Serum immunoglobulins in kwashiorkor.

Infection and protein calorie malnutrition frequently coexist (Smythe, 1958; Brown, 1965; Phillips and Wharton, 1968), and though it is apparent that infection may affect nutrition adversely, it is difficult to prove that malnutrition is a factor in poor response to infection. In 1965 the World Health Organization Expert Committee on nutrition stated: 'The concept that malnutrition could make man more susceptible to infectious disease and also alter the course and outcome of the resulting illness has long been current in the history of medicine and public health. Circumstantial evidence is plentiful, principally based on clinical experience. Well-controlled observations have been few, and hence clear proof in support of the concept has been slow to accumulate. It has been much easier to demonstrate that infection is often directly responsible for lowering the state of nutrition.' In a few diseases, however, there is proof that with coexistent protein calorie malnutrition the mortality rate is higher than expected, e.g. measles (Hendrickse, 1967) and herpes simplex infection (Becker, Kipps, and McKenzie, 1968). Yellow fever vaccination antibody response was found much impaired in children deficient in protein (Brown and Katz, 1966a, b). If it is assumed that protein calorie malnutrition can be held responsible for proneness and poor response to infection, the mechanism for the susceptibility to infection is still to be clarified. One mechanism for host resistance to infection is the production of immunoglobulins. Anderson and Altmann (1951) found that the total y-globulin fraction of the serum proteins tended to be high in kwashiorkor, whereas Brown and Katz (1965) reported a significant reduction (p<005) in the serum IgG concentrations of 20 kwashiorkor patients compared with 5 controls, with no difference between IgA and IgM levels in the two groups. The present study was undertaken to compare