Malnutrition induces dissociated changes in lymphocyte count and subset proportion in patients with anorexia nervosa

OBJECTIVE: The effect of nutritional state on lymphocytes in patients with anorexia nervosa (AN) was studied. METHOD: We studied total lymphocyte count (TLC), lymphocyte subsets, and nutritional markers [body mass index (BMI), insulin-like growth factor-1 (IGF-I)], and serum zinc concentration) in 33 patients with AN and 10 healthy controls. RESULTS: TLC positively correlated with BMI (r = .680, p < .001), IGF-I (r = .609 p < .001), and zinc (r = .589, p < .001). The CD4+ T-lymphocyte (CD4) proportion correlated negatively with BMI (r = -.301, p = .05) and IGF-I (r = -.346, p = .023), counteracting the effect of malnutrition on TLC. However, because this increase in CD4 proportion was weak, patients with very severe malnutrition (indicated by serum zinc less than 40 microg/dL) had critically low CD4 counts of less than 200 cells/microL. CONCLUSION: Our findings suggest that lymphocyte counts and subset proportion change in an opposite manner in patients with AN, and that decrease in serum zinc levels is nutrition-related.