Immune competence

Cellular immunity is the most sensitive component of malnutrition, but reduced immune competence is not specific to malnutrition, thus making it a poor predictor of such a state in sick patients. The lymphocyte subtype count, which correlates best with undernutrition in marasmus where metabolic stress is absent, cannot be used for that purpose in critically ill patients.

Many factors non-specifically alter delayed cutaneous hypersensitivity in the absence of malnutrition: viral, bacterial, and granulomatous infections; uremia, cirrhosis, hepatitis, trauma, burns, and haemorrhage; drugs such as steroids, immunosuppressants, and cimetidine; general anesthesia and surgery. Although anergy resulting from malnutrition can be reversed by nutritional support, delayed cutaneous hypersensitivity is valueless in assessing the state of nutrition as one or more of the above factors are generally present in critically ill patients. However, simply draining an abscess can reverse anergy. Hence, measuring delayed cutaneous hypersensitivity is not recommended in assessment of nutritional status.

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