Anthropometric Measures Of Nutritional Status Research Articles

Women's extreme seclusion during menstruation and children's health in Nepal.

There is limited empirical evidence from low-income countries on the effects of women's seclusion during menstruation on children's health. The objective of the current study was to examine the association between women's extreme seclusion during menstruation and their children's nutritional status and health in Nepal. Using nationally representative data from the 2019 Multiple Indicator Cluster Survey, we examined the relationship between mother's exposure to extreme forms of seclusion during menstruation and anthropometric measures of nutritional status and health outcomes among children ages 5-59 months (n = 6,301). We analyzed the data in a regression framework, controlling for potential confounders, including province fixed effects. We assessed extreme seclusion during menstruation based on women's exposure to chhaupadi, a practice in which women are forced to stay away from home-in separate huts or animal sheds-during menstruation and childbirth. Mothers' exposure to extreme seclusion during menstruation was associated with 0.18 standard deviation lower height-for-age z-scores (HAZ) (p = 0.046) and 0.20 standard deviation lower weight-for-age z-scores (WAZ) (p = 0.007) among children. Analysis by the place of seclusion showed that the negative association was stronger when women stayed in animal sheds-0.28 SD for HAZ (p = 0.007) and 0.32 SD for WAZ (p<0.001)-than when they stayed in separate huts. Extreme seclusion was associated with higher incidence of acute respiratory symptoms but not with incidence of diarrhea, irrespective of the place of seclusion. Women's extreme seclusion during menstruation in Nepal has profound implications on the physical health of their children. Additional research is needed to ascertain potential mechanisms.

Attributable is preventable: Corrected and revised estimates of population attributable fraction of TB related to undernutrition in 30 high TB burden countries

IntroductionThe Global TB Report 2020 estimated the population attributable fractions (PAF) for the major risk factors of TB. Undernourishment emerged as the leading risk factor accounting for 19% of the cases. The WHO however used the terms undernourishment and undernutrition interchangeably in its computation of PAF. Undernourishment is an indirect model derived estimate of decreased per capita energy availability, while undernutrition is defined by direct anthropometric measurements of nutritional status. An estimate of PAF for a risk factor should use the prevalence and the risk ratio of the same risk factor, which is not the case with the current methodology. MethodsWe re- estimated the PAF of undernutrition (instead of undernourishment) in 30 high TB burden countries as defined by WHO for the period 2016–2020, using the prevalence of undernutrition (age standardized estimate of BMI < 18.5 kg/m2 in adults for both sexes), and the relative risk (RR) of 3.2. Further, we revised PAF estimates of undernutrition with an RR of 4.49 (95% CI: 2.28, 8.86), in light of recent evidence. FindingsIn 30 high TB burden countries, 24.1% (95% CI: 17.6,30.0) of incident TB is attributable to undernutrition. The PAF of undernutrition was highest in Asian countries, unlike the PAF of undernourishment that was highest in Africa. The corrected estimate led up to 65% increase in number of cases attributable to undernutrition in Asian countries. If a revised relative risk was used, 33.0% (95% CI: 10.1, 60.1) of incident TB cases in the selected countries could be attributable to undernutrition. More than one-third to nearly half of incident TB cases in India could be attributable to undernutrition. InterpretationEstimation of the PAF of TB related to undernutrition is methodologically valid and operationally relevant, rather than PAF related to undernourishment, and should be used for future Global TB reports by WHO. Addressing undernutrition, the leading driver of TB in high TB burden countries (especially Asia) could enable achievement of END TB milestones of TB incidence for 2025.

Evaluation of the nutritional status of children under 5 years old from farmers, fishermen and fish farmers in the northern areas of the Republic of Congo

The objective of this study was to evaluate the nutritional status of children under 5 years old in the households of farmers, fishermen and fish farmers in the areas of Sangha, Cuvette, Cuvette-Ouest and Plateaux. The correlation between the nutritional status of the children and the main activities of the households was established by the anthropometric measurements of nutritional status from the weight/age/height indices. The results showed that the prevalence of the three types of malnutrition in children from 0 to 59 months were 9.8% for underweight, 19.2% for stunting and 8.9% for wasting. Nevertheless, they presented spatial variations in the studied areas. The malnutrition incidence was higher in girls in Cuvette, Cuvette-Ouest and Plateaux, compared to boys. In contrary to this, in Sangha the malnutrition incidence was detected higher in boys than in girls. The children of the households surveyed were victims of the three types of malnutrition. Overall, the main activity of the household surveyed had an influence on the nutritional status of the child. However, this influence varied according to the type of malnutrition.

Nutritional status, cognitive achievement, and educational attainment of children aged 8-11 in rural South India.

BackgroundMalnutrition among children is one of the most pressing health concerns middle- and low-income countries face today, particularly those in Sub-Saharan Africa and South Asia. Early-life malnutrition has been shown to affect long-term health and income. One hypothesized channel linking early-life malnutrition and long-term outcomes is cognitive development. However, there is limited empirical evidence on the relationship between nutritional status and cognitive achievement in middle childhood.Study designAs part of the South India Community Health Study (SICHS), we collected educational attainment and anthropometric data from 1,194 children in rural Vellore district of Tamil Nadu, India, and assessed their math and reading skills. We analyzed the relationship between continuous and binary anthropometric measures of nutritional status and three measures of cognitive achievement (reading, math, and grade level), adjusting for potential confounders, using a regression framework.ResultsLower height-for-age and weight-for-age and their corresponding binary measures (stunting, underweight) were associated with lower reading scores, lower math scores, and lower grade level, with the exception of the association between weight-for-age and reading, which was marginally significant. A stunted child had one-third of a grade disadvantage compared to a non-stunted counterpart, whereas an underweight child had one-fourth of a grade disadvantage compared to a non-underweight counterpart. Lower BMI-for-age was associated with grade level and marginally associated with lower math scores, and its binary measure (thinness) was marginally associated with lower math scores.ConclusionsAcute and chronic malnutrition in middle childhood were negatively associated with math scores, reading scores, and educational attainment. Our study provides new evidence that cognitive achievement during middle childhood could be an important mechanism underlying the association between early-life malnutrition and long-term wellbeing.

Structural Equation Modeling of the Effects of Family, Preschool, and Stunting on the Cognitive Development of School Children.

A recent study based on a sample of 1,580 children from five adjacent geographical locations in KwaZulu-Natal, South Africa, was carried out to examine the association of nutrition, family influence, preschool education, and disadvantages in geographical location with the cognitive development of school children. Data were collected on the children from 2009 to 2011 for this developmental study and included cognitive scores and information on the health and nutrition of the children. The current study analyzed the association of demographic variables (geographical location (site)), child variables (sex, preschool education and socioeconomic status), parental level of education (maternal and paternal), child’s health (HIV status and hemoglobin level) and anthropometric measures of nutritional status (height-for-age) with children’s cognitive outcomes. The hypothesis is that the nutritional status of children is a pathway through which the indirect effects of the variables of interest exert influence on their cognitive outcomes. Factor analysis based on principal components was used to create a variable based on the cognitive measures, correlations were used to examine the bivariate association between the variables of interest in the preliminary analysis and a path analysis was constructed, which was used for the disaggregation of the direct and indirect effects of the predictors for each cognitive test in a structural equation model. The results revealed that nutritional status directly predicts cognitive test scores and is a path through which other variables indirectly influence children’s cognitive outcome and development.

HOUSEHOLD NUCLEATION, DEPENDENCY AND CHILD HEALTH OUTCOMES IN GHANA.

This study uses three key anthropometric measures of nutritional status among children (stunting, wasting and underweight) to explore the dual effects of household composition and dependency on nutritional outcomes of under-five children in Ghana. The objective is to examine changes in household living arrangements of under-five children to explore the interaction of dependency and nucleation on child health outcomes. The concept of nucleation refers to the changing structure and composition of household living arrangements, from highly extended with its associated socioeconomic system of production and reproduction, social behaviour and values, towards single-family households - especially the nuclear family, containing a husband and wife and their children alone. A negative relationship between levels of dependency, as measured by the number of children in the household, and child health outcomes is premised on the grounds that high dependency depletes resources, both tangible and intangible, to the disadvantage of young children. Data were drawn from the last four rounds of the Ghana Demographic and Health Surveys (GDHSs), from 1993 to 2008, for the first objective - to explore changes in household composition. For the second objective, the study used data from the 2008 GDHS. The results show that, over time, households in Ghana have been changing towards nucleation. The main finding is that in households with the same number of dependent children, in nucleated households children under age 5 have better health outcomes compared with children under age 5 in non-nucleated households. The results also indicate that the effect of dependency on child health outcomes is mediated by household nucleation and wealth status and that, as such, high levels of dependency do not necessarily translate into negative health outcomes for children under age 5, based on anthropometric measures.

Examining short-term nutritional status among BaAka foragers in transitional economies.

Foragers in transitioning economies are at an increased risk of negative health outcomes as they undergo changes in subsistence patterns and diet. Here, we provide anthropometric data and examine the nutrition and health of adult BaAka foragers in relationship to declining wildlife and economic change in the Dzanga Sangha Protected Areas (APDS), Central African Republic. From June to August 2012, we collected biological data and dietary recall surveys from individuals in Mossapoula (MS) and Yandoumbé (YDBE) villages using standard anthropometric techniques and a single capillary blood finger prick. In our analysis, we identified variation in anthropometric measurements and hemoglobin levels by village (MS = 66, YDBE = 75) and gender (64 men, 77 women). Immigration, increased gun hunting and wildlife trades have reduced forager reliance on forest resources. These changes are evidenced in the marginal health of contemporary BaAka foragers of APDS. Although anthropometric measures of nutritional status do not significantly differ between communities, hemoglobin data highlight inequities in access to forest products between villages with different proximity to community hunting zones. Further, poor dietary diversity and low frequency of purchased foods in the diet indicate that the transition to a market economy has not been fully realized and diets are impoverished. Economic changes appear to have had the most impact at MS village, where forest use is most restricted and consumption of meat and forest products was reduced. This work highlights the nutritional and health needs of foragers in rapidly transitioning economies; especially those impacted by conservation management and zoning policies.

Infant and young child feeding practices and child undernutrition in Bangladesh: insights from nationally representative data

To determine the association between indicators of infant and young child feeding (IYCF) and anthropometric measures of nutritional status among children aged 0-23 months in a nationally representative data set. Data from the 2007 Bangladesh Demographic and Health Survey were used. Analyses were conducted using multiple linear regression and logistic regression analyses adjusted for the complex survey design of the survey, controlling for child, maternal and household characteristics, and including regional dummy variables. Bangladesh. Pairs (n 2096) of last born infants and their mothers. Exclusive breast-feeding under 6 months of age was associated with higher weight-for-height Z-score (effect size (ES) = 0·29; P < 0·05). Appropriate complementary feeding in children aged 6-8 months was associated with higher height-for-age Z-score (HAZ; ES = 0·63; P < 0·01) and higher weight-for-age Z-score (WAZ; ES = 0·30; P < 0·05). Higher dietary diversity index (DDI) was associated with higher HAZ (ES = 0·08; P < 0·01 for every 1 point higher DDI) and higher WAZ (ES = 0·04; P < 0·05). Children who achieved minimum diet diversity had higher HAZ (ES = 0·20; P < 0·05). Logistic regression models confirmed that exclusive breast-feeding was protective against wasting and DDI was protective against stunting and underweight. Our results highlight the importance of IYCF practices as determinants of child growth outcomes in this context, and reinforce the need for interventions that address the spectrum of IYCF practices, from exclusive breast-feeding to age-appropriate complementary feeding, especially diet diversity, in efforts to improve nutrition of infants and young children.

Anthropometric measurements of nutritional status in chronic pancreatitis in India: comparison of tropical and alcoholic pancreatitis

Undernutrition is considered to be a cause of tropical pancreatitis (TP) since this disease is commonly seen in the underprivileged populations of the world. This study was done to compare the nutritional status in patients with TP and alcoholic chronic pancreatitis (ACP) using anthropometric measurements. Anthropometric measurements were done in patients with TP and ACP aged >18 years and matched healthy controls. Presence of pain, recent dietary restriction, diabetes mellitus (DM), calcification, serum prealbumin (PAB), and quantitative fecal elastase (FE) was assessed. Premorbid body mass index (BMI) was determined from weight before the onset of illness as reported by the patients. Of 54 patients (47 male), 39 (72.2%) had TP and the rest had ACP. Patients with TP were younger than those with ACP; the frequency of pain, DM, calcification, and exocrine insufficiency was similar in the two groups. Compared to control subjects, patients had lower BMI, triceps skin fold thickness (TSFT) and mid-arm circumference (MAC) (p < 0.01), but waist-to-hip ratio (W/H) was similar. Undernutrition was equally common in TP and ACP (15 [38.5%] vs. 6 [40%]). The BMI, TSFT, MAC, and W/H were similar in TP and ACP. The premorbid BMI was higher than that at presentation (20.2 [3.8] kg/m² vs. 19.1 [3.3] kg/m², p < 0.01). There was no association between BMI and features contributing to undernutrition (DM, pain, recent dietary restriction, FE level, and calcification) on univariate analysis. Energy undernutrition occurs equally commonly in TP and ACP and this appears to develop after the onset of illness.

A lower body mass index is associated with cardiomyopathy in people with HIV infection: Evidence from a case comparison study

The cause of cardiomyopathy in patients infected with the human immunodeficiency virus (HIV) remains largely unknown, although a number of predisposing factors have been identified. Malnutrition has been postulated to be a contributory factor, but the association of anthropometric measures of nutritional status with HIV-associated cardiomyopathy has not been established. We investigated the association between anthropometric measures of nutritional status and cardiomyopathy in HIV-positive individuals in a cross-sectional case comparison study. Seventeen cases of HIV-associated cardiomyopathy and a comparison group of 18 HIV-positive individuals without cardiomyopathy were studied. There was no significant difference between the two groups in age, gender, CD4 cell count, HIV RNA viral load or World Health Organization (WHO) clinical stage of HIV disease. Patients with HIV-associated cardiomyopathy had evidence of undernutrition compared with HIV-infected people without cardiomyopathy, as evidenced by a significantly lower body mass index (BMI) (20.9 kg/m2 v. 27.0 kg/m2, p = 0.02), mid-upper arm circumference (26.2 cm v. 27.3 cm, p = 0.02), and bone-free arm muscle area (26.7 cm2 v. 32.8 cm2, p = 0.02). However, in a multivariate stepwise logistic regression model, a lower BMI was the only independent anthropometric risk factor for cardiomyopathy (odds ratio 0.76, 95% confidence interval 0.64 - 0.97, p = 0.02). A lower BMI is associated with cardiomyopathy in people who are living with HIV.

Effects of a school feeding intervention on school attendance rates among elementary schoolchildren in rural Kenya

Objective A randomized controlled school feeding intervention offered an opportunity to determine whether school feeding resulted in improved school attendance among elementary schoolchildren in a rural district of Kenya. Methods Twelve schools with a total of 554 children in the 1998 first-grade cohort were randomly assigned to four research groups, three of which received a fortified local staple-based snack (Githeri meal) at morning recess. The groups---designated as Meat-Githeri, Milk-Githeri, and Energy-Githeri---received a recess meal that provided 240 kcal in the first school year and 313 kcal for the remainder of study period. The intervention study covered the second school term of 1998 through the second school term of 2000. Assessment for all indexed children included baseline assessment of anthropometric measures of height-for-weight, weight-for-age, and height-for-age, and socioeconomic status at baseline, as well as daily school attendance for each of the school terms. Analysis included descriptive statistics, partial correlations statistics, regression analysis, χ 2, and General Linear Model (GLM) repeated measures analysis. In all the analyses, P < 0.05 was used as the criterion of statistical significance. Results Baseline regression analysis for the overall study sample population showed that age-dependent anthropometric measures of nutritional status were statistically significant predictors of school attendance rates. Partial correlation analysis evidenced a statistically significant positive association between baseline attendance rates and the measures of socioeconomic status and the age-dependent anthropometric measures. The intervention groups performed better than the control group on the repeated measure of school attendance.

Influence of helminth infections on childhood nutritional status in lowland Bolivia

Infectious disease, such as diarrheal disease, respiratory infections, and parasitic infections, are an important source of nutritional and energetic stress in many populations. Inspired by the research and methodological innovations of A. Roberto Frisancho, this work considers the impact of childhood environment and local disease ecology on child health and nutritional patterns among an indigenous group in lowland Bolivia. Specifically, we examine the association between soil-transmitted helminth infection, especially hookworm species, and anthropometric markers of short- and long-term nutritional status. Fecal samples, anthropometric dimensions, and health interviews were collected for 92 children ranging in age from 2.0 to 10.9 years. Microscopic examination revealed high levels of parasitic infection, with 76% of children positive for hookworm species infections (77% of girls and 74% of boys). Less common infections included Ascaris lumbricoides, Trichurius trichiura, and Strongyloides stercoralis with only 15% of children positive for multiple-species infections. After adjusting for sex and age, no statistically significant associations were observed between helminth infections and the frequency of reported illness or anthropometric measures of nutritional status. These data demonstrate the difficulty of assessing nutritional impacts of endemic infections.

Behavioral responsiveness and anthropometric measures of nutritional status in rural Ethiopian infants

Infants with nutritional deficiencies may exhibit aberrant responsiveness to their environments. This study examined relationships among anthropometrics and behavioral responsiveness in 96 infants in rural Ethiopia (mean age 9.5 mo). Weights and lengths of infants were converted to z‐scores using WHO software. Behavioral measures included activity level, interest, and emotional responses. Activity level proved to be most sensitive to variation in anthropometric measures and several sex differences were apparent, including males being shorter than females (p=.014). Males showed a significant correlation between length and the latency to move when placed in a supine or prone position (r= −.31; p=.05). Only about half of the infants were able to turn themselves over when placed on the ground. Males who did so showed a positive correlation between length for age z‐score and latency to turn over (r= +.44; p=.02); females showed a negative correlation (r= −.39; p=.06), though females were significantly faster. This suggests that nutritional deficiencies may affect responsiveness differently across genders. (Supported by NIH Grant R21 TW06729 (Fogarty International Center) &amp; the Office of Dietary Supplements).

Nigeria 1999: results from the Demographic and Health Survey.

With the technical assistance from ORC/Macro the National Population Commission in Abuja Nigeria conducted the Nigeria Demographic and Health Survey during March 29-May 29 1999. Data for the nationally representative population were gathered from 7647 households. Moreover complete interviews with 8199 women aged 15-49 and 2680 men aged 15-64 were conducted. This paper presents tables and graphs on the statistical results of the survey. It presents data on the general characteristics and percentage distribution of women surveyed according to educational level and residence. In addition the statistics on fertility fertility preferences contraceptive use contraception marital and contraceptive status postpartum variables infant mortality disease prevention and treatment and anthropometric measures of nutritional status are shown.

Hand grip dynamometry does not correlate with anthropometric measures of nutritional status in survivors of prolonged critical illness

Prolonged critical illness results in malnutrition and functional impairment. Impaired muscle function has several possible explanations in these patients such as reduced muscle mass, myopathy and neuropathy. There are no data regarding the relation between anthropometric measures and measures of muscle strength following critical illness. In other populations mid arm muscle circumference (MAMC, a measure of lean body mass) and muscle strength measured by hand grip dynamometry (HGD, a simple measure of muscle function) correlate. We have investigated the relation between anthropometric measures of nutritional status and muscle strength using HGD in patients attending our Intensive Care follow up clinic. Thirty patients who spent more than 4 days in Intensive Care (median stay 9.25 days (range 4.4–58.9)) were studied 3 months following ICU discharge. Height, weight, body mass index (BMI), triceps skinfold thickness (TSF), mid arm circumference (MAC) and MAMC were measured using standard anthropometric techniques. Pre-illness weight and BMI were determined retrospectively from patient records or recollection. HGD was measured with a single spring hand grip dynamometer. Quality of life was assessed using the SF-36 questionnaire. A total of 64% of patients had failed to regain the weight recorded prior to admission to ICU; 39% had a persistent weight loss of >10% (mean pre-illness BMI 24.3 (SEM 0.60), 3 month BMI 23.3 (0.51),P Our findings demonstrate marked loss of muscle mass and functional ability using established methods in about one third of patients 3 months following prolonged critical illness. However, unlike other populations MAMC did not correlate with HGD. This may be because (1) factors other than muscle mass contribute to functional impairment following critical illness such as neuropathy and myopathy (2) HGD is too insensitive or effort-dependent in this population. Evaluation of neuromuscular physiology should be included in studies of functional recovery from critical illness. More rigorous measures of functional ability are needed in order to understand and improve recovery from prolonged critical illness.

Validity of the minimum data set for assessing nutritional status in nursing home residents

The Minimum Data Set (MDS), a Health Care Financing Administration (HCFA)-mandated resident assessment system used in community nursing homes, is potentially useful for assessing nutritional status. We compared anthropometric measures of nutritional status available in the MDS [weight and body mass index (BMI)] with other anthropometric and bioelectrical measures of nutritional status, not available on the MDS. We also studied associations of MDS-measured clinical characteristics of nursing home residents with anthropometric and bioelectrical measures of lower and higher nutritional status, defined as measures in the 25th percentile and below, and 75th percentile and above, respectively. Data were from a sample of residents of an academic long-term care facility (n = 186, 75% female, mean age 89.9 +/- 5.6 y). Results were as follows: 1) MDS measures of weight and BMI were significantly correlated with all the anthropometric and bioelectrical measures of nutritional status in women, and most measures in men; 2) some MDS variables, including poor oral intake and advanced cognitive decline, were significantly associated with two or more anthropometric and bioelectrical measures of low nutritional status; and 3) complaints of hunger were significantly associated with two or more anthropometric and bioelectrical measures of high nutritional status. Results suggest that 1) weight and BMI, available in the MDS, are correlated with other measures of nutritional status not available, and 2) MDS clinical variables are associated with measures of low and high nutritional status, and may be useful in identifying patients at nutritional risk.

On the determinants of nutrition in Mozambique: The importance of age-specific effects

The literature indicates mixed results regarding the impact of income and other variables on the age and gender standardized height-for-age of children. This paper uses data from Maputo, Mozambique to show that the impact of household resources or health inputs may be masked if diverse age groups are aggregated. For example, increases in household incomes affect only the nutritional status of children two years of age and older. Conversely, for younger children, but not the older ones, mother's education is a significant determinant of anthropometric measures of nutritional status. This implies that education and efforts to improve childcare practices can be targeted to mothers of younger children, but that these children will not achieve improved linear growth from income-support programs, unlike older children.

Age and sex differences in the impact of seasonal energy stress among Andean agriculturalists

It has been widely argued that children and females are most severely affected during periods of food scarcity. This proposition is tested using dietary and anthropometric data from the Andean community of Nunoa, Peru. Contrary to expectation, children (ages 12 years and under) are relatively protected from seasonal food scarcity while adults experience severe caloric stress. Anthropometric measures of nutritional status corroborate the dietary analysis, indicating significantly better nutritional status in children. Sex differences in dietary adequacy are not evident. Adult males, however, have significantly poorer measures of nutritional status than adult females. These differences in dietary adequacy and nutritional status reflect adaptations to marked seasonality in work demands and energy availability.

Home environment, nutritional status, and maternal intelligence as determinants of intellectual development in rural Philippine preschool children

We investigated the relationship between home environment, nutritional status, and intellectual development in rural Philippine preschool children, using culture-relevant environment and intelligence scales and anthropometric measures of nutritional status. We found a moderate relationship between home environment and intellectual development. Intellectual malnourished range. Multiple regression analyses indicated that home environment variables provided more unique prediction of children's intelligence than did socioeconomic status (SES) and maternal intelligence, and that both the physical and psychosocial environment provided unique prediction. The relationship between home environment and intellectual development could not be accounted for entirely by maternal intelligence, a partial index of genetic influence. Results suggested the possibility of identifying environmental experiences related differentially to particular psychometric abilities (i.e., environmental specificity).

Effects of nutritional recuperation on E-rosetting lymphocytes and in vitro response to thymosin in malnourished children.

The percentage of peripheral blood lymphocytes forming rosettes with sheep erythrocytes (E-rosettes) was determined at admission to the INCAP Clinical Center in eight acutely malnourished Guatemalan children, and again after 14 and 28-30 days of nutritional therapy. While the mean percentage of E-rosettes increased during therapy, the change (from 35.6 +/- 10% to 43.3 +/- 19%) did not reach statistical significance because of the variable response of different subjects. At each time period, however, in vitro incubation with the thymic factor, thymosin fraction 5, significantly increased the percentage of E-rosetting lymphocytes. The presence of thymosin responsive cells in circulation after 1 month of optimal nutritional support indicates that immature T-lymphocytes can persist in circulation in patients with severe malnutrition, even after clinical improvement. Thus, neither the percentage of E-rosettes in peripheral blood nor their response to in vitro incubation with thymosin correlated with anthropometric measures of nutritional status in individual patients. This suggests that other nutritional or nonnutritional factors may be important modulating influences on T-lymphocytes, and that prospective studies with thymic factor administration are warranted.