Malnutrition and Infection: Complex Mechanisms and Global Impacts
Identifieur interne : 000F27 ( Pmc/Corpus ); précédent : 000F26; suivant : 000F28Malnutrition and Infection: Complex Mechanisms and Global Impacts
Auteurs : Ulrich E. Schaible ; Stefan H. E. KaufmannSource :
- PLoS Medicine [ 1549-1277 ] ; 2007.
Abstract
The authors discuss current concepts and controversies surrounding the complex influences of malnutrition on infection and immunity, and point to practical consequences of countermeasures in acute malnutrition.
Url:
DOI: 10.1371/journal.pmed.0040115
PubMed: 17472433
PubMed Central: 1858706
Links to Exploration step
PMC:1858706Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Malnutrition and Infection: Complex Mechanisms and Global Impacts</title><author><name sortKey="Schaible, Ulrich E" sort="Schaible, Ulrich E" uniqKey="Schaible U" first="Ulrich E" last="Schaible">Ulrich E. Schaible</name></author><author><name sortKey="Kaufmann, Stefan H E" sort="Kaufmann, Stefan H E" uniqKey="Kaufmann S" first="Stefan H. E" last="Kaufmann">Stefan H. E. Kaufmann</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17472433</idno><idno type="pmc">1858706</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1858706</idno><idno type="RBID">PMC:1858706</idno><idno type="doi">10.1371/journal.pmed.0040115</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">000F27</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000F27</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Malnutrition and Infection: Complex Mechanisms and Global Impacts</title><author><name sortKey="Schaible, Ulrich E" sort="Schaible, Ulrich E" uniqKey="Schaible U" first="Ulrich E" last="Schaible">Ulrich E. Schaible</name></author><author><name sortKey="Kaufmann, Stefan H E" sort="Kaufmann, Stefan H E" uniqKey="Kaufmann S" first="Stefan H. E" last="Kaufmann">Stefan H. E. Kaufmann</name></author></analytic><series><title level="j">PLoS Medicine</title><idno type="ISSN">1549-1277</idno><idno type="eISSN">1549-1676</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The authors discuss current concepts and controversies surrounding the complex influences of malnutrition on infection and immunity, and point to practical consequences of countermeasures in acute malnutrition.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Moret, Y" uniqKey="Moret Y">Y Moret</name></author><author><name sortKey="Schmid Hempel, P" uniqKey="Schmid Hempel P">P Schmid-Hempel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Scrimshaw, Ns" uniqKey="Scrimshaw N">NS Scrimshaw</name></author><author><name sortKey="Sangiovanni, Jp" uniqKey="Sangiovanni J">JP SanGiovanni</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ambrus, Jl" uniqKey="Ambrus J">JL Ambrus</name></author><author><name sortKey="Ambrus, Jl" uniqKey="Ambrus J">JL Ambrus</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woodward, B" uniqKey="Woodward B">B Woodward</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Savino, W" uniqKey="Savino W">W Savino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Beisel, Wr" uniqKey="Beisel W">WR Beisel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Field, Cj" uniqKey="Field C">CJ Field</name></author><author><name sortKey="Johnson, Ir" uniqKey="Johnson I">IR Johnson</name></author><author><name sortKey="Schley, Pd" uniqKey="Schley P">PD Schley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cegielski, Jp" uniqKey="Cegielski J">JP Cegielski</name></author><author><name sortKey="Mcmurray, Dn" uniqKey="Mcmurray D">DN McMurray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Enwonwu, Co" uniqKey="Enwonwu C">CO Enwonwu</name></author><author><name sortKey="Falkler, Wa" uniqKey="Falkler W">WA Falkler</name></author><author><name sortKey="Phillips, Rs" uniqKey="Phillips R">RS Phillips</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stephensen, Cb" uniqKey="Stephensen C">CB Stephensen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Villamor, E" uniqKey="Villamor E">E Villamor</name></author><author><name sortKey="Saathoff, E" uniqKey="Saathoff E">E Saathoff</name></author><author><name sortKey="Mugusi, F" uniqKey="Mugusi F">F Mugusi</name></author><author><name sortKey="Bosch, Rj" uniqKey="Bosch R">RJ Bosch</name></author><author><name sortKey="Urassa, W" uniqKey="Urassa W">W Urassa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Scrimshaw, Ns" uniqKey="Scrimshaw N">NS Scrimshaw</name></author><author><name sortKey="Taylor, Ce" uniqKey="Taylor C">CE Taylor</name></author><author><name sortKey="Gordon, Je" uniqKey="Gordon J">JE Gordon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bronte, V" uniqKey="Bronte V">V Bronte</name></author><author><name sortKey="Zanovello, P" uniqKey="Zanovello P">P Zanovello</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kurpad, Av" uniqKey="Kurpad A">AV Kurpad</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Phillips, Rs" uniqKey="Phillips R">RS Phillips</name></author><author><name sortKey="Enwonwu, Co" uniqKey="Enwonwu C">CO Enwonwu</name></author><author><name sortKey="Okolo, S" uniqKey="Okolo S">S Okolo</name></author><author><name sortKey="Hassan, A" uniqKey="Hassan A">A Hassan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schneider, Sm" uniqKey="Schneider S">SM Schneider</name></author><author><name sortKey="Veyres, P" uniqKey="Veyres P">P Veyres</name></author><author><name sortKey="Pivot, X" uniqKey="Pivot X">X Pivot</name></author><author><name sortKey="Soummer, Am" uniqKey="Soummer A">AM Soummer</name></author><author><name sortKey="Jambou, P" uniqKey="Jambou P">P Jambou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Caulfield, Le" uniqKey="Caulfield L">LE Caulfield</name></author><author><name sortKey="De Onis, M" uniqKey="De Onis M">M de Onis</name></author><author><name sortKey="Blossner, M" uniqKey="Blossner M">M Blossner</name></author><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abe, M" uniqKey="Abe M">M Abe</name></author><author><name sortKey="Akbar, F" uniqKey="Akbar F">F Akbar</name></author><author><name sortKey="Matsuura, B" uniqKey="Matsuura B">B Matsuura</name></author><author><name sortKey="Horiike, N" uniqKey="Horiike N">N Horiike</name></author><author><name sortKey="Onji, M" uniqKey="Onji M">M Onji</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Najera, O" uniqKey="Najera O">O Najera</name></author><author><name sortKey="Gonzalez, C" uniqKey="Gonzalez C">C Gonzalez</name></author><author><name sortKey="Toledo, G" uniqKey="Toledo G">G Toledo</name></author><author><name sortKey="Lopez, L" uniqKey="Lopez L">L Lopez</name></author><author><name sortKey="Cortes, E" uniqKey="Cortes E">E Cortes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Najera, O" uniqKey="Najera O">O Najera</name></author><author><name sortKey="Gonzalez, C" uniqKey="Gonzalez C">C Gonzalez</name></author><author><name sortKey="Toledo, G" uniqKey="Toledo G">G Toledo</name></author><author><name sortKey="Lopez, L" uniqKey="Lopez L">L Lopez</name></author><author><name sortKey="Ortiz, R" uniqKey="Ortiz R">R Ortiz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rodriguez, L" uniqKey="Rodriguez L">L Rodriguez</name></author><author><name sortKey="Gonzalez, C" uniqKey="Gonzalez C">C Gonzalez</name></author><author><name sortKey="Flores, L" uniqKey="Flores L">L Flores</name></author><author><name sortKey="Jimenez Zamudio, L" uniqKey="Jimenez Zamudio L">L Jimenez-Zamudio</name></author><author><name sortKey="Graniel, J" uniqKey="Graniel J">J Graniel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Woodward, B" uniqKey="Woodward B">B Woodward</name></author><author><name sortKey="Hillyer, L" uniqKey="Hillyer L">L Hillyer</name></author><author><name sortKey="Hunt, K" uniqKey="Hunt K">K Hunt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ten Bruggencate, Sj" uniqKey="Ten Bruggencate S">SJ ten Bruggencate</name></author><author><name sortKey="Hillyer, Lm" uniqKey="Hillyer L">LM Hillyer</name></author><author><name sortKey="Woodward, Bd" uniqKey="Woodward B">BD Woodward</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Neyestani, Tr" uniqKey="Neyestani T">TR Neyestani</name></author><author><name sortKey="Woodward, B" uniqKey="Woodward B">B Woodward</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hagel, I" uniqKey="Hagel I">I Hagel</name></author><author><name sortKey="Lynch, Nr" uniqKey="Lynch N">NR Lynch</name></author><author><name sortKey="Di Prisco, Mc" uniqKey="Di Prisco M">MC Di Prisco</name></author><author><name sortKey="Sanchez, J" uniqKey="Sanchez J">J Sanchez</name></author><author><name sortKey="Perez, M" uniqKey="Perez M">M Perez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hagel, I" uniqKey="Hagel I">I Hagel</name></author><author><name sortKey="Lynch, Nr" uniqKey="Lynch N">NR Lynch</name></author><author><name sortKey="Puccio, F" uniqKey="Puccio F">F Puccio</name></author><author><name sortKey="Rodriguez, O" uniqKey="Rodriguez O">O Rodriguez</name></author><author><name sortKey="Luzondo, R" uniqKey="Luzondo R">R Luzondo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ing, R" uniqKey="Ing R">R Ing</name></author><author><name sortKey="Su, Z" uniqKey="Su Z">Z Su</name></author><author><name sortKey="Scott, Me" uniqKey="Scott M">ME Scott</name></author><author><name sortKey="Koski, Kg" uniqKey="Koski K">KG Koski</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singal, A" uniqKey="Singal A">A Singal</name></author><author><name sortKey="Pandhi, D" uniqKey="Pandhi D">D Pandhi</name></author><author><name sortKey="Agrawal, Sk" uniqKey="Agrawal S">SK Agrawal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liebeschuetz, S" uniqKey="Liebeschuetz S">S Liebeschuetz</name></author><author><name sortKey="Bamber, S" uniqKey="Bamber S">S Bamber</name></author><author><name sortKey="Ewer, K" uniqKey="Ewer K">K Ewer</name></author><author><name sortKey="Deeks, J" uniqKey="Deeks J">J Deeks</name></author><author><name sortKey="Pathan, Aa" uniqKey="Pathan A">AA Pathan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Metcalfe, N" uniqKey="Metcalfe N">N Metcalfe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dai, G" uniqKey="Dai G">G Dai</name></author><author><name sortKey="Mcmurray, Dn" uniqKey="Mcmurray D">DN McMurray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dai, G" uniqKey="Dai G">G Dai</name></author><author><name sortKey="Mcmurray, Dn" uniqKey="Mcmurray D">DN McMurray</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, J" uniqKey="Chan J">J Chan</name></author><author><name sortKey="Tian, Y" uniqKey="Tian Y">Y Tian</name></author><author><name sortKey="Tanaka, Ke" uniqKey="Tanaka K">KE Tanaka</name></author><author><name sortKey="Tsang, Ms" uniqKey="Tsang M">MS Tsang</name></author><author><name sortKey="Yu, K" uniqKey="Yu K">K Yu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcmurray, Dn" uniqKey="Mcmurray D">DN McMurray</name></author><author><name sortKey="Dai, G" uniqKey="Dai G">G Dai</name></author><author><name sortKey="Phalen, S" uniqKey="Phalen S">S Phalen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Matarese, G" uniqKey="Matarese G">G Matarese</name></author><author><name sortKey="Moschos, S" uniqKey="Moschos S">S Moschos</name></author><author><name sortKey="Mantzoros, Cs" uniqKey="Mantzoros C">CS Mantzoros</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Matarese, G" uniqKey="Matarese G">G Matarese</name></author><author><name sortKey="La Cava, A" uniqKey="La Cava A">A La Cava</name></author><author><name sortKey="Sanna, V" uniqKey="Sanna V">V Sanna</name></author><author><name sortKey="Lord, Gm" uniqKey="Lord G">GM Lord</name></author><author><name sortKey="Lechler, Ri" uniqKey="Lechler R">RI Lechler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lord, Gm" uniqKey="Lord G">GM Lord</name></author><author><name sortKey="Matarese, G" uniqKey="Matarese G">G Matarese</name></author><author><name sortKey="Howard, Jk" uniqKey="Howard J">JK Howard</name></author><author><name sortKey="Baker, Rj" uniqKey="Baker R">RJ Baker</name></author><author><name sortKey="Bloom, Sr" uniqKey="Bloom S">SR Bloom</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lord, Gm" uniqKey="Lord G">GM Lord</name></author><author><name sortKey="Matarese, G" uniqKey="Matarese G">G Matarese</name></author><author><name sortKey="Howard, Jk" uniqKey="Howard J">JK Howard</name></author><author><name sortKey="Bloom, Sr" uniqKey="Bloom S">SR Bloom</name></author><author><name sortKey="Lechler, Ri" uniqKey="Lechler R">RI Lechler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Faggioni, R" uniqKey="Faggioni R">R Faggioni</name></author><author><name sortKey="Feingold, Kr" uniqKey="Feingold K">KR Feingold</name></author><author><name sortKey="Grunfeld, C" uniqKey="Grunfeld C">C Grunfeld</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cakir, B" uniqKey="Cakir B">B Cakir</name></author><author><name sortKey="Yonem, A" uniqKey="Yonem A">A Yonem</name></author><author><name sortKey="Guler, S" uniqKey="Guler S">S Guler</name></author><author><name sortKey="Odabasi, E" uniqKey="Odabasi E">E Odabasi</name></author><author><name sortKey="Demirbas, B" uniqKey="Demirbas B">B Demirbas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schwenk, A" uniqKey="Schwenk A">A Schwenk</name></author><author><name sortKey="Hodgson, L" uniqKey="Hodgson L">L Hodgson</name></author><author><name sortKey="Rayner, Cf" uniqKey="Rayner C">CF Rayner</name></author><author><name sortKey="Griffin, Ge" uniqKey="Griffin G">GE Griffin</name></author><author><name sortKey="Macallan, Dc" uniqKey="Macallan D">DC Macallan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Crevel, R" uniqKey="Van Crevel R">R van Crevel</name></author><author><name sortKey="Karyadi, E" uniqKey="Karyadi E">E Karyadi</name></author><author><name sortKey="Netea, Mg" uniqKey="Netea M">MG Netea</name></author><author><name sortKey="Verhoef, H" uniqKey="Verhoef H">H Verhoef</name></author><author><name sortKey="Nelwan, Rh" uniqKey="Nelwan R">RH Nelwan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Lettow, M" uniqKey="Van Lettow M">M van Lettow</name></author><author><name sortKey="Van Der Meer, Jw" uniqKey="Van Der Meer J">JW van der Meer</name></author><author><name sortKey="West, Ce" uniqKey="West C">CE West</name></author><author><name sortKey="Van Crevel, R" uniqKey="Van Crevel R">R van Crevel</name></author><author><name sortKey="Semba, Rd" uniqKey="Semba R">RD Semba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wieland, Cw" uniqKey="Wieland C">CW Wieland</name></author><author><name sortKey="Florquin, S" uniqKey="Florquin S">S Florquin</name></author><author><name sortKey="Chan, Ed" uniqKey="Chan E">ED Chan</name></author><author><name sortKey="Leemans, Jc" uniqKey="Leemans J">JC Leemans</name></author><author><name sortKey="Weijer, S" uniqKey="Weijer S">S Weijer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Monk, Jm" uniqKey="Monk J">JM Monk</name></author><author><name sortKey="Makinen, K" uniqKey="Makinen K">K Makinen</name></author><author><name sortKey="Shrum, B" uniqKey="Shrum B">B Shrum</name></author><author><name sortKey="Woodward, B" uniqKey="Woodward B">B Woodward</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jacobson, L" uniqKey="Jacobson L">L Jacobson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alleyne, Ga" uniqKey="Alleyne G">GA Alleyne</name></author><author><name sortKey="Young, Vh" uniqKey="Young V">VH Young</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Auphan, N" uniqKey="Auphan N">N Auphan</name></author><author><name sortKey="Didonato, Ja" uniqKey="Didonato J">JA Didonato</name></author><author><name sortKey="Helmberg, A" uniqKey="Helmberg A">A Helmberg</name></author><author><name sortKey="Rosette, C" uniqKey="Rosette C">C Rosette</name></author><author><name sortKey="Karin, M" uniqKey="Karin M">M Karin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Molle, W" uniqKey="Van Molle W">W Van Molle</name></author><author><name sortKey="Libert, C" uniqKey="Libert C">C Libert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mccarter, Md" uniqKey="Mccarter M">MD McCarter</name></author><author><name sortKey="Naama, Ha" uniqKey="Naama H">HA Naama</name></author><author><name sortKey="Shou, J" uniqKey="Shou J">J Shou</name></author><author><name sortKey="Kwi, Lx" uniqKey="Kwi L">LX Kwi</name></author><author><name sortKey="Evoy, Da" uniqKey="Evoy D">DA Evoy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Redmond, Hp" uniqKey="Redmond H">HP Redmond</name></author><author><name sortKey="Gallagher, Hj" uniqKey="Gallagher H">HJ Gallagher</name></author><author><name sortKey="Shou, J" uniqKey="Shou J">J Shou</name></author><author><name sortKey="Daly, Jm" uniqKey="Daly J">JM Daly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Redmond, Hp" uniqKey="Redmond H">HP Redmond</name></author><author><name sortKey="Leon, P" uniqKey="Leon P">P Leon</name></author><author><name sortKey="Lieberman, Md" uniqKey="Lieberman M">MD Lieberman</name></author><author><name sortKey="Hofmann, K" uniqKey="Hofmann K">K Hofmann</name></author><author><name sortKey="Shou, J" uniqKey="Shou J">J Shou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Redmond, Hp" uniqKey="Redmond H">HP Redmond</name></author><author><name sortKey="Shou, J" uniqKey="Shou J">J Shou</name></author><author><name sortKey="Kelly, Cj" uniqKey="Kelly C">CJ Kelly</name></author><author><name sortKey="Leon, P" uniqKey="Leon P">P Leon</name></author><author><name sortKey="Daly, Jm" uniqKey="Daly J">JM Daly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stapleton, Pp" uniqKey="Stapleton P">PP Stapleton</name></author><author><name sortKey="Barden, Cb" uniqKey="Barden C">CB Barden</name></author><author><name sortKey="Mccarter, Md" uniqKey="Mccarter M">MD McCarter</name></author><author><name sortKey="Mackrell, Pj" uniqKey="Mackrell P">PJ Mackrell</name></author><author><name sortKey="Freeman, Ta" uniqKey="Freeman T">TA Freeman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tanaka, S" uniqKey="Tanaka S">S Tanaka</name></author><author><name sortKey="Isoda, F" uniqKey="Isoda F">F Isoda</name></author><author><name sortKey="Ishihara, Y" uniqKey="Ishihara Y">Y Ishihara</name></author><author><name sortKey="Kimura, M" uniqKey="Kimura M">M Kimura</name></author><author><name sortKey="Yamakawa, T" uniqKey="Yamakawa T">T Yamakawa</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tanaka, S" uniqKey="Tanaka S">S Tanaka</name></author><author><name sortKey="Isoda, F" uniqKey="Isoda F">F Isoda</name></author><author><name sortKey="Kiuchi, Y" uniqKey="Kiuchi Y">Y Kiuchi</name></author><author><name sortKey="Ikeda, H" uniqKey="Ikeda H">H Ikeda</name></author><author><name sortKey="Mobbs, Cv" uniqKey="Mobbs C">CV Mobbs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nieman, Dc" uniqKey="Nieman D">DC Nieman</name></author><author><name sortKey="Henson, Da" uniqKey="Henson D">DA Henson</name></author><author><name sortKey="Nehlsen Cannarella, Sl" uniqKey="Nehlsen Cannarella S">SL Nehlsen-Cannarella</name></author><author><name sortKey="Ekkens, M" uniqKey="Ekkens M">M Ekkens</name></author><author><name sortKey="Utter, Ac" uniqKey="Utter A">AC Utter</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yamakawa, T" uniqKey="Yamakawa T">T Yamakawa</name></author><author><name sortKey="Tanaka, S" uniqKey="Tanaka S">S Tanaka</name></author><author><name sortKey="Yamakawa, Y" uniqKey="Yamakawa Y">Y Yamakawa</name></author><author><name sortKey="Kiuchi, Y" uniqKey="Kiuchi Y">Y Kiuchi</name></author><author><name sortKey="Isoda, F" uniqKey="Isoda F">F Isoda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zarkesh Esfahani, H" uniqKey="Zarkesh Esfahani H">H Zarkesh-Esfahani</name></author><author><name sortKey="Pockley, Ag" uniqKey="Pockley A">AG Pockley</name></author><author><name sortKey="Wu, Z" uniqKey="Wu Z">Z Wu</name></author><author><name sortKey="Hellewell, Pg" uniqKey="Hellewell P">PG Hellewell</name></author><author><name sortKey="Weetman, Ap" uniqKey="Weetman A">AP Weetman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zarkesh Esfahani, H" uniqKey="Zarkesh Esfahani H">H Zarkesh-Esfahani</name></author><author><name sortKey="Pockley, G" uniqKey="Pockley G">G Pockley</name></author><author><name sortKey="Metcalfe, Ra" uniqKey="Metcalfe R">RA Metcalfe</name></author><author><name sortKey="Bidlingmaier, M" uniqKey="Bidlingmaier M">M Bidlingmaier</name></author><author><name sortKey="Wu, Z" uniqKey="Wu Z">Z Wu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sanchez Margalet, V" uniqKey="Sanchez Margalet V">V Sanchez-Margalet</name></author><author><name sortKey="Martin Romero, C" uniqKey="Martin Romero C">C Martin-Romero</name></author><author><name sortKey="Santos Alvarez, J" uniqKey="Santos Alvarez J">J Santos-Alvarez</name></author><author><name sortKey="Goberna, R" uniqKey="Goberna R">R Goberna</name></author><author><name sortKey="Najib, S" uniqKey="Najib S">S Najib</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dixit, Vd" uniqKey="Dixit V">VD Dixit</name></author><author><name sortKey="Schaffer, Em" uniqKey="Schaffer E">EM Schaffer</name></author><author><name sortKey="Pyle, Rs" uniqKey="Pyle R">RS Pyle</name></author><author><name sortKey="Collins, Gd" uniqKey="Collins G">GD Collins</name></author><author><name sortKey="Sakthivel, Sk" uniqKey="Sakthivel S">SK Sakthivel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Xia, Q" uniqKey="Xia Q">Q Xia</name></author><author><name sortKey="Pang, W" uniqKey="Pang W">W Pang</name></author><author><name sortKey="Pan, H" uniqKey="Pan H">H Pan</name></author><author><name sortKey="Zheng, Y" uniqKey="Zheng Y">Y Zheng</name></author><author><name sortKey="Kang, Js" uniqKey="Kang J">JS Kang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Netea, Mg" uniqKey="Netea M">MG Netea</name></author><author><name sortKey="Joosten, La" uniqKey="Joosten L">LA Joosten</name></author><author><name sortKey="Lewis, E" uniqKey="Lewis E">E Lewis</name></author><author><name sortKey="Jensen, Dr" uniqKey="Jensen D">DR Jensen</name></author><author><name sortKey="Voshol, Pj" uniqKey="Voshol P">PJ Voshol</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Turnbaugh, Pj" uniqKey="Turnbaugh P">PJ Turnbaugh</name></author><author><name sortKey="Ley, Re" uniqKey="Ley R">RE Ley</name></author><author><name sortKey="Mahowald, Ma" uniqKey="Mahowald M">MA Mahowald</name></author><author><name sortKey="Magrini, V" uniqKey="Magrini V">V Magrini</name></author><author><name sortKey="Mardis, Er" uniqKey="Mardis E">ER Mardis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Perez Guzman, C" uniqKey="Perez Guzman C">C Perez-Guzman</name></author><author><name sortKey="Vargas, Mh" uniqKey="Vargas M">MH Vargas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Perez Guzman, C" uniqKey="Perez Guzman C">C Perez-Guzman</name></author><author><name sortKey="Vargas, Mh" uniqKey="Vargas M">MH Vargas</name></author><author><name sortKey="Quinonez, F" uniqKey="Quinonez F">F Quinonez</name></author><author><name sortKey="Bazavilvazo, N" uniqKey="Bazavilvazo N">N Bazavilvazo</name></author><author><name sortKey="Aguilar, A" uniqKey="Aguilar A">A Aguilar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Joshi, N" uniqKey="Joshi N">N Joshi</name></author><author><name sortKey="Caputo, Gm" uniqKey="Caputo G">GM Caputo</name></author><author><name sortKey="Weitekamp, Mr" uniqKey="Weitekamp M">MR Weitekamp</name></author><author><name sortKey="Karchmer, Aw" uniqKey="Karchmer A">AW Karchmer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Guptan, A" uniqKey="Guptan A">A Guptan</name></author><author><name sortKey="Shah, A" uniqKey="Shah A">A Shah</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Blackburn, Gl" uniqKey="Blackburn G">GL Blackburn</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Tectonidis, M" uniqKey="Tectonidis M">M Tectonidis</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="other"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Med</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Med</journal-id><journal-id journal-id-type="publisher-id">pmed</journal-id><journal-id journal-id-type="publisher-id">plme</journal-id><journal-id journal-id-type="pmc">plosmed</journal-id><journal-title-group><journal-title>PLoS Medicine</journal-title></journal-title-group><issn pub-type="ppub">1549-1277</issn><issn pub-type="epub">1549-1676</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">17472433</article-id><article-id pub-id-type="pmc">1858706</article-id><article-id pub-id-type="doi">10.1371/journal.pmed.0040115</article-id><article-id pub-id-type="publisher-id">06-PLME-RIT-0448R2</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research in Translation</subject></subj-group><subj-group subj-group-type="Discipline"><subject>Immunology</subject><subject>Immunology</subject><subject>Infectious Diseases</subject><subject>Infectious Diseases</subject><subject>Non-Clinical Medicine</subject><subject>Non-Clinical Medicine</subject><subject>Nutrition</subject><subject>Pediatrics and Child Health</subject><subject>Pediatrics and Child Health</subject><subject>Public Health and Epidemiology</subject><subject>Public Health and Epidemiology</subject><subject>Public Health and Epidemiology</subject><subject>Public Health and Epidemiology</subject><subject>Virology</subject><subject>Virology</subject></subj-group><subj-group subj-group-type="System Taxonomy"><subject>Infectious Diseases</subject><subject>Nutrition and Metabolism</subject><subject>Pediatrics</subject><subject>Medicine in Developing Countries</subject><subject>HIV Infection/AIDS</subject></subj-group></article-categories><title-group><article-title>Malnutrition and Infection: Complex Mechanisms and Global Impacts</article-title><alt-title alt-title-type="running-head">Research in Translation</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Schaible</surname><given-names>Ulrich E</given-names></name><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Kaufmann</surname><given-names>Stefan H. E</given-names></name></contrib></contrib-group><author-notes><corresp id="cor1">*To whom correspondence should be addressed. E-mail: <email>Ulrich.Schaible@lshtm.ac.uk</email></corresp></author-notes><pub-date pub-type="ppub"><month>5</month><year>2007</year></pub-date><pub-date pub-type="epub"><day>1</day><month>5</month><year>2007</year></pub-date><volume>4</volume><issue>5</issue><elocation-id>e115</elocation-id><permissions><copyright-statement> © 2007 Schaible and Kaufmann.</copyright-statement><copyright-year>2007</copyright-year><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.</license-p></license></permissions><abstract abstract-type="toc"><p>The authors discuss current concepts and controversies surrounding the complex influences of malnutrition on infection and immunity, and point to practical consequences of countermeasures in acute malnutrition.</p></abstract><counts><page-count count="7"></page-count></counts><custom-meta-group><custom-meta><meta-name>citation</meta-name><meta-value>Schaible UE, Kaufmann SHE (2007) Malnutrition and infection: Complex mechanisms and global impacts. PLoS Med 4(5): e115. doi:<ext-link ext-link-type="doi" xlink:href="10.1371/journal.pmed.0040115">10.1371/journal.pmed.0040115</ext-link></meta-value></custom-meta></custom-meta-group></article-meta></front><body><disp-quote><p><italic>“I am not interested in the bloody system! Why has he no food? Why is he starving to death?”</italic></p><p><italic>Bob Geldof in</italic> The Observer, <italic>1985</italic></p></disp-quote><p>Activation and sustenance of immune responses during infection requires increased energy consumption. Protein energy malnutrition (PEM) is a critical, yet underestimated factor in susceptibility to infection, including the “big three” infectious diseases: HIV/AIDS, tuberculosis, and malaria. In this article, we discuss current concepts and controversies surrounding the complex influences of malnutrition on infection and immunity, and point to practical consequences of countermeasures in acute malnutrition. We call for new strategies to overcome worldwide morbidity and mortality caused by chronic malnutrition in impoverished countries and by the newly emerging public health threat of overnutrition in industrialized societies.</p><sec id="s2"><title>Background</title><p>In response to infection, the immune system first executes innate and then subsequently acquired host defense functions of high diversity. Both processes involve activation and propagation of immune cells and synthesis of an array of molecules requiring DNA replication, RNA expression, and protein synthesis and secretion, and therefore consume additional anabolic energy. Mediators of inflammation further increase the catabolic response. Studies in a simple system, involving measurement of the survival of malnourished bumblebee workers, showed that the energy cost of immunity further impairs fitness [<xref rid="pmed-0040115-b001" ref-type="bibr">1</xref>]. Consequently, the nutritive status of the host critically determines the outcome of infection.</p><p>Apart from deficiencies in single nutrients, such as vitamins, fatty acids, amino acids, iron, and trace elements, undernourishment based on PEM greatly increases susceptibility to major human infectious diseases in low-income countries, particularly in children [<xref rid="pmed-0040115-b002" ref-type="bibr">2–4</xref>]. Malnutrition is responsible, directly or indirectly, for 54% of the 10.8 million deaths per year in children under five and contributes to every second death (53%) associated with infectious diseases among children under five years of age in developing countries [<xref rid="pmed-0040115-b005" ref-type="bibr">5</xref>]. Infection causes energy loss on the part of the individual, which reduces productivity on the community level and perpetuates the alarming spiral of malnutrition, infection, disease, and poverty (<xref ref-type="fig" rid="pmed-0040115-g001">Figure 1</xref>).</p><fig id="pmed-0040115-g001" position="float"><label>Figure 1</label><caption><title>Protein Energy Malnutrition Increases Prevalence of Infection, Leading to Energy Loss for the Individual</title><p>On the community level, this burden reduces productivity, including food production, and perpetuates the relentless spiral of further malnutrition, infection, disease, poverty, and socioeconomic and political instability.</p></caption><graphic xlink:href="pmed.0040115.g001"></graphic></fig></sec><sec id="s3"><title>Malnutrition and Infection</title><sec id="s3a"><title>Malnutrition increases risk of infection</title><p>PEM is a common cause of secondary immune deficiency and susceptibility to infection in humans (<xref ref-type="table" rid="pmed-0040115-t001">Table 1</xref>). This causal relationship is further supported by animal studies.</p><table-wrap id="pmed-0040115-t001" content-type="3col" position="float"><label>Table 1</label><caption><p>Conditions of Under- and Overnutrition and Their Influence on Host Defense Functions</p></caption><graphic xlink:href="pmed.0040115.t001"></graphic></table-wrap><p>Severe PEM in children is clinically defined as less than 70% weight-to-height and/or the appearance of pitting edema on both feet, described as either marasmus, a chronic wasting condition, or kwashiorkor, characterized by edema and anemia. Children with kwashiorkor often suffer from marked skin infections. Severe malnutrition during childhood affects thymic development, which compromises immunity in children by a long-term reduction of peripheral lymphocyte counts [<xref rid="pmed-0040115-b006" ref-type="bibr">6</xref>]. This immunodeficiency represents a key factor in susceptibility to infections and has therefore been termed nutritionally acquired immunodeficiency syndrome [<xref rid="pmed-0040115-b007" ref-type="bibr">7</xref>]. In severely malnourished patients, both acquired immunity—i.e., lymphocyte functions—as well as innate host defense mechanisms—i.e., macrophages and granulocytes—are affected. Diminished immune functions render undernourished patients more susceptible to infections, notably those by opportunistic pathogens commonly prevalent in patients with HIV/AIDS [<xref rid="pmed-0040115-b002" ref-type="bibr">2–4</xref>,<xref rid="pmed-0040115-b008" ref-type="bibr">8</xref>,<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>]. The opportunistic fungus <named-content content-type="genus-species">Pneumocystis carinii</named-content>, frequently diagnosed in patients with AIDS, was repeatedly identified in malnourished children after the Second World War [<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>]. Noma is an opportunistic infection in children between one and four years with PEM, which occurs worldwide, but is most common in sub-Saharan Africa. The infection evolves from gingival inflammation to orofacial gangrene and is commonly preceded by other infections such as measles, malaria, severe diarrhea, and necrotising ulcerative gingivitis. Noma coincides with the period of linear growth retardation in malnourished children [<xref rid="pmed-0040115-b010" ref-type="bibr">10</xref>].</p><p>In addition to promoting acute and chronic infections, PEM impairs the linear growth of children, leading to a further reduction in food intake, nutrient absorption, direct or catabolic nutrient losses, and increased metabolic requirements. It has been suggested that acute phase response and proinflammatory cytokines directly affect the bone remodelling required for longitudinal growth [<xref rid="pmed-0040115-b011" ref-type="bibr">11</xref>].</p><p>Correlation of malnutrition and growth retardation allows assessment of the individual nutritional state, which is usually measured as mid-upper arm circumference or body mass index (BMI). BMIs are given either as weight-for-height to indicate acute PEM (wasting), or as weight-for-age (underweight) or height-for-age (stunting), correlations for chronic PEM. A study in Kenya found a significant association between HIV infection and lower mid-upper arm circumferences and serum albumin concentration, another measure of malnutrition, but found no such association with BMI [<xref rid="pmed-0040115-b012" ref-type="bibr">12</xref>]. Independent of HIV, socioeconomic factors and severity of tuberculosis are important correlates of acute PEM or wasting [<xref rid="pmed-0040115-b012" ref-type="bibr">12</xref>].</p><p><bold>Infection itself contributes to malnutrition.</bold> The relationship of malnutrition on immune suppression and infection is complicated by the profound effects of a number of infections on nutrition itself. Examples of how infections can contribute to malnutrition are: (1) gastrointestinal infection can lead to diarrhea; (2) HIV/AIDS, tuberculosis, and other chronic infections can cause cachexia and anemia; and (3) intestinal parasites can cause anemia and nutrient deprivation [<xref rid="pmed-0040115-b013" ref-type="bibr">13</xref>].</p><p>Stimulation of an immune response by infection increases the demand for metabolically derived anabolic energy and associated substrates, leading to a synergistic vicious cycle of adverse nutritional status and increased susceptibility to infection. Under inflammatory conditions such as sepsis, mediators increase the catabolic disease state characterised by enhanced arginine use. Furthermore, arginase is induced during infection and uses up arginine as substrate. It has been suggested that depletion of this amino acid impairs T cell responses [<xref rid="pmed-0040115-b014" ref-type="bibr">14</xref>], and exceeding the body’s arginine production leads to a negative nitrogen balance [<xref rid="pmed-0040115-b015" ref-type="bibr">15</xref>].</p><p>A study in Nigeria found that the severe metabolic demands made during acute measles infection further deteriorated the condition of malnourished children, leading to further weight loss, wasting, and reduced serum levels of essential amino acids [<xref rid="pmed-0040115-b016" ref-type="bibr">16</xref>]. Increased energy consumption due to immune responses may also affect the efficacy of live attenuated vaccines in populations ridden with PEM.</p><p>Arginine treatment has been shown to improve nitrogen balance and lymphocyte function and stimulate arginine transport in the liver. These benefits have made arginine an essential constituent of immunonutritive formulas currently in use for critically ill patients.</p><p>PEM is an important health determinant for critically ill patients and increases susceptibility to infections in malnourished elderly patients and patients with anorexia. A large and strictly controlled inpatient study in France pinpoints malnutrition as an independent risk factor for nosocomial infections, which account for 6%–10% of all in-hospital deaths worldwide [<xref rid="pmed-0040115-b017" ref-type="bibr">17</xref>]. Accordingly, nutritive management has to become an elementary part of intensive health care. In summary, nutritional quality and composition are pivotal for anti-infectious immunity.</p></sec></sec><sec id="s4"><title>Malnutrition Affects Immunity</title><p>Severe protein malnutrition in newborns and small children causes atrophy of the thymus with reduced cell numbers and subsequently ill-developed peripheral lymphoid organs, i.e., lymph nodes and spleen [<xref rid="pmed-0040115-b006" ref-type="bibr">6</xref>]. This causal chain leads to long-lasting immune defects characterized by leucopenia, decreased CD4 to CD8 ratio and increased numbers of CD4/CD8 double-negative T cells, and, therefore, the appearance of immature T cells in the periphery. Malnourished children suffer in greater proportion from respiratory infections, infectious diarrhea, measles, and malaria, characterized by a protracted course and exacerbated disease. These malnourished children present with diminished functional T cell counts, increased undifferentiated lymphocyte numbers, and depressed serum complement activity (<xref ref-type="table" rid="pmed-0040115-t001">Table 1</xref>).</p><p>Reduced antibody responses to polysaccharide antigens of encapsulated bacteria such as <named-content content-type="genus-species">Streptococcus pneumoniae</named-content> and <named-content content-type="genus-species">Haemophilus influenzae</named-content> exacerbate susceptibility to these pathogens [<xref rid="pmed-0040115-b002" ref-type="bibr">2</xref>,<xref rid="pmed-0040115-b004" ref-type="bibr">4</xref>,<xref rid="pmed-0040115-b018" ref-type="bibr">18</xref>]. Moreover, immune defense at the epithelial barrier of the undernourished host is compromised due to altered architecture of the gut mucosa, such as flattened hypotrophic microvilli, reduced lymphocyte counts in Peyer’s patches, and reduced immunoglobulin A (IgA) secretion [<xref rid="pmed-0040115-b007" ref-type="bibr">7</xref>]. Availability of complement components is restricted by malnutrition, thereby affecting the capacity of professional phagocytes to engulf and eliminate pathogens. In mice with experimental PEM, phagocytosis and production of reactive oxygen intermediates (ROIs) and reactive nitrogen intermediates (RNIs) by macrophages is diminished, as is antigen presentation to T cells by dendritic cells [<xref rid="pmed-0040115-b019" ref-type="bibr">19</xref>]. Temporary PEM in mice challenged by experimental peritonitis resulted in impaired immune cell migration and extravasation, as indicated by reduced numbers of CD11b/CD18-positive cells at the site of infection, probably involving lower concentrations of the chemokine MIP-2.</p><p>Peripheral T lymphocytes from infected children with PEM had lower expression of the activation marker CD69, and predominantly showed an intermediate (CD45RA<sup>low</sup>/CD45RO<sup>low</sup>) rather than a memory phenotype (CD45RO<sup>high</sup>) when compared to healthy donors [<xref rid="pmed-0040115-b020" ref-type="bibr">20</xref>,<xref rid="pmed-0040115-b021" ref-type="bibr">21</xref>]. These T cells were biased towards type 2 T helper cell (Th2) responses, represented by decreased IFN-γ/IL-2 (type 1 T helper cell [Th1]) and increased IL-4/IL-10 (Th2) production [<xref rid="pmed-0040115-b022" ref-type="bibr">22</xref>]. Experimentally undernourished weanling mice had predominantly T cells of the naïve quiescent phenotype (CD45RA<sup>+</sup>/CD62L<sup>+</sup>) [<xref rid="pmed-0040115-b023" ref-type="bibr">23</xref>,<xref rid="pmed-0040115-b024" ref-type="bibr">24</xref>]. In these mice, IFN-γ- responses were depressed and IL-10 and the Th2-associated antibody, IgE, were increased, while IL-4 production remained normal [<xref rid="pmed-0040115-b025" ref-type="bibr">25</xref>].</p><p>These findings, however, should not be taken to suggest that PEM generally biases towards Th2 responses. Rather, PEM appears to alter immune responses, thus hampering protective immunity of any type. Protective T cell responses against helminth infections are predominantly of the Th2 type comprising IL-4 production, expansion of eosinophils, and IgE secretion. However, malnourished children are deficient for protective IgE antibodies against <named-content content-type="genus-species">Ascaris lumbricoides</named-content> [<xref rid="pmed-0040115-b026" ref-type="bibr">26</xref>,<xref rid="pmed-0040115-b027" ref-type="bibr">27</xref>]. By suppressing such responses in mice, PEM increases susceptibility to infection with the intestinal parasite, <named-content content-type="genus-species">Heligmosomoides polygyrus</named-content> [<xref rid="pmed-0040115-b028" ref-type="bibr">28</xref>]. Malnourished children suffering from helminth infections have high concentrations of total IgE. Yet these antibodies are neither worm-specific nor protective, and their memory T cells do not recognize helminth antigens [<xref rid="pmed-0040115-b027" ref-type="bibr">27</xref>,<xref rid="pmed-0040115-b028" ref-type="bibr">28</xref>].</p></sec><sec id="s5"><title>Malnutrition and Tuberculosis: Yesterday and Today</title><p>Malnutrition is generally appreciated as a major risk factor in the onset of active tuberculosis [<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>]. This notion is largely based on historical reports but also on more recent experimental animal studies.</p><p>One of the major disease burdens globally, tuberculosis is a well-documented example of the way in which malnutrition leads to worse disease outcomes. During the First World War, Denmark was affected by a tuberculosis epidemic similar to that prevailing in countries at war. The Danish tuberculosis epidemic could be explained by widespread malnourishment, since the export of meat, fish, poultry, and dairy products meant that food was scarce inside the country. This tuberculosis epidemic plummeted once the German blockade of Denmark was established and food became available to the Danish population again, but the epidemic continued in other countries [<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>].</p><boxed-text position="float"><sec><title>Five Key Papers on the Link Between Malnutrition, Immunity, and Infection</title><p><bold>Ing et al., 2000 [<xref rid="pmed-0040115-b028" ref-type="bibr">28</xref>]</bold> Employing an animal model for helminth infection, this study shows that malnutrition interferes with protective immunity.</p><p><bold>Cegielski et al., 2004 [<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>]</bold> This paper summarizes, for the first time, clear evidence of the link between malnutrition and tuberculosis.</p><p><bold>Zarkesh-Esfahani et al., 2004 [<xref rid="pmed-0040115-b060" ref-type="bibr">60</xref>]</bold> The authors show the link between leptin-induced TNF- and neutrophil activation.</p><p><bold>Turnbaugh et al., 2006 [<xref rid="pmed-0040115-b066" ref-type="bibr">66</xref>]</bold> This paper puts a new component on to the map of research on overnutrition: the gut flora’s influence on energy uptake.</p><p><bold>Tectonidis, 2006 [<xref rid="pmed-0040115-b076" ref-type="bibr">76</xref>]</bold> This paper points out a quick and practical approach to remediate acute malnutrition.</p></sec></boxed-text><p>A comparative radiographic survey of prisoners of war held in German camps during the Second World War under similar living conditions found a tuberculosis prevalence of 1.2% versus up to 19.0% among the British and Russians, respectively, with more severe outcomes in the latter. This difference in prevalence and severity is probably a direct consequence of the fact that only the British prisoners received—in addition to the regular prison diet—a Red Cross supplement of 30 grams of protein and 1,000 kilocalories per day. This causal relationship is in line with the positive correlation of below average BMI with increased risk of pulmonary tuberculosis [<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>].</p><boxed-text position="float"><sec><title>Unexplored Research Topics on the Link Between Malnutrition and Infection</title><list list-type="order"><list-item><p>Control of energy uptake by the host through microbial communities in the gut.</p></list-item><list-item><p>Changes of gut flora in malnutrition and influence of probiotics.</p></list-item><list-item><p>Regulation of energy requirement and food uptake during immune responses.</p></list-item><list-item><p>Role of cytokines in regulating nutrient uptake.</p></list-item><list-item><p>Crosstalk between immune (cytokines) and nutrition-related “hormones” (e.g., leptin).</p></list-item><list-item><p>Tissue-specific loss of nutrients during infection, inflammation, and immunity.</p></list-item><list-item><p>Efficacy of vaccines and drugs given under acute and chronic PEM conditions.</p></list-item><list-item><p>Identification of essential immunonutrients and development of food supplements easily accessible for societies with chronic PEM.</p></list-item><list-item><p>Schedules for sustainable local food production and safe water supplies by societies suffering from PEM.</p></list-item><list-item><p>Efficacy of additives to drinking water and food to prevent infection.</p></list-item><list-item><p>Engineering nutritionally enhanced food to prevent infections (e.g., rice, sorghum)</p></list-item><list-item><p>Bringing it to the people: Improved infrastructures for food distribution in developing countries.</p></list-item></list></sec></boxed-text><p>More contemporary reports provide further support that malnutrition has an impact on the clinical outcome of tuberculosis [<xref rid="pmed-0040115-b029" ref-type="bibr">29</xref>]. A statistically significant number of patients with tuberculosis were malnourished in a recent study in Sri Lanka and skin test reactions for tuberculosis were negatively affected by malnutrition [<xref rid="pmed-0040115-b030" ref-type="bibr">30</xref>,<xref rid="pmed-0040115-b031" ref-type="bibr">31</xref>]. Hence, in poor settings, nutritional measures should be considered as an adjunct to anti-tuberculosis drug treatment.</p><p>Animal experiments, mainly in the guinea pig tuberculosis model, document detrimental consequences of chronic PEM on immunity to <named-content content-type="genus-species">Mycobacterium tuberculosis</named-content>. In these experiments, lymphocyte stimulation as well as secretion of the Th1 cytokines IL-2, IFN-γ, and TNF-α, involved in control of <named-content content-type="genus-species">M. tuberculosis</named-content>, were significantly reduced in animals with PEM [<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>]. Moreover, macrophages from such animals produced more transforming growth factor β (TGFβ), which further suppresses T cells and inflammation [<xref rid="pmed-0040115-b032" ref-type="bibr">32</xref>,<xref rid="pmed-0040115-b033" ref-type="bibr">33</xref>]. A study in murine tuberculosis reached similar conclusions and additionally found that malnourished mice showed hampered production of RNIs, which act as critical effectors against tuberculosis in mice. Consequently, malnourished mice suffered from higher bacterial burdens and died earlier of infection [<xref rid="pmed-0040115-b034" ref-type="bibr">34</xref>]. Finally, efficacy of BCG vaccination against tuberculosis was profoundly reduced in malnourished guinea pigs as compared to normally fed animals, due to impaired T cell priming and function [<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>,<xref rid="pmed-0040115-b035" ref-type="bibr">35</xref>].</p></sec><sec id="s6"><title>Malnutrition, Leptin, and Immunity</title><p>Leptin is a central mediator connecting nutrition and immunity. Levels of the pleiotropic hormone leptin, which regulates satiety, are reduced in patients with PEM. Leptin concentrations correlate with body fat mass and are quickly reduced by fasting [<xref rid="pmed-0040115-b036" ref-type="bibr">36</xref>]. Leptin is a 16 kDa α-helix type protein similar to the cytokines IL-6 and IL-12, and is mainly secreted by adipose tissue. At least six receptors representing different splice forms encoded by one gene are broadly distributed on different cell types. The isoform is not only full-length ObR<sub>b</sub> expressed in the hypothalamus, but is also prevalent on lymphocytes and macrophages [<xref rid="pmed-0040115-b036" ref-type="bibr">36</xref>,<xref rid="pmed-0040115-b037" ref-type="bibr">37</xref>]. Leptin binding activates immune cells via the to ObR<sub>b</sub> JAK-2/STAT-3 and the MAPK pathway and induces TNF-α, IL-6, and IL-12 secretion in macrophages. Leptin stimulates naïve T cells (CD45RA<sup>+</sup>) but blocks proliferation of memory T cells (CD45RO<sup>+</sup>). Concomitantly, leptin promotes IFN-γ secretion by memory T cells, inhibits Th2 responses [<xref rid="pmed-0040115-b038" ref-type="bibr">38</xref>,<xref rid="pmed-0040115-b039" ref-type="bibr">39</xref>], and induces activation markers (CD69, CD25, and CD71) [<xref rid="pmed-0040115-b040" ref-type="bibr">40</xref>]. Apart from inducing lymphopoiesis, leptin seems to deliver survival signals to T cells by upregulating anti-apoptotic proteins T-bet and Bcl-x<sub>L</sub> [<xref rid="pmed-0040115-b036" ref-type="bibr">36</xref>].</p><p>Active tuberculosis is associated with cachexia, weight loss, and low serum concentrations of leptin [<xref rid="pmed-0040115-b041" ref-type="bibr">41–44</xref>]. Moreover, leptin-deficient mice are more susceptible to <named-content content-type="genus-species">M. tuberculosis</named-content> than wild-type mice, and T cell numbers, including those producing IFN-γ, are reduced in infected lungs, suggesting that leptin contributes to protection against tuberculosis [<xref rid="pmed-0040115-b045" ref-type="bibr">45</xref>]. However, a causative correlation between severity of tuberculosis and leptin is not fully established, and leptin concentrations do not predict wasting in human tuberculosis [<xref rid="pmed-0040115-b044" ref-type="bibr">44</xref>].</p><p>Malnutrition causes immunosuppression through a variety of mechanisms, including the involvement of leptin and the hypothalamic-pituitary-adrenal axis. PEM reduces leptin concentrations and increases serum levels of stress hormones, i.e., glucocorticoids [<xref rid="pmed-0040115-b002" ref-type="bibr">2</xref>,<xref rid="pmed-0040115-b004" ref-type="bibr">4</xref>,<xref rid="pmed-0040115-b046" ref-type="bibr">46–48</xref>]. Thus, it is likely that the hypothalamic-pituitary-adrenal axis plays a critical role in malnutrition-associated immune deficiency.</p><p>In well-nourished people, infection and inflammation increase leptin levels in an IL-1-dependent manner and increase glucocorticoid concentrations, which subsequently can control inflammation [<xref rid="pmed-0040115-b040" ref-type="bibr">40</xref>,<xref rid="pmed-0040115-b049" ref-type="bibr">49</xref>,<xref rid="pmed-0040115-b050" ref-type="bibr">50</xref>]. Under conditions of PEM and low leptin concentrations, glucocorticoids impair macrophage functions by decreasing NF-kB translocation into the nucleus [<xref rid="pmed-0040115-b049" ref-type="bibr">49</xref>]. Macrophages from mice with experimental PEM are less sensitive to activation with lipopolysaccharides, partly due to decreased NF-kB translocation. Their ability to engulf pathogens and to produce cytokines and ROIs is impaired [<xref rid="pmed-0040115-b051" ref-type="bibr">51–54</xref>]. However, the suggestion that malnutrition suppresses macrophage functions due to elevated glucocorticoid levels was not supported by a recent study [<xref rid="pmed-0040115-b055" ref-type="bibr">55</xref>]. Further experiments are required to identify the mechanisms connecting PEM and immunosuppression.</p></sec><sec id="s7"><title>Overnutrition and Immunity</title><p>The hormonal connection between immunity and nutrition becomes equally evident in nutritional dysregulatory eating disorders such as obesity, which is becoming alarmingly common in high-income countries, notably in the United States and United Kingdom, and is also spreading to transitional societies at an unexpectedly high speed.</p><p>Obesity in humans is correlated with high concentrations of leptin, often associated with leptin resistance [<xref rid="pmed-0040115-b036" ref-type="bibr">36</xref>]. Patients with obesity present with increased TNF-α production, altered T cell subset ratios, repressed T cell responses, and higher incidence of infectious diseases, all of which can be reversed by weight loss (<xref ref-type="table" rid="pmed-0040115-t001">Table 1</xref>) [<xref rid="pmed-0040115-b056" ref-type="bibr">56–58</xref>]. Diet-induced or inherited obesity in rodents causes NK and T cell suppression and increased TNF-α secretion [<xref rid="pmed-0040115-b056" ref-type="bibr">56</xref>,<xref rid="pmed-0040115-b057" ref-type="bibr">57</xref>,<xref rid="pmed-0040115-b059" ref-type="bibr">59</xref>]. Leptin-induced production of proinflammatory cytokines by macrophages causes neutrophil activation and TH1-derived IFN-γ secretion [<xref rid="pmed-0040115-b060" ref-type="bibr">60–62</xref>]. The obese phenotype in leptin-deficient <italic>ob/ob</italic> mice is also associated with diminished circulating T cells, reduced T cell responses, and lymphoid atrophy [<xref rid="pmed-0040115-b040" ref-type="bibr">40</xref>]. Although seemingly in a committed stage, macrophages from <italic>ob/ob</italic> mice have reduced phagocytic activity [<xref rid="pmed-0040115-b040" ref-type="bibr">40</xref>]. Furthermore, the natural ligand of the secretagogue receptor of the pituitary gland, ghrelin, which regulates fat storage and consumption, is directly linked to immune functions by its counteraction of leptin-induced activation of monocytes and T cells [<xref rid="pmed-0040115-b063" ref-type="bibr">63</xref>,<xref rid="pmed-0040115-b064" ref-type="bibr">64</xref>].</p><p>Recently, the cytokine IL-18, which usually drives TH1 responses in synergy with IL-12, has been linked to obesity. IL-18 knockout mice became obese through overeating and resistant to insulin through increased gluconeogenesis in the liver [<xref rid="pmed-0040115-b065" ref-type="bibr">65</xref>]. Consequently, intracerebrally administered IL-18 inhibited food intake. Another study demonstrated that a differential gut flora with distinct metabolic requirements was found in obese versus lean humans as well as mice. Even more intriguingly, when transferred to germ-free mice, the “obese” but not the “lean” gut flora caused an increase of total body fat [<xref rid="pmed-0040115-b066" ref-type="bibr">66</xref>]. These reports add two more components to the already complex relationship of nutrition, inflammation, immunity, and infection: cytokine patterns and gut flora compositions.</p><p>Thus, regulation of food uptake and storage is closely intermingled with immune functions. However, a higher nutrient uptake may also be beneficial for the host response, likely due to higher energy requirements, as illustrated by a recent study showing that a cholesterol-rich diet accelerates clearance of bacilli during the treatment of tuberculosis [<xref rid="pmed-0040115-b067" ref-type="bibr">67</xref>,<xref rid="pmed-0040115-b068" ref-type="bibr">68</xref>].</p><p>Diabetes mellitus is a hormonally regulated metabolic disease which affects immunity to infection (<xref ref-type="table" rid="pmed-0040115-t001">Table 1</xref>). Neutrophils and macrophages from patients with diabetes have suppressed functions, including phagocytosis, generation of ROIs, chemotaxis, and extravasation. T cell activation is also affected, as evidenced by reduced delayed-type hypersensitivity reactions [<xref rid="pmed-0040115-b069" ref-type="bibr">69</xref>]. Generation of ROIs requires NADPH, which is consumed by the polyol pathway for glucose metabolism. Patients with diabetes are more prone to diseases caused by <named-content content-type="genus-species">Staphylococcus aureus</named-content> and <named-content content-type="genus-species">M. tuberculosis</named-content>, and show higher mortality and morbidity from infections with <named-content content-type="genus-species">S. pneumoniae</named-content> and influenza virus [<xref rid="pmed-0040115-b069" ref-type="bibr">69</xref>]. In patients with diabetes, diseases due to urogenital tract and opportunistic infections by <named-content content-type="genus-species">Enterococcus</named-content>, <named-content content-type="genus-species">Mucor mucedo</named-content>, and <named-content content-type="genus-species">Candida albicans</named-content> are common. <named-content content-type="genus-species">Pseudomonas aeruginosa</named-content> is a frequent cause of abscesses in patients with diabetes, as are polybacterial infections causing skin ulcers (diabetic foot), and severe osteomyelitis [<xref rid="pmed-0040115-b069" ref-type="bibr">69</xref>,<xref rid="pmed-0040115-b070" ref-type="bibr">70</xref>]. There is clear evidence that proper control of hyperglycemia improves immune functions and resistance to infection.</p></sec><sec id="s8"><title>Outlook</title><p>Extrapolating the studies discussed, malnutrition can be considered a major risk factor for morbidity and mortality worldwide due to infections with bacterial, viral, and protozoal agents [<xref rid="pmed-0040115-b002" ref-type="bibr">2</xref>,<xref rid="pmed-0040115-b008" ref-type="bibr">8</xref>,<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>]. This causal relationship was suggested in the US Surgeon General’s Report in 1988 [<xref rid="pmed-0040115-b071" ref-type="bibr">71</xref>]. With more than 842 million chronically malnourished people worldwide [<xref rid="pmed-0040115-b072" ref-type="bibr">72</xref>], we agree with the notion that “…malnutrition may account for a greater population-attributable risk of tuberculosis than HIV infection, and certainly a much more correctable one” [<xref rid="pmed-0040115-b009" ref-type="bibr">9</xref>].</p><p>In the context of what is known as the 10/90 gap (10% of global health research funding is being targeted to health problems that account for 90% of the global disease burden) [<xref rid="pmed-0040115-b073" ref-type="bibr">73</xref>,<xref rid="pmed-0040115-b074" ref-type="bibr">74</xref>], research on infection and malnutrition are highly warranted for scientific, economic, and ethical reasons [<xref rid="pmed-0040115-b075" ref-type="bibr">75</xref>].</p><p>To conquer malnutrition, cost-efficient and practical approaches need to be established. Measures to counteract acute malnutrition are now available and were successfully applied in 2005 when Niger was affected by a famine. The crisis did not come as a surprise to the consortium of stakeholders, i.e., the government of Niger, its international partners, and the Famine Early Warning Systems Network of the US Agency for International Development. To avoid disturbance of the market and long-term development goals, food was sold to starving people for too high a price instead of being freely distributed. The catastrophe became apparent as vast numbers of malnourished children were brought to medical stations. Ready-to-use therapeutic food was delivered by doctors from Médecins Sans Frontières as an outpatient measure (community therapeutic care) with enormous success [<xref rid="pmed-0040115-b076" ref-type="bibr">76</xref>].</p><p>Usually children are hospitalized under such circumstances and given milk products as therapeutic food. Outpatient treatment during emergencies, however, decreases (1) duration of maternal absence from the family, thereby limiting children’s risk of malnourishment, (2) time needed to establish treatment centers, and (3) risk of spreading nosocomial infections among hospitalized children in a limited number of overcrowded places. New therapeutic food formulations with balanced contents of macro- and micronutrients, which are ready to use and do not need a clean water supply for their preparation, are important prerequisites for such rapid aid measures. In the past, life-threatening respiratory infections, diarrhea, and malaria were frequent complications requiring short-term inpatient anti-infectious treatment. Under the emergency conditions of the Niger famine in 2005, the measures employed by Médecins Sans Frontières kept child mortality at the rate of non-famine periods. Thus, there is a precedent of effective interventions for acute malnutrition in an emergency to avoid subsequent infections.</p><p>This measure, however, is unlikely to minimize mortality and morbidity due to <italic>chronic</italic> malnutrition worldwide. Further research and development in diverse areas ranging from biomedicine to public health are required to stop the downward spiral of chronic malnutrition, infection, disease, and reduced economic productivity in impoverished societies with the consequences of migration and economical and political instability or war (<xref ref-type="fig" rid="pmed-0040115-g001">Figure 1</xref>). Diseases resulting from overnutrition in industrial societies are of equal concern and similar conditions are already spreading to developing countries. Under- and overnutrition and diet-related chronic diseases represent a critical risk factor for more than half of the world’s diseases and incur hundreds of millions of dollars in public expenditure [<xref rid="pmed-0040115-b005" ref-type="bibr">5</xref>], requiring the immediate attention of biomedical science and public health agencies alike.</p></sec><sec sec-type="supplementary-material" id="s9"><title>Supporting Information</title><supplementary-material content-type="local-data" id="pmed-0040115-sd001"><label>Alternative Language Abstract S1</label><caption><title>Translation of article summary into Russian</title><p>(21 KB DOC).</p></caption><media xlink:href="pmed.0040115.sd001.doc"><caption><p>Click here for additional data file.</p></caption></media></supplementary-material><supplementary-material content-type="local-data" id="pmed-0040115-sd002"><label>Alternative Language Abstract S2</label><caption><title>Translation of article summary into Spanish</title><p>(20 KB DOC).</p></caption><media xlink:href="pmed.0040115.sd002.doc"><caption><p>Click here for additional data file.</p></caption></media></supplementary-material><supplementary-material content-type="local-data" id="pmed-0040115-sd003"><label>Alternative Language Abstract S3</label><caption><title>Translation of article summary into French</title><p>(20 KB DOC).</p></caption><media xlink:href="pmed.0040115.sd003.doc"><caption><p>Click here for additional data file.</p></caption></media></supplementary-material></sec></body><back><ack><p>The authors would like to thank Jana Koth and Mary Louise Grossman for expert secretarial assistance, and Maria Podinovskaia, Melanie DeReynal, and Roberto Garcia for the Russian, French, and Spanish translations, respectively, of the abstract.</p></ack><fn-group><fn id="n3" fn-type="current-aff"><p>Ulrich E. Schaible is at the London School of Hygiene and Tropical Medicine, Department of Infectious and Tropical Diseases, Immunology Unit, London, United Kingdom. Stefan H. E. Kaufmann is at the Max Planck Institute for Infection Biology, Department of Immunology, Berlin, Germany.</p></fn><fn id="n1" fn-type="financial-disclosure"><p><bold>Funding:</bold> The authors received no specific funding for this article.</p></fn><fn id="n2" fn-type="COI-statement"><p><bold>Competing Interests:</bold> The authors have declared that no competing interests exist.</p></fn></fn-group><glossary><title>Abbreviations</title><def-list><def-item><term>BMI</term><def><p>body mass index</p></def></def-item><def-item><term>lg</term><def><p>immunoglobulin</p></def></def-item><def-item><term>PEM</term><def><p>protein energy malnutrition</p></def></def-item><def-item><term>RNI</term><def><p>reactive nitrogen intermediate</p></def></def-item><def-item><term>ROI</term><def><p>reactive oxygen intermediate</p></def></def-item><def-item><term>TH1</term><def><p>type 1 T helper cell</p></def></def-item><def-item><term>TH2</term><def><p>type 2 T helper cell</p></def></def-item></def-list></glossary><ref-list><title>References</title><ref id="pmed-0040115-b001"><element-citation publication-type="journal"><person-group><name><surname>Moret</surname><given-names>Y</given-names></name><name><surname>Schmid-Hempel</surname><given-names>P</given-names></name></person-group><year>2000</year><article-title>Survival for immunity: The price of immune system activation for bumblebee workers</article-title><source>Science</source><volume>290</volume><fpage>1166</fpage><lpage>1168</lpage><pub-id pub-id-type="pmid">11073456</pub-id></element-citation></ref><ref id="pmed-0040115-b002"><element-citation publication-type="journal"><person-group><name><surname>Scrimshaw</surname><given-names>NS</given-names></name><name><surname>SanGiovanni</surname><given-names>JP</given-names></name></person-group><year>1997</year><article-title>Synergism of nutrition, infection, and immunity: An overview</article-title><source>Am J Clin Nutr</source><volume>66</volume><fpage>464S</fpage><lpage>477S</lpage><pub-id pub-id-type="pmid">9250134</pub-id></element-citation></ref><ref id="pmed-0040115-b003"><element-citation publication-type="journal"><person-group><name><surname>Ambrus</surname><given-names>JL</given-names><suffix>Sr</suffix></name><name><surname>Ambrus</surname><given-names>JL</given-names><suffix>Jr</suffix></name></person-group><year>2004</year><article-title>Nutrition and infectious diseases in developing countries and problems of acquired immunodeficiency syndrome</article-title><source>Exp Biol Med (Maywood)</source><volume>229</volume><fpage>464</fpage><lpage>472</lpage><pub-id pub-id-type="pmid">15169964</pub-id></element-citation></ref><ref id="pmed-0040115-b004"><element-citation publication-type="journal"><person-group><name><surname>Woodward</surname><given-names>B</given-names></name></person-group><year>1998</year><article-title>Protein, calories, and immune defenses</article-title><source>Nutr Rev</source><volume>56</volume><fpage>S84</fpage><lpage>S92</lpage><pub-id pub-id-type="pmid">9481128</pub-id></element-citation></ref><ref id="pmed-0040115-b005"><element-citation publication-type="other"><collab>World Health Organization</collab><year>2005</year><article-title>Nutrition: Challenges</article-title><comment>Available: <ext-link ext-link-type="uri" xlink:href="http://www.who.int/nutrition/challenges">http://www.who.int/nutrition/challenges</ext-link>. Accessed 29 March 2007</comment></element-citation></ref><ref id="pmed-0040115-b006"><element-citation publication-type="journal"><person-group><name><surname>Savino</surname><given-names>W</given-names></name></person-group><year>2002</year><article-title>The thymus gland is a target in malnutrition</article-title><source>Eur J Clin Nutr</source><volume>56</volume><issue>Suppl 3</issue><fpage>S46</fpage><lpage>S49</lpage></element-citation></ref><ref id="pmed-0040115-b007"><element-citation publication-type="journal"><person-group><name><surname>Beisel</surname><given-names>WR</given-names></name></person-group><year>1996</year><article-title>Nutrition in pediatric HIV infection: Setting the research agenda. Nutrition and immune function: Overview</article-title><source>J Nutr</source><volume>126</volume><fpage>2611S</fpage><lpage>2615S</lpage><pub-id pub-id-type="pmid">8861922</pub-id></element-citation></ref><ref id="pmed-0040115-b008"><element-citation publication-type="journal"><person-group><name><surname>Field</surname><given-names>CJ</given-names></name><name><surname>Johnson</surname><given-names>IR</given-names></name><name><surname>Schley</surname><given-names>PD</given-names></name></person-group><year>2002</year><article-title>Nutrients and their role in host resistance to infection</article-title><source>J Leukoc Biol</source><volume>71</volume><fpage>16</fpage><lpage>32</lpage><pub-id pub-id-type="pmid">11781377</pub-id></element-citation></ref><ref id="pmed-0040115-b009"><element-citation publication-type="journal"><person-group><name><surname>Cegielski</surname><given-names>JP</given-names></name><name><surname>McMurray</surname><given-names>DN</given-names></name></person-group><year>2004</year><article-title>The relationship between malnutrition and tuberculosis: Evidence from studies in humans and experimental animals</article-title><source>Int J Tuberc Lung Dis</source><volume>8</volume><fpage>286</fpage><lpage>298</lpage><pub-id pub-id-type="pmid">15139466</pub-id></element-citation></ref><ref id="pmed-0040115-b010"><element-citation publication-type="journal"><person-group><name><surname>Enwonwu</surname><given-names>CO</given-names></name><name><surname>Falkler</surname><given-names>WA</given-names><suffix>Jr</suffix></name><name><surname>Phillips</surname><given-names>RS</given-names></name></person-group><year>2006</year><article-title>Noma (cancrum oris)</article-title><source>Lancet</source><volume>368</volume><fpage>147</fpage><lpage>156</lpage><pub-id pub-id-type="pmid">16829299</pub-id></element-citation></ref><ref id="pmed-0040115-b011"><element-citation publication-type="journal"><person-group><name><surname>Stephensen</surname><given-names>CB</given-names></name></person-group><year>1999</year><article-title>Burden of infection on growth failure</article-title><source>J Nutr</source><volume>129</volume><fpage>534S</fpage><lpage>538S</lpage><pub-id pub-id-type="pmid">10064326</pub-id></element-citation></ref><ref id="pmed-0040115-b012"><element-citation publication-type="journal"><person-group><name><surname>Villamor</surname><given-names>E</given-names></name><name><surname>Saathoff</surname><given-names>E</given-names></name><name><surname>Mugusi</surname><given-names>F</given-names></name><name><surname>Bosch</surname><given-names>RJ</given-names></name><name><surname>Urassa</surname><given-names>W</given-names></name><etal></etal></person-group><year>2006</year><article-title>Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis</article-title><source>Eur J Clin Nutr</source><volume>60</volume><fpage>163</fpage><lpage>171</lpage><pub-id pub-id-type="pmid">16234841</pub-id></element-citation></ref><ref id="pmed-0040115-b013"><element-citation publication-type="journal"><person-group><name><surname>Scrimshaw</surname><given-names>NS</given-names></name><name><surname>Taylor</surname><given-names>CE</given-names></name><name><surname>Gordon</surname><given-names>JE</given-names></name></person-group><year>1968</year><article-title>Interactions of nutrition and infection</article-title><source>Monogr Ser World Health Organ</source><volume>57</volume><fpage>3</fpage><lpage>329</lpage></element-citation></ref><ref id="pmed-0040115-b014"><element-citation publication-type="journal"><person-group><name><surname>Bronte</surname><given-names>V</given-names></name><name><surname>Zanovello</surname><given-names>P</given-names></name></person-group><year>2005</year><article-title>Regulation of immune responses by L-arginine metabolism</article-title><source>Nat Rev Immunol</source><volume>5</volume><fpage>641</fpage><lpage>654</lpage><pub-id pub-id-type="pmid">16056256</pub-id></element-citation></ref><ref id="pmed-0040115-b015"><element-citation publication-type="journal"><person-group><name><surname>Kurpad</surname><given-names>AV</given-names></name></person-group><year>2006</year><article-title>The requirements of protein & amino acid during acute & chronic infections</article-title><source>Indian J Med Res</source><volume>124</volume><fpage>129</fpage><lpage>148</lpage><pub-id pub-id-type="pmid">17015927</pub-id></element-citation></ref><ref id="pmed-0040115-b016"><element-citation publication-type="journal"><person-group><name><surname>Phillips</surname><given-names>RS</given-names></name><name><surname>Enwonwu</surname><given-names>CO</given-names></name><name><surname>Okolo</surname><given-names>S</given-names></name><name><surname>Hassan</surname><given-names>A</given-names></name></person-group><year>2004</year><article-title>Metabolic effects of acute measles in chronically malnourished Nigerian children</article-title><source>J Nutr Biochem</source><volume>15</volume><fpage>281</fpage><lpage>288</lpage><pub-id pub-id-type="pmid">15135152</pub-id></element-citation></ref><ref id="pmed-0040115-b017"><element-citation publication-type="journal"><person-group><name><surname>Schneider</surname><given-names>SM</given-names></name><name><surname>Veyres</surname><given-names>P</given-names></name><name><surname>Pivot</surname><given-names>X</given-names></name><name><surname>Soummer</surname><given-names>AM</given-names></name><name><surname>Jambou</surname><given-names>P</given-names></name><etal></etal></person-group><year>2004</year><article-title>Malnutrition is an independent factor associated with nosocomial infections</article-title><source>Br J Nutr</source><volume>92</volume><fpage>105</fpage><lpage>111</lpage><pub-id pub-id-type="pmid">15230993</pub-id></element-citation></ref><ref id="pmed-0040115-b018"><element-citation publication-type="journal"><person-group><name><surname>Caulfield</surname><given-names>LE</given-names></name><name><surname>de Onis</surname><given-names>M</given-names></name><name><surname>Blossner</surname><given-names>M</given-names></name><name><surname>Black</surname><given-names>RE</given-names></name></person-group><year>2004</year><article-title>Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles</article-title><source>Am J Clin Nutr</source><volume>80</volume><fpage>193</fpage><lpage>198</lpage><pub-id pub-id-type="pmid">15213048</pub-id></element-citation></ref><ref id="pmed-0040115-b019"><element-citation publication-type="journal"><person-group><name><surname>Abe</surname><given-names>M</given-names></name><name><surname>Akbar</surname><given-names>F</given-names></name><name><surname>Matsuura</surname><given-names>B</given-names></name><name><surname>Horiike</surname><given-names>N</given-names></name><name><surname>Onji</surname><given-names>M</given-names></name></person-group><year>2003</year><article-title>Defective antigen-presenting capacity of murine dendritic cells during starvation</article-title><source>Nutrition</source><volume>19</volume><fpage>265</fpage><lpage>269</lpage><pub-id pub-id-type="pmid">12620532</pub-id></element-citation></ref><ref id="pmed-0040115-b020"><element-citation publication-type="journal"><person-group><name><surname>Najera</surname><given-names>O</given-names></name><name><surname>Gonzalez</surname><given-names>C</given-names></name><name><surname>Toledo</surname><given-names>G</given-names></name><name><surname>Lopez</surname><given-names>L</given-names></name><name><surname>Cortes</surname><given-names>E</given-names></name><etal></etal></person-group><year>2001</year><article-title>CD45RA and CD45RO isoforms in infected malnourished and infected well-nourished children</article-title><source>Clin Exp Immunol</source><volume>126</volume><fpage>461</fpage><lpage>465</lpage><pub-id pub-id-type="pmid">11737063</pub-id></element-citation></ref><ref id="pmed-0040115-b021"><element-citation publication-type="journal"><person-group><name><surname>Najera</surname><given-names>O</given-names></name><name><surname>Gonzalez</surname><given-names>C</given-names></name><name><surname>Toledo</surname><given-names>G</given-names></name><name><surname>Lopez</surname><given-names>L</given-names></name><name><surname>Ortiz</surname><given-names>R</given-names></name></person-group><year>2004</year><article-title>Flow cytometry study of lymphocyte subsets in malnourished and well-nourished children with bacterial infections</article-title><source>Clin Diagn Lab Immunol</source><volume>11</volume><fpage>577</fpage><lpage>580</lpage><pub-id pub-id-type="pmid">15138185</pub-id></element-citation></ref><ref id="pmed-0040115-b022"><element-citation publication-type="journal"><person-group><name><surname>Rodriguez</surname><given-names>L</given-names></name><name><surname>Gonzalez</surname><given-names>C</given-names></name><name><surname>Flores</surname><given-names>L</given-names></name><name><surname>Jimenez-Zamudio</surname><given-names>L</given-names></name><name><surname>Graniel</surname><given-names>J</given-names></name><etal></etal></person-group><year>2005</year><article-title>Assessment by flow cytometry of cytokine production in malnourished children</article-title><source>Clin Diagn Lab Immunol</source><volume>12</volume><fpage>502</fpage><lpage>507</lpage><pub-id pub-id-type="pmid">15817757</pub-id></element-citation></ref><ref id="pmed-0040115-b023"><element-citation publication-type="journal"><person-group><name><surname>Woodward</surname><given-names>B</given-names></name><name><surname>Hillyer</surname><given-names>L</given-names></name><name><surname>Hunt</surname><given-names>K</given-names></name></person-group><year>1999</year><article-title>T cells with a quiescent phenotype (CD45RA+) are overabundant in the blood and involuted lymphoid tissues in wasting protein and energy deficiencies</article-title><source>Immunology</source><volume>96</volume><fpage>246</fpage><lpage>253</lpage><pub-id pub-id-type="pmid">10233702</pub-id></element-citation></ref><ref id="pmed-0040115-b024"><element-citation publication-type="journal"><person-group><name><surname>ten Bruggencate</surname><given-names>SJ</given-names></name><name><surname>Hillyer</surname><given-names>LM</given-names></name><name><surname>Woodward</surname><given-names>BD</given-names></name></person-group><year>2001</year><article-title>The proportion of CD45RA(+)CD62L(+) (quiescent-phenotype) T cells within the CD8(+) subset increases in advanced weight loss in the protein- or energy-deficient weanling mouse</article-title><source>J Nutr</source><volume>131</volume><fpage>3266</fpage><lpage>3269</lpage><pub-id pub-id-type="pmid">11739878</pub-id></element-citation></ref><ref id="pmed-0040115-b025"><element-citation publication-type="journal"><person-group><name><surname>Neyestani</surname><given-names>TR</given-names></name><name><surname>Woodward</surname><given-names>B</given-names></name></person-group><year>2005</year><article-title>Blood concentrations of Th2-type immunoglobulins are selectively increased in weanling mice subjected to acute malnutrition</article-title><source>Exp Biol Med (Maywood)</source><volume>230</volume><fpage>128</fpage><lpage>134</lpage><pub-id pub-id-type="pmid">15673561</pub-id></element-citation></ref><ref id="pmed-0040115-b026"><element-citation publication-type="journal"><person-group><name><surname>Hagel</surname><given-names>I</given-names></name><name><surname>Lynch</surname><given-names>NR</given-names></name><name><surname>Di Prisco</surname><given-names>MC</given-names></name><name><surname>Sanchez</surname><given-names>J</given-names></name><name><surname>Perez</surname><given-names>M</given-names></name></person-group><year>1995</year><article-title>Nutritional status and the IgE response against Ascaris lumbricoides in children from a tropical slum</article-title><source>Trans R Soc Trop Med Hyg</source><volume>89</volume><fpage>562</fpage><lpage>565</lpage><pub-id pub-id-type="pmid">8560541</pub-id></element-citation></ref><ref id="pmed-0040115-b027"><element-citation publication-type="journal"><person-group><name><surname>Hagel</surname><given-names>I</given-names></name><name><surname>Lynch</surname><given-names>NR</given-names></name><name><surname>Puccio</surname><given-names>F</given-names></name><name><surname>Rodriguez</surname><given-names>O</given-names></name><name><surname>Luzondo</surname><given-names>R</given-names></name><etal></etal></person-group><year>2003</year><article-title>Defective regulation of the protective IgE response against intestinal helminth Ascaris lumbricoides in malnourished children</article-title><source>J Trop Pediatr</source><volume>49</volume><fpage>136</fpage><lpage>142</lpage><pub-id pub-id-type="pmid">12848201</pub-id></element-citation></ref><ref id="pmed-0040115-b028"><element-citation publication-type="journal"><person-group><name><surname>Ing</surname><given-names>R</given-names></name><name><surname>Su</surname><given-names>Z</given-names></name><name><surname>Scott</surname><given-names>ME</given-names></name><name><surname>Koski</surname><given-names>KG</given-names></name></person-group><year>2000</year><article-title>Suppressed T helper 2 immunity and prolonged survival of a nematode parasite in protein-malnourished mice</article-title><source>Proc Natl Acad Sci U S A</source><volume>97</volume><fpage>7078</fpage><lpage>7083</lpage><pub-id pub-id-type="pmid">10860974</pub-id></element-citation></ref><ref id="pmed-0040115-b029"><element-citation publication-type="journal"><person-group><name><surname>Singal</surname><given-names>A</given-names></name><name><surname>Pandhi</surname><given-names>D</given-names></name><name><surname>Agrawal</surname><given-names>SK</given-names></name></person-group><year>2005</year><article-title>Multifocal scrofuloderma with disseminated tuberculosis in a severely malnourished child</article-title><source>Pediatr Dermatol</source><volume>22</volume><fpage>440</fpage><lpage>443</lpage><pub-id pub-id-type="pmid">16190997</pub-id></element-citation></ref><ref id="pmed-0040115-b030"><element-citation publication-type="journal"><person-group><name><surname>Liebeschuetz</surname><given-names>S</given-names></name><name><surname>Bamber</surname><given-names>S</given-names></name><name><surname>Ewer</surname><given-names>K</given-names></name><name><surname>Deeks</surname><given-names>J</given-names></name><name><surname>Pathan</surname><given-names>AA</given-names></name><etal></etal></person-group><year>2004</year><article-title>Diagnosis of tuberculosis in South African children with a T-cell-based assay: a prospective cohort study</article-title><source>Lancet</source><volume>364</volume><fpage>2196</fpage><lpage>2203</lpage><pub-id pub-id-type="pmid">15610806</pub-id></element-citation></ref><ref id="pmed-0040115-b031"><element-citation publication-type="journal"><person-group><name><surname>Metcalfe</surname><given-names>N</given-names></name></person-group><year>2005</year><article-title>A study of tuberculosis, malnutrition and gender in Sri Lanka</article-title><source>Trans R Soc Trop Med Hyg</source><volume>99</volume><fpage>115</fpage><lpage>119</lpage><pub-id pub-id-type="pmid">15607338</pub-id></element-citation></ref><ref id="pmed-0040115-b032"><element-citation publication-type="journal"><person-group><name><surname>Dai</surname><given-names>G</given-names></name><name><surname>McMurray</surname><given-names>DN</given-names></name></person-group><year>1999</year><article-title>Effects of modulating TGF-beta 1 on immune responses to mycobacterial infection in guinea pigs</article-title><source>Tuber Lung Dis</source><volume>79</volume><fpage>207</fpage><lpage>214</lpage><pub-id pub-id-type="pmid">10692988</pub-id></element-citation></ref><ref id="pmed-0040115-b033"><element-citation publication-type="journal"><person-group><name><surname>Dai</surname><given-names>G</given-names></name><name><surname>McMurray</surname><given-names>DN</given-names></name></person-group><year>1998</year><article-title>Altered cytokine production and impaired antimycobacterial immunity in protein-malnourished guinea pigs</article-title><source>Infect Immun</source><volume>66</volume><fpage>3562</fpage><lpage>3568</lpage><pub-id pub-id-type="pmid">9673234</pub-id></element-citation></ref><ref id="pmed-0040115-b034"><element-citation publication-type="journal"><person-group><name><surname>Chan</surname><given-names>J</given-names></name><name><surname>Tian</surname><given-names>Y</given-names></name><name><surname>Tanaka</surname><given-names>KE</given-names></name><name><surname>Tsang</surname><given-names>MS</given-names></name><name><surname>Yu</surname><given-names>K</given-names></name><etal></etal></person-group><year>1996</year><article-title>Effects of protein calorie malnutrition on tuberculosis in mice</article-title><source>Proc Natl Acad Sci U S A</source><volume>93</volume><fpage>14857</fpage><lpage>14861</lpage><pub-id pub-id-type="pmid">8962145</pub-id></element-citation></ref><ref id="pmed-0040115-b035"><element-citation publication-type="journal"><person-group><name><surname>McMurray</surname><given-names>DN</given-names></name><name><surname>Dai</surname><given-names>G</given-names></name><name><surname>Phalen</surname><given-names>S</given-names></name></person-group><year>1999</year><article-title>Mechanisms of vaccine-induced resistance in a guinea pig model of pulmonary tuberculosis</article-title><source>Tuber Lung Dis</source><volume>79</volume><fpage>261</fpage><lpage>266</lpage><pub-id pub-id-type="pmid">10692995</pub-id></element-citation></ref><ref id="pmed-0040115-b036"><element-citation publication-type="journal"><person-group><name><surname>Matarese</surname><given-names>G</given-names></name><name><surname>Moschos</surname><given-names>S</given-names></name><name><surname>Mantzoros</surname><given-names>CS</given-names></name></person-group><year>2005</year><article-title>Leptin in immunology</article-title><source>J Immunol</source><volume>174</volume><fpage>3137</fpage><lpage>3142</lpage><pub-id pub-id-type="pmid">15749839</pub-id></element-citation></ref><ref id="pmed-0040115-b037"><element-citation publication-type="journal"><person-group><name><surname>Matarese</surname><given-names>G</given-names></name><name><surname>La Cava</surname><given-names>A</given-names></name><name><surname>Sanna</surname><given-names>V</given-names></name><name><surname>Lord</surname><given-names>GM</given-names></name><name><surname>Lechler</surname><given-names>RI</given-names></name><etal></etal></person-group><year>2002</year><article-title>Balancing susceptibility to infection and autoimmunity: A role for leptin?</article-title><source>Trends Immunol</source><volume>23</volume><fpage>182</fpage><lpage>187</lpage><pub-id pub-id-type="pmid">11923112</pub-id></element-citation></ref><ref id="pmed-0040115-b038"><element-citation publication-type="journal"><person-group><name><surname>Lord</surname><given-names>GM</given-names></name><name><surname>Matarese</surname><given-names>G</given-names></name><name><surname>Howard</surname><given-names>JK</given-names></name><name><surname>Baker</surname><given-names>RJ</given-names></name><name><surname>Bloom</surname><given-names>SR</given-names></name><etal></etal></person-group><year>1998</year><article-title>Leptin modulates the T-cell immune response and reverses starvation-induced immunosuppression</article-title><source>Nature</source><volume>394</volume><fpage>897</fpage><lpage>901</lpage><pub-id pub-id-type="pmid">9732873</pub-id></element-citation></ref><ref id="pmed-0040115-b039"><element-citation publication-type="journal"><person-group><name><surname>Lord</surname><given-names>GM</given-names></name><name><surname>Matarese</surname><given-names>G</given-names></name><name><surname>Howard</surname><given-names>JK</given-names></name><name><surname>Bloom</surname><given-names>SR</given-names></name><name><surname>Lechler</surname><given-names>RI</given-names></name></person-group><year>2002</year><article-title>Leptin inhibits the anti-CD3-driven proliferation of peripheral blood T cells but enhances the production of proinflammatory cytokines</article-title><source>J Leukoc Biol</source><volume>72</volume><fpage>330</fpage><lpage>338</lpage><pub-id pub-id-type="pmid">12149424</pub-id></element-citation></ref><ref id="pmed-0040115-b040"><element-citation publication-type="journal"><person-group><name><surname>Faggioni</surname><given-names>R</given-names></name><name><surname>Feingold</surname><given-names>KR</given-names></name><name><surname>Grunfeld</surname><given-names>C</given-names></name></person-group><year>2001</year><article-title>Leptin regulation of the immune response and the immunodeficiency of malnutrition</article-title><source>Faseb J</source><volume>15</volume><fpage>2565</fpage><lpage>2571</lpage><pub-id pub-id-type="pmid">11726531</pub-id></element-citation></ref><ref id="pmed-0040115-b041"><element-citation publication-type="journal"><person-group><name><surname>Cakir</surname><given-names>B</given-names></name><name><surname>Yonem</surname><given-names>A</given-names></name><name><surname>Guler</surname><given-names>S</given-names></name><name><surname>Odabasi</surname><given-names>E</given-names></name><name><surname>Demirbas</surname><given-names>B</given-names></name><etal></etal></person-group><year>1999</year><article-title>Relation of leptin and tumor necrosis factor alpha to body weight changes in patients with pulmonary tuberculosis</article-title><source>Horm Res</source><volume>52</volume><fpage>279</fpage><lpage>283</lpage><pub-id pub-id-type="pmid">10965207</pub-id></element-citation></ref><ref id="pmed-0040115-b042"><element-citation publication-type="journal"><person-group><name><surname>Schwenk</surname><given-names>A</given-names></name><name><surname>Hodgson</surname><given-names>L</given-names></name><name><surname>Rayner</surname><given-names>CF</given-names></name><name><surname>Griffin</surname><given-names>GE</given-names></name><name><surname>Macallan</surname><given-names>DC</given-names></name></person-group><year>2003</year><article-title>Leptin and energy metabolism in pulmonary tuberculosis</article-title><source>Am J Clin Nutr</source><volume>77</volume><fpage>392</fpage><lpage>398</lpage><pub-id pub-id-type="pmid">12540399</pub-id></element-citation></ref><ref id="pmed-0040115-b043"><element-citation publication-type="journal"><person-group><name><surname>van Crevel</surname><given-names>R</given-names></name><name><surname>Karyadi</surname><given-names>E</given-names></name><name><surname>Netea</surname><given-names>MG</given-names></name><name><surname>Verhoef</surname><given-names>H</given-names></name><name><surname>Nelwan</surname><given-names>RH</given-names></name><etal></etal></person-group><year>2002</year><article-title>Decreased plasma leptin concentrations in tuberculosis patients are associated with wasting and inflammation</article-title><source>J Clin Endocrinol Metab</source><volume>87</volume><fpage>758</fpage><lpage>763</lpage><pub-id pub-id-type="pmid">11836317</pub-id></element-citation></ref><ref id="pmed-0040115-b044"><element-citation publication-type="journal"><person-group><name><surname>van Lettow</surname><given-names>M</given-names></name><name><surname>van der Meer</surname><given-names>JW</given-names></name><name><surname>West</surname><given-names>CE</given-names></name><name><surname>van Crevel</surname><given-names>R</given-names></name><name><surname>Semba</surname><given-names>RD</given-names></name></person-group><year>2005</year><article-title>Interleukin-6 and human immunodeficiency virus load, but not plasma leptin concentration, predict anorexia and wasting in adults with pulmonary tuberculosis in Malawi</article-title><source>J Clin Endocrinol Metab</source><volume>90</volume><fpage>4771</fpage><lpage>4776</lpage><pub-id pub-id-type="pmid">15928249</pub-id></element-citation></ref><ref id="pmed-0040115-b045"><element-citation publication-type="journal"><person-group><name><surname>Wieland</surname><given-names>CW</given-names></name><name><surname>Florquin</surname><given-names>S</given-names></name><name><surname>Chan</surname><given-names>ED</given-names></name><name><surname>Leemans</surname><given-names>JC</given-names></name><name><surname>Weijer</surname><given-names>S</given-names></name><etal></etal></person-group><year>2005</year><article-title>Pulmonary <named-content content-type="genus-species">Mycobacterium tuberculosis</named-content> infection in leptin-deficient ob/ob mice</article-title><source>Int Immunol</source><volume>17</volume><fpage>1399</fpage><lpage>1408</lpage><pub-id pub-id-type="pmid">16141243</pub-id></element-citation></ref><ref id="pmed-0040115-b046"><element-citation publication-type="journal"><person-group><name><surname>Monk</surname><given-names>JM</given-names></name><name><surname>Makinen</surname><given-names>K</given-names></name><name><surname>Shrum</surname><given-names>B</given-names></name><name><surname>Woodward</surname><given-names>B</given-names></name></person-group><year>2006</year><article-title>Blood corticosterone concentration reaches critical illness levels early during acute malnutrition in the weanling mouse</article-title><source>Exp Biol Med (Maywood)</source><volume>231</volume><fpage>264</fpage><lpage>268</lpage><pub-id pub-id-type="pmid">16514171</pub-id></element-citation></ref><ref id="pmed-0040115-b047"><element-citation publication-type="journal"><person-group><name><surname>Jacobson</surname><given-names>L</given-names></name></person-group><year>2005</year><article-title>Hypothalamic-pituitary-adrenocortical axis regulation</article-title><source>Endocrinol Metab Clin North Am</source><volume>34</volume><fpage>271</fpage><lpage>292</lpage><pub-id pub-id-type="pmid">15850842</pub-id></element-citation></ref><ref id="pmed-0040115-b048"><element-citation publication-type="journal"><person-group><name><surname>Alleyne</surname><given-names>GA</given-names></name><name><surname>Young</surname><given-names>VH</given-names></name></person-group><year>1967</year><article-title>Adrenocortical function in children with severe protein-calorie malnutrition</article-title><source>Clin Sci</source><volume>33</volume><fpage>189</fpage><lpage>200</lpage><pub-id pub-id-type="pmid">4293824</pub-id></element-citation></ref><ref id="pmed-0040115-b049"><element-citation publication-type="journal"><person-group><name><surname>Auphan</surname><given-names>N</given-names></name><name><surname>Didonato</surname><given-names>JA</given-names></name><name><surname>Helmberg</surname><given-names>A</given-names></name><name><surname>Rosette</surname><given-names>C</given-names></name><name><surname>Karin</surname><given-names>M</given-names></name></person-group><year>1997</year><article-title>Immunoregulatory genes and immunosuppression by glucocorticoids</article-title><source>Arch Toxicol Suppl</source><volume>19</volume><fpage>87</fpage><lpage>95</lpage><pub-id pub-id-type="pmid">9079197</pub-id></element-citation></ref><ref id="pmed-0040115-b050"><element-citation publication-type="journal"><person-group><name><surname>Van Molle</surname><given-names>W</given-names></name><name><surname>Libert</surname><given-names>C</given-names></name></person-group><year>2005</year><article-title>How glucocorticoids control their own strength and the balance between pro- and anti-inflammatory mediators</article-title><source>Eur J Immunol</source><volume>35</volume><fpage>3396</fpage><lpage>3399</lpage><pub-id pub-id-type="pmid">16331703</pub-id></element-citation></ref><ref id="pmed-0040115-b051"><element-citation publication-type="journal"><person-group><name><surname>McCarter</surname><given-names>MD</given-names></name><name><surname>Naama</surname><given-names>HA</given-names></name><name><surname>Shou</surname><given-names>J</given-names></name><name><surname>Kwi</surname><given-names>LX</given-names></name><name><surname>Evoy</surname><given-names>DA</given-names></name><etal></etal></person-group><year>1998</year><article-title>Altered macrophage intracellular signaling induced by protein-calorie malnutrition</article-title><source>Cell Immunol</source><volume>183</volume><fpage>131</fpage><lpage>136</lpage><pub-id pub-id-type="pmid">9606997</pub-id></element-citation></ref><ref id="pmed-0040115-b052"><element-citation publication-type="journal"><person-group><name><surname>Redmond</surname><given-names>HP</given-names></name><name><surname>Gallagher</surname><given-names>HJ</given-names></name><name><surname>Shou</surname><given-names>J</given-names></name><name><surname>Daly</surname><given-names>JM</given-names></name></person-group><year>1995</year><article-title>Antigen presentation in protein-energy malnutrition</article-title><source>Cell Immunol</source><volume>163</volume><fpage>80</fpage><lpage>87</lpage><pub-id pub-id-type="pmid">7758132</pub-id></element-citation></ref><ref id="pmed-0040115-b053"><element-citation publication-type="journal"><person-group><name><surname>Redmond</surname><given-names>HP</given-names></name><name><surname>Leon</surname><given-names>P</given-names></name><name><surname>Lieberman</surname><given-names>MD</given-names></name><name><surname>Hofmann</surname><given-names>K</given-names></name><name><surname>Shou</surname><given-names>J</given-names></name><etal></etal></person-group><year>1991</year><article-title>Impaired macrophage function in severe protein-energy malnutrition</article-title><source>Arch Surg</source><volume>126</volume><fpage>192</fpage><lpage>196</lpage><pub-id pub-id-type="pmid">1847038</pub-id></element-citation></ref><ref id="pmed-0040115-b054"><element-citation publication-type="journal"><person-group><name><surname>Redmond</surname><given-names>HP</given-names></name><name><surname>Shou</surname><given-names>J</given-names></name><name><surname>Kelly</surname><given-names>CJ</given-names></name><name><surname>Leon</surname><given-names>P</given-names></name><name><surname>Daly</surname><given-names>JM</given-names></name></person-group><year>1991</year><article-title>Protein-calorie malnutrition impairs host defense against Candida albicans</article-title><source>J Surg Res</source><volume>50</volume><fpage>552</fpage><lpage>559</lpage><pub-id pub-id-type="pmid">1646910</pub-id></element-citation></ref><ref id="pmed-0040115-b055"><element-citation publication-type="journal"><person-group><name><surname>Stapleton</surname><given-names>PP</given-names></name><name><surname>Barden</surname><given-names>CB</given-names></name><name><surname>McCarter</surname><given-names>MD</given-names></name><name><surname>Mackrell</surname><given-names>PJ</given-names></name><name><surname>Freeman</surname><given-names>TA</given-names></name><etal></etal></person-group><year>2003</year><article-title>Serum leptin levels in acute protein deprivation</article-title><source>JPEN J Parenter Enteral Nutr</source><volume>27</volume><fpage>132</fpage><lpage>136</lpage><pub-id pub-id-type="pmid">12665169</pub-id></element-citation></ref><ref id="pmed-0040115-b056"><element-citation publication-type="journal"><person-group><name><surname>Tanaka</surname><given-names>S</given-names></name><name><surname>Isoda</surname><given-names>F</given-names></name><name><surname>Ishihara</surname><given-names>Y</given-names></name><name><surname>Kimura</surname><given-names>M</given-names></name><name><surname>Yamakawa</surname><given-names>T</given-names></name></person-group><year>2001</year><article-title>T lymphopaenia in relation to body mass index and TNF-alpha in human obesity: Adequate weight reduction can be corrective</article-title><source>Clin Endocrinol (Oxf)</source><volume>54</volume><fpage>347</fpage><lpage>354</lpage><pub-id pub-id-type="pmid">11298087</pub-id></element-citation></ref><ref id="pmed-0040115-b057"><element-citation publication-type="journal"><person-group><name><surname>Tanaka</surname><given-names>S</given-names></name><name><surname>Isoda</surname><given-names>F</given-names></name><name><surname>Kiuchi</surname><given-names>Y</given-names></name><name><surname>Ikeda</surname><given-names>H</given-names></name><name><surname>Mobbs</surname><given-names>CV</given-names></name><etal></etal></person-group><year>2000</year><article-title>T lymphopenia in genetically obese-diabetic Wistar fatty rats: Effects of body weight reduction on T cells</article-title><source>Metabolism</source><volume>49</volume><fpage>1261</fpage><lpage>1266</lpage><pub-id pub-id-type="pmid">11079813</pub-id></element-citation></ref><ref id="pmed-0040115-b058"><element-citation publication-type="journal"><person-group><name><surname>Nieman</surname><given-names>DC</given-names></name><name><surname>Henson</surname><given-names>DA</given-names></name><name><surname>Nehlsen-Cannarella</surname><given-names>SL</given-names></name><name><surname>Ekkens</surname><given-names>M</given-names></name><name><surname>Utter</surname><given-names>AC</given-names></name><etal></etal></person-group><year>1999</year><article-title>Influence of obesity on immune function</article-title><source>J Am Diet Assoc</source><volume>99</volume><fpage>294</fpage><lpage>299</lpage><pub-id pub-id-type="pmid">10076580</pub-id></element-citation></ref><ref id="pmed-0040115-b059"><element-citation publication-type="journal"><person-group><name><surname>Yamakawa</surname><given-names>T</given-names></name><name><surname>Tanaka</surname><given-names>S</given-names></name><name><surname>Yamakawa</surname><given-names>Y</given-names></name><name><surname>Kiuchi</surname><given-names>Y</given-names></name><name><surname>Isoda</surname><given-names>F</given-names></name><etal></etal></person-group><year>1995</year><article-title>Augmented production of tumor necrosis factor-alpha in obese mice</article-title><source>Clin Immunol Immunopathol</source><volume>75</volume><fpage>51</fpage><lpage>56</lpage><pub-id pub-id-type="pmid">7882592</pub-id></element-citation></ref><ref id="pmed-0040115-b060"><element-citation publication-type="journal"><person-group><name><surname>Zarkesh-Esfahani</surname><given-names>H</given-names></name><name><surname>Pockley</surname><given-names>AG</given-names></name><name><surname>Wu</surname><given-names>Z</given-names></name><name><surname>Hellewell</surname><given-names>PG</given-names></name><name><surname>Weetman</surname><given-names>AP</given-names></name><etal></etal></person-group><year>2004</year><article-title>Leptin indirectly activates human neutrophils via induction of TNF-alpha</article-title><source>J Immunol</source><volume>172</volume><fpage>1809</fpage><lpage>1814</lpage><pub-id pub-id-type="pmid">14734764</pub-id></element-citation></ref><ref id="pmed-0040115-b061"><element-citation publication-type="journal"><person-group><name><surname>Zarkesh-Esfahani</surname><given-names>H</given-names></name><name><surname>Pockley</surname><given-names>G</given-names></name><name><surname>Metcalfe</surname><given-names>RA</given-names></name><name><surname>Bidlingmaier</surname><given-names>M</given-names></name><name><surname>Wu</surname><given-names>Z</given-names></name><etal></etal></person-group><year>2001</year><article-title>High-dose leptin activates human leukocytes via receptor expression on monocytes</article-title><source>J Immunol</source><volume>167</volume><fpage>4593</fpage><lpage>4599</lpage><pub-id pub-id-type="pmid">11591788</pub-id></element-citation></ref><ref id="pmed-0040115-b062"><element-citation publication-type="journal"><person-group><name><surname>Sanchez-Margalet</surname><given-names>V</given-names></name><name><surname>Martin-Romero</surname><given-names>C</given-names></name><name><surname>Santos-Alvarez</surname><given-names>J</given-names></name><name><surname>Goberna</surname><given-names>R</given-names></name><name><surname>Najib</surname><given-names>S</given-names></name><etal></etal></person-group><year>2003</year><article-title>Role of leptin as an immunomodulator of blood mononuclear cells: Mechanisms of action</article-title><source>Clin Exp Immunol</source><volume>133</volume><fpage>11</fpage><lpage>19</lpage><pub-id pub-id-type="pmid">12823272</pub-id></element-citation></ref><ref id="pmed-0040115-b063"><element-citation publication-type="journal"><person-group><name><surname>Dixit</surname><given-names>VD</given-names></name><name><surname>Schaffer</surname><given-names>EM</given-names></name><name><surname>Pyle</surname><given-names>RS</given-names></name><name><surname>Collins</surname><given-names>GD</given-names></name><name><surname>Sakthivel</surname><given-names>SK</given-names></name><etal></etal></person-group><year>2004</year><article-title>Ghrelin inhibits leptin- and activation-induced proinflammatory cytokine expression by human monocytes and T cells</article-title><source>J Clin Invest</source><volume>114</volume><fpage>57</fpage><lpage>66</lpage><pub-id pub-id-type="pmid">15232612</pub-id></element-citation></ref><ref id="pmed-0040115-b064"><element-citation publication-type="journal"><person-group><name><surname>Xia</surname><given-names>Q</given-names></name><name><surname>Pang</surname><given-names>W</given-names></name><name><surname>Pan</surname><given-names>H</given-names></name><name><surname>Zheng</surname><given-names>Y</given-names></name><name><surname>Kang</surname><given-names>JS</given-names></name><etal></etal></person-group><year>2004</year><article-title>Effects of ghrelin on the proliferation and secretion of splenic T lymphocytes in mice</article-title><source>Regul Pept</source><volume>122</volume><fpage>173</fpage><lpage>178</lpage><pub-id pub-id-type="pmid">15491788</pub-id></element-citation></ref><ref id="pmed-0040115-b065"><element-citation publication-type="journal"><person-group><name><surname>Netea</surname><given-names>MG</given-names></name><name><surname>Joosten</surname><given-names>LA</given-names></name><name><surname>Lewis</surname><given-names>E</given-names></name><name><surname>Jensen</surname><given-names>DR</given-names></name><name><surname>Voshol</surname><given-names>PJ</given-names></name><etal></etal></person-group><year>2006</year><article-title>Deficiency of interleukin-18 in mice leads to hyperphagia, obesity and insulin resistance</article-title><source>Nat Med</source><volume>12</volume><fpage>650</fpage><lpage>656</lpage><pub-id pub-id-type="pmid">16732281</pub-id></element-citation></ref><ref id="pmed-0040115-b066"><element-citation publication-type="journal"><person-group><name><surname>Turnbaugh</surname><given-names>PJ</given-names></name><name><surname>Ley</surname><given-names>RE</given-names></name><name><surname>Mahowald</surname><given-names>MA</given-names></name><name><surname>Magrini</surname><given-names>V</given-names></name><name><surname>Mardis</surname><given-names>ER</given-names></name><etal></etal></person-group><year>2006</year><article-title>An obesity-associated gut microbiome with increased capacity for energy harvest</article-title><source>Nature</source><volume>444</volume><fpage>1027</fpage><lpage>1131</lpage><pub-id pub-id-type="pmid">17183312</pub-id></element-citation></ref><ref id="pmed-0040115-b067"><element-citation publication-type="journal"><person-group><name><surname>Perez-Guzman</surname><given-names>C</given-names></name><name><surname>Vargas</surname><given-names>MH</given-names></name></person-group><year>2006</year><article-title>Hypocholesterolemia: A major risk factor for developing pulmonary tuberculosis?</article-title><source>Med Hypotheses</source><volume>66</volume><fpage>1227</fpage><lpage>1230</lpage><pub-id pub-id-type="pmid">16500037</pub-id></element-citation></ref><ref id="pmed-0040115-b068"><element-citation publication-type="journal"><person-group><name><surname>Perez-Guzman</surname><given-names>C</given-names></name><name><surname>Vargas</surname><given-names>MH</given-names></name><name><surname>Quinonez</surname><given-names>F</given-names></name><name><surname>Bazavilvazo</surname><given-names>N</given-names></name><name><surname>Aguilar</surname><given-names>A</given-names></name></person-group><year>2005</year><article-title>A cholesterol-rich diet accelerates bacteriologic sterilization in pulmonary tuberculosis</article-title><source>Chest</source><volume>127</volume><fpage>643</fpage><lpage>651</lpage><pub-id pub-id-type="pmid">15706008</pub-id></element-citation></ref><ref id="pmed-0040115-b069"><element-citation publication-type="journal"><person-group><name><surname>Joshi</surname><given-names>N</given-names></name><name><surname>Caputo</surname><given-names>GM</given-names></name><name><surname>Weitekamp</surname><given-names>MR</given-names></name><name><surname>Karchmer</surname><given-names>AW</given-names></name></person-group><year>1999</year><article-title>Infections in patients with diabetes mellitus</article-title><source>N Engl J Med</source><volume>341</volume><fpage>1906</fpage><lpage>1912</lpage><pub-id pub-id-type="pmid">10601511</pub-id></element-citation></ref><ref id="pmed-0040115-b070"><element-citation publication-type="journal"><person-group><name><surname>Guptan</surname><given-names>A</given-names></name><name><surname>Shah</surname><given-names>A</given-names></name></person-group><year>2000</year><article-title>Tuberculosis and diabetes: An appraisal</article-title><source>Ind J Tub</source><volume>47</volume><fpage>2</fpage><lpage>8</lpage></element-citation></ref><ref id="pmed-0040115-b071"><element-citation publication-type="book"><collab>United States Department of Health and Human Services</collab><year>1988</year><source>The Surgeon General’s report on nutrition and health</source><publisher-loc>Washington (D. C.)</publisher-loc><publisher-name>DHHS Publishing</publisher-name><fpage>427</fpage><lpage>463</lpage></element-citation></ref><ref id="pmed-0040115-b072"><element-citation publication-type="other"><collab>World Food Programme</collab><year>2004</year><article-title>Hunger facts</article-title><comment>Available: <ext-link ext-link-type="uri" xlink:href="http://www.wfp.org/aboutwfp/facts/hunger_facts.asp">http://www.wfp.org/aboutwfp/facts/hunger_facts.asp</ext-link>. Accessed 29 March 2007</comment></element-citation></ref><ref id="pmed-0040115-b073"><element-citation publication-type="journal"><person-group><name><surname>Blackburn</surname><given-names>GL</given-names></name></person-group><year>2001</year><article-title>Pasteur’s Quadrant and malnutrition</article-title><source>Nature</source><volume>409</volume><fpage>397</fpage><lpage>401</lpage><pub-id pub-id-type="pmid">11201754</pub-id></element-citation></ref><ref id="pmed-0040115-b074"><element-citation publication-type="other"><collab>World Health Organization</collab><year>2003</year><source>Investing in health: A summary of the findings of the Commission on Macroeconomics and Health</source><comment>Available: 29 March 2007</comment></element-citation></ref><ref id="pmed-0040115-b075"><element-citation publication-type="other"><collab>The World Bank</collab><year>2006</year><article-title>Repositioning nutrition as central to development: A strategy for large-scale action</article-title><comment>Available: <ext-link ext-link-type="uri" xlink:href="http://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/NutritionStrategy.pdf">http://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/NutritionStrategy.pdf</ext-link>. Accessed 29 March 2007</comment></element-citation></ref><ref id="pmed-0040115-b076"><element-citation publication-type="journal"><person-group><name><surname>Tectonidis</surname><given-names>M</given-names></name></person-group><year>2006</year><article-title>Crisis in Niger—Outpatient care for severe acute malnutrition</article-title><source>N Engl J Med</source><volume>354</volume><fpage>224</fpage><lpage>227</lpage><pub-id pub-id-type="pmid">16421363</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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