¹Institute for International Cooperation, JICA, Tokyo, Japan

²Program in International Nutrition, Department of Nutrition, University of California, Davis, USA

³Department of Epidemiology, National Institute of Health, Tokyo, Japan

⁴Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana

^aCorrespondence: Dr T Rikimaru, Institute for International Cooperation, JICA, 10-5 Honmura-cho, Ichigaya, Shinjuku-ku, Tokyo 162, Japan.

Objective: To examine the relationship between immunological variables and the different types and severity of malnutrition in Ghanaian children.

Design: Case-control study.

Setting: The study was done at Princess Marie Louise Hospital, Accra, Ghana.

Subjects: One hundred and seventy children, aged 8-36 months, were recruited at the clinical ward and public health service section of the hospital: 61 normal children, 49 moderately malnourished (underweight) children and 60 severely malnourished children (19 kwashiorkor, 30 marasmus, and 11 marasmic kwashiorkor children).

Method: The children underwent clinical observations, anthropometric measurements and blood sampling for biochemical analysis to evaluate their nutritional and immunological status. Serum immunoglobulins (IgA subclasses, IgG subclasses and IgM), complements (C3 and C4) and lymphocyte subpopulations (T cells, B cells, CD4⁺, CD8⁺, NK cells and HLADR) were determined for the assessment of humoral and cell-mediated immunity.

Results: Serum levels of IgA₁, IgA₂ and C4 tended to be higher in severely malnourished children than in normal children, while serum level of C3 and the proportion of B cells were significantly lower in the severely malnourished children than in the normal children (P<0.05). There were no notable differences in most immunological parameters among the three severely malnourished groups. No differences were observed in the immunological parameters except for the proportion of B cells between normal and moderately malnourished children. Factor analysis revealed that C3 levels were positively correlated with a factor which was strongly associated with weight-for-height z-score and biochemical indicators for evaluating protein nutrition. In addition, IgA₂, IgG₁ and IgM levels were positively correlated with a factor which was associated with C-reactive protein.

Conclusion: Several immunological variables responded positively or negatively with the different levels of severity of malnutrition, but most variables did not on the different types of malnutrition. The changes of C3 level were more associated with the severity of malnutrition.

malnutrition; immunoglobulin; complement; lymphocyte subpopulation; marasmus; kwashiorkor