Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug 25;9(8):e105017.
doi: 10.1371/journal.pone.0105017. eCollection 2014.

The immune system in children with malnutrition--a systematic review

Maren Johanne Heilskov Rytter  1 , Lilian Kolte  2 , André Briend  3 , Henrik Friis  1 , Vibeke Brix Christensen  4
Affiliations

The immune system in children with malnutrition--a systematic review

Maren Johanne Heilskov Rytter et al. PLoS One. .

Abstract

Background: Malnourished children have increased risk of dying, with most deaths caused by infectious diseases. One mechanism behind this may be impaired immune function. However, this immune deficiency of malnutrition has not previously been systematically reviewed.

Objectives: To review the scientific literature about immune function in children with malnutrition.

Methods: A systematic literature search was done in PubMed, and additional articles identified in reference lists and by correspondence with experts in the field. The inclusion criteria were studies investigating immune parameters in children aged 1-60 months, in relation to malnutrition, defined as wasting, underweight, stunting, or oedematous malnutrition.

Results: The literature search yielded 3402 articles, of which 245 met the inclusion criteria. Most were published between 1970 and 1990, and only 33 after 2003. Malnutrition is associated with impaired gut-barrier function, reduced exocrine secretion of protective substances, and low levels of plasma complement. Lymphatic tissue, particularly the thymus, undergoes atrophy, and delayed-type hypersensitivity responses are reduced. Levels of antibodies produced after vaccination are reduced in severely malnourished children, but intact in moderate malnutrition. Cytokine patterns are skewed towards a Th2-response. Other immune parameters seem intact or elevated: leukocyte and lymphocyte counts are unaffected, and levels of immunoglobulins, particularly immunoglobulin A, are high. The acute phase response appears intact, and sometimes present in the absence of clinical infection. Limitations to the studies include their observational and often cross-sectional design and frequent confounding by infections in the children studied.

Conclusion: The immunological alterations associated with malnutrition in children may contribute to increased mortality. However, the underlying mechanisms are still inadequately understood, as well as why different types of malnutrition are associated with different immunological alterations. Better designed prospective studies are needed, based on current understanding of immunology and with state-of-the-art methods.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Conceptual framework on the relationship between malnutrition, infections and poverty.
Figure 2
Figure 2. Clinical picture: two forms of severe acute malnutrition, oedematous and non-oedematous malnutrition.
Figure 3
Figure 3. Full search strategy in PubMed, including search terms and filters.
Figure 4
Figure 4. Number of studies published per 5-year period about immune function in malnourished children.
Figure 5
Figure 5. Summary of immune parameters affected and not affected by malnutrition.
See this image and copyright information in PMC

References

    1. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 382: 427–451 10.1016/S0140-6736(13)60937-X - DOI - PubMed
    1. Pelletier DL, Frongillo EA Jr, Schroeder DG, Habicht JP (1995) The effects of malnutrition on child mortality in developing countries. Bull World Health Organ 73: 443–448. - PMC - PubMed
    1. Tomkins A, Watson F (1989) Malnutrition and Infection - A Review - Nutrition Policy Discussion Paper No. 5. United Nations - Administrative Commitee on Coordination - Subcommitee on Nutrition
    1. Chisti MJ, Tebruegge M, La Vincente S, Graham SM, Duke T (2009) Pneumonia in severely malnourished children in developing countries - mortality risk, aetiology and validity of WHO clinical signs: a systematic review. Trop Med Int Health TM IH 14: 1173–1189 10.1111/j.1365-3156.2009.02364.x - DOI - PubMed
    1. Waterlow JC (1992) Protein Energy malnutrition, 2nd ed. London: Hodder&Stouton.

Publication types