[Effect of the nutritional recovery on the concentration of Interleukin-2 in severely malnourished children]. / Efecto de la recuperación nutricia sobre la concentración de Interleucina-2 en niñios con desnutrición grave.

The severely malnourished child has dysfunction of the immune response that may increase the risk of morbidity or mortality due to infectious diseases, therefore, the purpose of this study was to demonstrate the effect of intensive nutritional support on the cellular and serum concentration of IL-2 and CD4+, as well as CD8+ T cells in children with severe protein energy malnutrition. A clinical assay was carried out in a tertiary care hospital. 10 severely malnourished children < 48 months of age who received formula without lactose via enteral feeding for two weeks and ad libitum for an additional two weeks were included. Cellular and serum concentrations of IL-2 and the subpopulation of CD4+ and CD8+ were obtained. A control group (n = 13) was included. A paired student t test for initial-final determinations and the Mann-Whitney Test for comparison with control group were used, and null hypothesis was rejected with a p value < 0.05. There was a noteworthy increase in the comparison between the initial vs. final percentage of the cellular expression of IL-2 (p < 0.001) and in the serum concentration of IL-2 (p = 0.001). Therefore, four weeks of nutritional recovery significantly restored the production of IL-2, independently of the nutrients involved in the process, although, the rate of restoration seems to depend on the severity of the children primary PEM.

Efecto de la recuperación nutricia sobre la concentración de Interleucina-2 en niños con desnutrición grave

El niño con desnutrición grave tiene una disfunción de la respuesta inmune que puede aumentar de manera significativa la morbilidad y la mortalidad por infecciones. Por ello, el objetivo del presente estudio fue demostrar el efecto del apoyo nutricio intensivo en la concentración en suero y celular de IL-2 y sub-poblaciones de células CD4+, y CD8+ T en niños con desnutrición proteínico-energética grave. En un ensayo clínico se incluyeron 10 niños con desnutrición primaria grave, menores de 48 meses de edad, quienes recibieron una fórmula sin lactosa por alimentación enteral continua por dos semanas y dos semanas más ad libitum. Se obtuvieron la concentración sérica y celular de IL-2 y las sub-poblaciones de linfocitos CD4+ y CD8+ en los casos y en un grupo control (n = 13). Con la prueba t de student pareada se compararon los valores inicial vs. final de los sujetos y se utilizó la prueba U-Mann-Whitney para la comparación con el grupo control. Se rechazó la hipótesis nula con una p < 0,05. Se observó un incremento notable inicial vs. final en el porcentaje de expresión celular de IL-2 (p < 0,001) y en la concentración sérica de esta citocina (p = 0,001). Por tanto, cuatro semanas de apoyo nutricio intensivo fueron suficientes para mostrar un incremento significativo en la producción de IL-2, independientemente de los nutrimentos involucrados, aunque aparentemente este incremento dependió de la gravedad de la DPE.

Effect of the nutritional recovery on the concentration of Interleukin-2 in severely malnourished children. The severely malnourished child has dysfunction of the immune response that may increase the risk of morbidity or mortality due to infectious diseases, therefore, the purpose of this study was to demonstrate the effect of intensive nutritional support on the cellular and serum concentration of IL-2 and CD4+, as well as CD8+ T cells in children with severe protein energy malnutrition. A clinical assay was carried out in a tertiary care hospital. 10 severely malnourished children < 48 months of age who received formula without lactose via enteral feeding for two weeks and ad libitum for an additional two weeks were included. Cellular and serum concentrations of IL- 2 and the subpopulation of CD4+ and CD8+ were obtained. A control group (n = 13) was included. A paired student t test for initial-final determinations and the Mann-Whitney Test for comparison with control group were used, and null hypothesis was rejected with a p value < 0,05. There was a noteworthy increase in the comparison between the initial vs. final percentage of the cellular expression of IL-2 (p < 0,001) and in the serum concentration of IL-2 (p = 0,001). Therefore, four weeks of nutritional recovery significantly restored the production of IL-2, independently of the nutrients involved in the process, although, the rate of restoration seems to depend on the severity of the children primary PEM.

Nutritional support with nucleotide addition favors immune response in severely malnourished infants.

BACKGROUND: Adequate nutritional support of severe primary protein energy malnutrition (PEM) is indispensable for achieving normal immune response. However, an ideal dietetic criterion has not yet been established or accepted by the majority of health professionals caring for malnourished infants. Our objective was to demonstrate improvement in immune response in infants with PEM who received starting infant formula with nucleotides. METHODS: Twelve malnourished infants 3-18 months of age were included in our study and were fed through a nasogastric tube with infant formula (3.35 kJ/mL) for 2 weeks and ad libitum for an additional 2 weeks. Anthropometric measurements and immunologic indicators such as phagocytosis, microbicidal activity, chemotaxis, and cell proliferation index were determined. The sample was divided into two groups; group 1 (n=6) was fed formula with nucleotides added, while group 2 (n=6) was fed a formula with no nucleotides. Paired t test was used to determine differences between initial and final results for each group for comparison between group 1 vs. group 2; a nonparametric Mann-Whitney U test was used for immunologic indicators. RESULTS: Comparison of immunologic indicators showed no significant difference between groups. Groups 1 and 2 showed improvement in phagocytosis and microbicidal activity (p <0.05) and group 2 additionally showed improvement in cell proliferation index. CONCLUSIONS: Infant formula with intake of 837 kJ/kg/d (200 kcal/kg/d) and proteins of 4 g/kg/d in infants with PEM had a favorable impact on immunologic indicators regardless of addition of nucleotides.

Effect of renutrition on natural and cell-mediated immune response in infants with severe malnutrition.

BACKGROUND: The purpose of this study was to evaluate whether a 4-week nutritional recovery period with a starting infant formula and 3.35 kJ/mL energy density would favorably affect the natural and cell-mediated immune response in infants with severe and primary protein-energy malnutrition. METHODOLOGY: The study included 12 severely malnourished infants, 3 to 18 months of age. For 2 weeks, infants were fed a starting infant formula, with energy density increased to 0.8 kcal/mL, through a nasogastric tube. Infants were fed "ad libitum" for 2 more weeks. On the fifth day, 837 kJ/kg and 4 g/kg protein were given daily. At the beginning and at the end of the 4-week period, weight, length, phagocytosis, microbicidal activity, chemotaxis, and cell proliferation indices were measured. Null hypothesis was rejected with a paired t test and a P value less than 0.05. RESULTS: After the 4-week period of nutritional recovery, the weight and length indicators and the four immunologic assays showed significant increase (P < 0.005). CONCLUSION: The study demonstrated that a 4-week nutritional recovery period with a starting infant formula and 0.8 kcal/mL energy density favorably affected the natural and cell-mediated immune response in infants with severe protein-energy malnutrition.