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Although several hundred publications discussed delayed cutaneous hypersensitivity testing and nutritional status, only 15 provided new, objective data correlating these variables in hospitalized adults. Of these, only three provided age\u2010matched control groups to control for antigen variability, lack of prior exposure, and other technical problems. The majority of reports took no account of diseases (cancer, immune disease, infection) or therapies (radiation, drugs, surgery) known to affect skin test response. In the reports specifying different degrees of malnutrition, the most important group, those with less than obvious malnutrition, were not abnormal by skin testing. Ten reports described serial skin testing during nutritional intervention. None reported serially tested controls without nutritional intervention, important since serial testing alone can augment skin test response. Nonnutritional intercurrent therapy which might affect skin tests was seldom mentioned. In the few reports specifying that nutritional repletion was even achieved, repleted patients were not separated from unrepleted in subsequent analyses. No report examined skin testing for its predictive accuracy, cost\/benefit ratio, or influence on outcome. Because of these problems in experimental design, the frequent lack of appropriate controls, and the low specificity of abnormal delayed cutaneous hypersensitivity responses, we conclude that the utility of skin testing in nutritional assessment remains unproved.<\/jats:p>","DOI":"10.1177\/014860718200600150","type":"journal-article","created":{"date-parts":[[2008,5,14]],"date-time":"2008-05-14T19:51:26Z","timestamp":1210794686000},"page":"50-58","source":"Crossref","is-referenced-by-count":76,"title":["Utility of Skin Testing in Nutritional Assessment: A Critical Review"],"prefix":"10.1002","volume":"6","author":[{"given":"Patrick","family":"Twomey","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Ziegler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Rombeau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[1982,1]]},"reference":[{"key":"e_1_2_1_2_1","volume-title":"Malnutrition and the Immune Response","author":"Suskind RM","year":"1977"},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-79-4-545"},{"key":"e_1_2_1_4_1","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1093\/ajcn\/28.10.1148","article-title":"Cellular immunity in semistarved states in hospitalized adults","volume":"28","author":"Bistrian BR","year":"1975","journal-title":"Am J Clin Nutr"},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197607000-00010"},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197509000-00004"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1977.03630220050013"},{"key":"e_1_2_1_8_1","first-page":"332","article-title":"The relationship between immune competence and nutrition","volume":"27","author":"Spanier AH","year":"1976","journal-title":"Surg Forum"},{"key":"e_1_2_1_9_1","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/S0022-5223(19)39884-8","article-title":"Nutritional support in cardiac cachexia","volume":"73","author":"Blackburn GL","year":"1977","journal-title":"J Thorac Cardiovasc Surg"},{"key":"e_1_2_1_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197903)43:3<925::AID-CNCR2820430321>3.0.CO;2-5"},{"key":"e_1_2_1_11_1","first-page":"475","article-title":"Nutritional status and the nonspecific cellular and humoral immune response in esophageal carcinoma","volume":"189","author":"Haffejee AA","year":"1979","journal-title":"Ann Surg"},{"key":"e_1_2_1_12_1","first-page":"115","article-title":"Influence of cancer on host defense and susceptibility to infection","volume":"30","author":"Meakins JL","year":"1979","journal-title":"Surg Forum"},{"key":"e_1_2_1_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(75)91490-7"},{"key":"e_1_2_1_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02468842"},{"key":"e_1_2_1_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197905)43:5 <2108::AID-CNCR2820430720>3.0.CO;2-6"},{"key":"e_1_2_1_16_1","first-page":"138","article-title":"Hyperalimentation and immune competence in cancer","volume":"26","author":"Copeland EM","year":"1976","journal-title":"Surg Forum"},{"key":"e_1_2_1_17_1","first-page":"242","article-title":"The influence of catabolism on immunocompetence in burned patients","volume":"86","author":"Hiebert JM","year":"1979","journal-title":"Surgery"},{"key":"e_1_2_1_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/014860717700100101"},{"key":"e_1_2_1_19_1","first-page":"292","article-title":"Anergy: is nutritional reversal possible\/outcome significant","volume":"3","author":"Willcutts HD","year":"1979","journal-title":"JPEN"},{"key":"e_1_2_1_20_1","first-page":"349","article-title":"The delayed hypersensitivity response: application in clinical surgery","volume":"82","author":"Pietsch JB","year":"1977","journal-title":"Surgery"},{"key":"e_1_2_1_21_1","first-page":"45","article-title":"Nutritional assessment\u2010diagnosis of malnutrition and selection of therapy","volume":"8","author":"Kaminski MV Jr.","year":"1979","journal-title":"J Surg Prac"},{"key":"e_1_2_1_22_1","first-page":"83","article-title":"Malnutrition: a poorly understood surgical risk factor in aged cardiac patients","volume":"32","author":"Harken DE","year":"1977","journal-title":"Geriatrics"},{"key":"e_1_2_1_23_1","first-page":"40","article-title":"Nutritional aspects of cancer","volume":"22","author":"Copeland EM","year":"1976","journal-title":"Chicago. 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