474. doi: 10.1097/00000658-197704000-00017

The effects of total parenteral nutrition on immunodepression due to malnutrition.

R Dionigi, Ariszonta, L Dominioni, F Gnes, A Ballabio
PMCID: PMC1396127  PMID: 402893

Abstract

An experimental study was performed in 16 dogs to investigate the effects of sub-acute malnutrition on humoral and cellular immunity and phagocytic functions and, subsequently, to investigate the ability of total parenteral nutrition (TPN) to restore abnormal immunological variables. Deficiencies of IgG, C3, primary immune response to sheep red blood cells (SRBC),lymphocyte counts, lymphocyte response to phytohemagglutinin (PHA), and neutrophi chemotaxis were found to be caused by malnutrition. Nutritional repletion by means of TPN resulted in a return to normal or supranormal serum concentrations of IgG, IgM, and C3, and the primary immune response to SRVC was prompter and higher. Moreover, TPN resulted in restoration of normal neutrophil chemotactic responses. TPN did not improve lymphocyte response to PHA in these experiments. The study demonstrates that subacute malnutrition results in broad based deficiencies of the immunological response of the type that predispose to infection and that the proper use of TPN can correct most of these abnormalities.

Full text

PDF
467

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alexander J. W. Emerging concepts in the control of surgical infections. Surgery. 1974 Jun;75(6):934–946. [PubMed] [Google Scholar]
  2. Alleyne G. A., Young V. H. Adrenocortical function in children with severe protein-calorie malnutrition. Clin Sci. 1967 Aug;33(1):189–200. [PubMed] [Google Scholar]
  3. Alper C. A., Johnson A. M., Birtch A. G., Moore F. D. Human C'3: evidence for the liver as the primary site of synthesis. Science. 1969 Jan 17;163(3864):286–288. doi: 10.1126/science.163.3864.286. [DOI] [PubMed] [Google Scholar]
  4. Altay C., Dogramaci N., Bingol A., Say B. Nitroblue tetrazolium test in children with malnutrition. J Pediatr. 1972 Aug;81(2):392–393. doi: 10.1016/s0022-3476(72)80319-6. [DOI] [PubMed] [Google Scholar]
  5. Aref G. H., el-Din M. K., Hassan A. I., Araby I. I. Immunoglobulins in kwashiorkor. J Trop Med Hyg. 1970 Aug;73(8):186–191. [PubMed] [Google Scholar]
  6. Brown R. E., Katz M. Failure of antibody production to yellow fever vaccine in children with kwashiorkor. Trop Geogr Med. 1966 Jun;18(2):125–128. [PubMed] [Google Scholar]
  7. Chandra R. K. Immunocompetence in undernutrition. J Pediatr. 1972 Dec;81(6):1194–1200. doi: 10.1016/s0022-3476(72)80262-2. [DOI] [PubMed] [Google Scholar]
  8. Chandra R. K. Rosette-forming T lymphocytes and cell-mediated immunity in malnutrition. Br Med J. 1974 Sep 7;3(5931):608–609. doi: 10.1136/bmj.3.5931.608. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Copeland E. M., 3rd, MacFadyen B. V., Jr, Rapp M. A., Dudrick S. J. Hyperalimentation and immune competence in cancer. Surg Forum. 1975;26:138–140. [PubMed] [Google Scholar]
  10. Dhillon K. S., MacLean L. D., Meakins J. L. Neutrophil function in surgical patients: correlation of neutrophil bactericidal function, serum albumin, and sepsis. Surg Forum. 1975;26:27–28. [PubMed] [Google Scholar]
  11. Dionigi R., Zonta A., Albertario F., Galeazzi R., Bellinzona G. Cyclic variation in the response of lymphocytes to phytohemagglutinin in healthy individuals. Transplantation. 1973 Dec;16(6):550–557. doi: 10.1097/00007890-197312000-00003. [DOI] [PubMed] [Google Scholar]
  12. Dudrick S. J., Steiger E., Wilmore D. W., Vars H. M. Continuous long-term intravenous infusion in unrestrained animals. Lab Anim Care. 1970 Jun;20(3):521–529. [PubMed] [Google Scholar]
  13. Dudrick S. J., Wilmore D. W., Vars H. M., Rhoads J. E. Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery. 1968 Jul;64(1):134–142. [PubMed] [Google Scholar]
  14. Gordon J. E., Scrimshaw N. S. Infectious disease in the malnourished. Med Clin North Am. 1970 Nov;54(6):1495–1508. [PubMed] [Google Scholar]
  15. Jose D. G., Good R. A. Absence of enhancing antibody in cell mediated immunity to tumour heterografts in protein deficient rats. Nature. 1971 Jun 4;231(5301):323–325. doi: 10.1038/231323b0. [DOI] [PubMed] [Google Scholar]
  16. Jose D. G., Stutman O., Good R. A. Long term effects on immune function of early nutritional deprivation. Nature. 1973 Jan 5;241(5384):57–58. doi: 10.1038/241057a0. [DOI] [PubMed] [Google Scholar]
  17. Keet M. P., Thom H. Serum immunoglobulins in kwashiorkor. Arch Dis Child. 1969 Oct;44(237):600–603. doi: 10.1136/adc.44.237.600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Law D. K., Dudrick S. J., Abdou N. I. Immunocompetence of patients with protein-calorie malnutrition. The effects of nutritional repletion. Ann Intern Med. 1973 Oct;79(4):545–550. doi: 10.7326/0003-4819-79-4-545. [DOI] [PubMed] [Google Scholar]
  19. Law D. K., Dudrick S. J., Abdou N. I. The effect of dietary protein depletion on immunocompetence: the importance of nutritional repletion prior to immunologic induction. Ann Surg. 1974 Feb;179(2):168–173. doi: 10.1097/00000658-197402000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Lennard E. S., Bjornson A. B., Petering H. G., Alexander J. W. An immunologic and nutritional evaluation of burn neutrophil function. J Surg Res. 1974 Mar;16(3):286–298. doi: 10.1016/0022-4804(74)90045-6. [DOI] [PubMed] [Google Scholar]
  21. Mata L. J., Urrutia J. J., Lechtig A. Infection and nutrition of children of a low socioeconomic rural community. Am J Clin Nutr. 1971 Feb;24(2):249–259. doi: 10.1093/ajcn/24.2.249. [DOI] [PubMed] [Google Scholar]
  22. Mathews J. D., Mackay I. R., Whittingham S., Malcolm L. A. Protein supplementation and enhanced antibody-producing capacity in New Guinean school-children. Lancet. 1972 Sep 30;2(7779):675–677. doi: 10.1016/s0140-6736(72)92086-7. [DOI] [PubMed] [Google Scholar]
  23. McFarlane H., Reddy S., Cooke A., Longe O., Onabamiro M. O., Houba J. E. Immunoglobulins, transferrin, caeruloplasmin and heterophile antibodies in kwashiorkor. Trop Geogr Med. 1970 Mar;22(1):61–64. [PubMed] [Google Scholar]
  24. Miller M. E., Oski F. A., Harris M. B. Lazy-leucocyte syndrome. A new disorder of neutrophil function. Lancet. 1971 Apr 3;1(7701):665–669. doi: 10.1016/s0140-6736(71)92679-1. [DOI] [PubMed] [Google Scholar]
  25. Najjar S. S., Stephan M., Asfour R. Y. Serum levels of immunoglobulins in marasmic infants. Arch Dis Child. 1969 Feb;44(233):120–123. doi: 10.1136/adc.44.233.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Neumann C. G., Lawlor G. J., Jr, Stiehm E. R., Swenseid M. E., Newton C., Herbert J., Ammann A. J., Jacob M. Immunologic responses in malnourished children. Am J Clin Nutr. 1975 Feb;28(2):89–104. doi: 10.1093/ajcn/28.2.89. [DOI] [PubMed] [Google Scholar]
  27. PRETORIUS P. J., DE VILLIERS L. S. Antibody response in children with protein malnutrition. Am J Clin Nutr. 1962 May;10:379–383. doi: 10.1093/ajcn/10.5.379. [DOI] [PubMed] [Google Scholar]
  28. Passwell J. H., Steward M. W., Soothill J. F. The effects of protein malnutrition on macrophage function and the amount and affinity of antibody response. Clin Exp Immunol. 1974 Jul;17(3):491–495. [PMC free article] [PubMed] [Google Scholar]
  29. REDDY V., SRIKANTIA S. G. ANTIBODY RESPONSE IN KWASHIORKOR. Indian J Med Res. 1964 Nov;52:1154–1158. [PubMed] [Google Scholar]
  30. Rhoads J. E., Steiger E., Dudrick S. J., Long J. M. Intravenous hyperalimentation. Med Clin North Am. 1970 May;54(3):577–589. [PubMed] [Google Scholar]
  31. Rosen E. U., Geefhuysen J., Ipp T. Immunoglobulin levels in protein calorie malnutrition. S Afr Med J. 1971 Sep 4;45(35):980–982. [PubMed] [Google Scholar]
  32. SCRIMSHAW N. S., BEHAR M. Worldwide occurrence of protein malnutrition. Fed Proc. 1959 Jul;18(2 Pt 2):82–88. [PubMed] [Google Scholar]
  33. Schonland M. M., Shanley B. C., Loening W. E., Parent M. A., Coovadia H. M. Plasma-cortisol and immunosuppression in protein-calorie malnutrition. Lancet. 1972 Aug 26;2(7774):435–436. doi: 10.1016/s0140-6736(72)91841-7. [DOI] [PubMed] [Google Scholar]
  34. Selvaraj R. J., Bhat K. S. Phagocytosis and leucocyte enzymes in protein-calorie malnutrition. Biochem J. 1972 Mar;127(1):255–259. doi: 10.1042/bj1270255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Seth V., Chandra R. K. Opsonic activity, phagocytosis, and bactericidal capacity of polymorphs in undernutrition. Arch Dis Child. 1972 Apr;47(252):282–284. doi: 10.1136/adc.47.252.282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Sirisinha S., Edelman R., Suskind R., Charupatana C., Olson R. E. Complement and C3-proactivator levels in children with protein-calorie malnutrition and effect of dietary treatment. Lancet. 1973 May 12;1(7811):1016–1020. doi: 10.1016/s0140-6736(73)90663-6. [DOI] [PubMed] [Google Scholar]
  37. Smythe P. M., Brereton-Stiles G. G., Grace H. J., Mafoyane A., Schonland M., Coovadia H. M., Loening W. E., Parent M. A., Vos G. H. Thymolymphatic deficiency and depression of cell-mediated immunity in protein-calorie malnutrition. Lancet. 1971 Oct 30;2(7731):939–943. doi: 10.1016/s0140-6736(71)90267-4. [DOI] [PubMed] [Google Scholar]
  38. Warden G. D., Mason A. D., Jr, Pruitt B. A., Jr Evaluation of leukocyte chemotaxis in vitro in thermally injured patients. J Clin Invest. 1974 Oct;54(4):1001–1004. doi: 10.1172/JCI107815. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Watson C. E., Freesemann C. Immunoglobulins in protein-calorie malnutrition. Arch Dis Child. 1970 Apr;45(240):282–284. doi: 10.1136/adc.45.240.282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Woodruff J. F. The influence of quantitated post-weaning undernutrition on coxsackievirus B3 infection of adult mice. II. Alteration of host defense mechanisms. J Infect Dis. 1970 Feb;121(2):164–181. doi: 10.1093/infdis/121.2.164. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES