Percent Weight Gain for different categories of height on admission to Outpatient Therapeutic Program.

<p>The box extends between the upper and lower quartiles, the line in the box marks the position of the median, the notches around the median show the extent of an approximate 95% confidence for the position of the median. The whiskers extend to 1.5 times the interquartile distance above and below the upper and lower quartiles, and the asterisks mark the positions of points more extreme than the range of values covered by the whiskers.</p

Length of Stay for different categories of WHZ on admission to Outpatient Therapeutic Program.

<p>The box extends between the upper and lower quartiles, the line in the box marks the position of the median, the notches around the median show the extent of an approximate 95% confidence for the position of the median. The whiskers extend to 1.5 times the interquartile distance above and below the upper and lower quartiles, and the asterisks mark the positions of points more extreme than the range of values covered by the whiskers; all children had mid-upper arm circumference <115 mm.</p

Weight gain greater than 15% by MUAC category on admission to Outpatient Therapeutic Program.

<p>Weight gain greater than 15% by MUAC category on admission to Outpatient Therapeutic Program.</p

Length of Stay by categories of MUAC on admission to Outpatient Therapeutic Program.

<p>The box extends between the upper and lower quartiles, the line in the box marks the position of the median, the notches around the median show the extent of an approximate 95% confidence for the position of the median. The whiskers extend to 1.5 times the interquartile distance above and below the upper and lower quartiles, and the asterisks mark the positions of points more extreme than the range of values covered by the whiskers.</p

Population profile of the Outpatient Therapeutic Program.

<p>Population profile of the Outpatient Therapeutic Program.</p

Percent Weight Gain by categories of MUAC on admission to Outpatient Therapeutic Program.

<p>The box extends between the upper and lower quartiles, the line in the box marks the position of the median, the notches around the median show the extent of an approximate 95% confidence for the position of the median. The whiskers extend to 1.5 times the interquartile distance above and below the upper and lower quartiles, and the asterisks mark the positions of points more extreme than the range of values covered by the whiskers.</p

The Immune System in Children with Malnutrition—A Systematic Review

<div><p>Background</p><p>Malnourished children have increased risk of dying, with most deaths caused by infectious diseases. One mechanism behind this may be impaired immune function. However, this immune deficiency of malnutrition has not previously been systematically reviewed.</p><p>Objectives</p><p>To review the scientific literature about immune function in children with malnutrition.</p><p>Methods</p><p>A systematic literature search was done in PubMed, and additional articles identified in reference lists and by correspondence with experts in the field. The inclusion criteria were studies investigating immune parameters in children aged 1–60 months, in relation to malnutrition, defined as wasting, underweight, stunting, or oedematous malnutrition.</p><p>Results</p><p>The literature search yielded 3402 articles, of which 245 met the inclusion criteria. Most were published between 1970 and 1990, and only 33 after 2003. Malnutrition is associated with impaired gut-barrier function, reduced exocrine secretion of protective substances, and low levels of plasma complement. Lymphatic tissue, particularly the thymus, undergoes atrophy, and delayed-type hypersensitivity responses are reduced. Levels of antibodies produced after vaccination are reduced in severely malnourished children, but intact in moderate malnutrition. Cytokine patterns are skewed towards a Th2-response. Other immune parameters seem intact or elevated: leukocyte and lymphocyte counts are unaffected, and levels of immunoglobulins, particularly immunoglobulin A, are high. The acute phase response appears intact, and sometimes present in the absence of clinical infection. Limitations to the studies include their observational and often cross-sectional design and frequent confounding by infections in the children studied.</p><p>Conclusion</p><p>The immunological alterations associated with malnutrition in children may contribute to increased mortality. However, the underlying mechanisms are still inadequately understood, as well as why different types of malnutrition are associated with different immunological alterations. Better designed prospective studies are needed, based on current understanding of immunology and with state-of-the-art methods.</p></div

Conceptual framework on the relationship between malnutrition, infections and poverty.

<p>Conceptual framework on the relationship between malnutrition, infections and poverty.</p

Summary of results in studies of each immune parameter.

<p><b>Legend</b>: ↑ =  higher in malnourished than well-nourished, ↓ =  lower in malnourished than well-nourished, 0 =  similar in malnourished and well-nourished; ↕ = inconsistent results; OM =  Oedematous malnutrition, NOM =  Non-oedematous malnutrition, GRAN = Granulocytes (Polymorph nuclear cells); sIgA =  secretory immunoglobulin A; NK =  Natural killer; APP =  Acute phase protein; C = Complement component, BCG =  Bacille Calmette-Guérin, PHA: phyto-hemaglutinin; Ig =  immunoglobulin; IL =  Interleukin; IFNγ = Interferon-gamma; TNFα = Tumour-necrosis-factor-alpha.</p

Summary of immune parameters affected and not affected by malnutrition.

<p>Summary of immune parameters affected and not affected by malnutrition.</p