Antibody malnutrition

The higher than normal serum IgA in many children with protein calorie malnutrition may be related to increased synthesis of IgA by the intestinal lamina propria in resjionse to increased antigenic stimuli from bacteria and virus. This is probably supported by the observation that children with kwashiorkor were found to maintain their polio antibodies during malnutrition, and their immune mechanism seemed to be quite capable of inhibiting poliovirus infection, indicating that the intestinal receptor cell for poliovirus operates normally in kwashiorkor (B8). It is now known that polio antiliodies are mainly associated with IgA. 

Although the synthesis of the immunoglobulins in the majority of children with malnutrition, age above 7 months, is not impaired, there is now mounting evidence that the ability to produce specific antibody to some well known antigens may be subnormal (M14). 

In rabbits with undemutrition due to a shortage of calories there was a depressed agglutinin production against typhoid vaccine (C3, R4). A similar incapacity to produce antibodies to typhoid vaccine was reported in children with severe protein malnutrition (Bll). During treatment of 5 children, mean age 24 months, with chronic primary malnutrition, it was observed that their response to a single standard dose of 100 imits of purified diphtheroid toxoid was small and slow. Furthermore there was no correlation between specific antibody response and serum protein levels (02). 

Antibody Production to Yellow Fever, Smallpox, Polio, and Other Viruses in Malnutrition... 

The antibody response to yellow fever vaccine was impaired in protein-deficient children with kwashiorkor compared to the well-nourished controls. Polio antibody production was normal in the malnourished children, all of whom also responded in the normal fashion to smallpox vaccination. They had no evidence of disseminated vaccinia (B8). In Guatemala, on the other hand, smallpox vaccination of children who had fully recovered from severe protein-calorie malnutrition led to a drop in their nitrogen retention with the added complication of disseminated vaccinia (V3). 

Synthesis of immunoglobulins is not impaired in most patients with malnutrition. The majority of children above 7 months of age have normal serum immunoglobulin values. About 10% have elevated or low-values, which are now not alw-ays related to the severity of the nutritional defect, but also to whether infection is present or not. Production of specific antibody to many antigens, as well as cell-mediated immunity, are depressed, however, in malnutrition. 

Check for hypothyroidism, malnutrition, antibodies or opportunistic infections (AIDS patients) if no response to initial dose... 

In India, insulin antibodies have been investigated in 25 patients with type 1 diabetes, 19 patients with so-called malnutrition-related diabetes, and eight patients with fibrocalculous pancreatopathy, who used bovine insulin because it was cheaper (147). Antibodies appeared within 3 months of treatment. The development of antibodies was not related to the type of diabetes. There was a fall in antibody titer with increased duration of treatment. There was no correlation between daily insulin requirement and antibody titers. 

Infectious diseases are common and result in significant morbidity and mortality in patients with ESKD. Although multiple abnormalities in host defenses and an increased susceptibility to infection have been described, the causal link between these observations remains speculative. Absolute lymphopenia and impaired cell-mediated immunity are common in ESKD patients and may be caused by uremic toxins or protein-calorie malnutrition. Although plasma concentrations of IgG, IgM, and IgA are usually normal, antibody responses appear to be significantly depressed. Patients requiring dialysis have many problems with vascular access which puts them at higher risk for exposure to infectious sources. The risk of infections in patients with CKD, and particularly ESKD, is an important consideration when reviewing the clinical presentation of a patient, as hospitalization rates for infection and sepsis have increased dramatically in the last 10 years. ... 

The immune system is also compromised in uremia. That and the use of dialysis catheters and synthetic grafts, the frequent blood transfusions, the exposure to nosocomial organisms during repeated hospitalization, the presence of anemia and malnutrition, and the immunocompromised state associated with certain renal diseases (nephrotic syndrome, lupus erythematosus) all conspire to make infection a major cause of mortality, accounting for 15-20% of uremic deaths. Pyogenic infections are facilitated by impaired neutrophil adherence and chemotaxis (L7, S27), blunted antibody response (B15), and defective phagocytosis by macrophages due to decreased Fc-receptor activity (R19). 

Looking at the problem from another viewpoint, Corkill (1950) points out that in a number of diseases such as kala-azar, malaria, trypanosomiasis, and amebic dysentery in which periods of latency exist, there may be breakdown of resistance or disturbance of host-parasite balance leading to relapse or exacerbation in response to a variety of stress conditions. Such stresses are trauma, intercurrent infection, malnutrition, and pregnancy. Corkill puts forward the hypothesis that an important factor in this lowered resistance is failure of the host to synthesize antibody 7-globulin under conditions in which there is excessive breakdown of tissue protein or insufficient intake of dietary essential amino acids. Particularly he incriminates lysine, in which a number of widely used tropical staple cereals are notably deficient. 

It is noteworthy that the ability of the body to form antibodies against disease appears to be related to nutritional status since it has been shown that various forms of malnutrition, particularly protein deficiency, are accompanied by both subnormal levels of antibodies and increased susceptibility to infection. 

Because animal proteins are in short supply in the developing countries, it has been estimated that 20 to 30% of the children in these countries suffer severe protein- calorie malnutrition, and that it may contribute to as much as 50% of the mortality for this group. Kwashiorkor and marasmus are common manifestations of protein and protein-calorie deficiencies in infants and children. Also, the ability of the human body to produce antibodies (substances that attack specific foreign bodies) is dependent upon an... 

Passwell, J. H., Steward, M. W., and Soothill, J. T. (1974) The effect of protein malnutrition on macrophage function and the amount and affinity of antibody response. Clin. Exp. Immunol. 17 491. 

Charupatana, C., and Olson, R. E. (1976b) Immunoglobulins and antibody response in children with protein calorie malnutrition. Am. J. Clin. Nutr. 29 836. 

Malnutrition lowers immunity, and infections are more common transferrin (the body s iron-carrying protein) and antibody response to some antigens are defective in protein-energy malnutrition . A vicious circle results ... 

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