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The effect of nutritional state on lymphocytes in patients with anorexia nervosa (AN) was studied.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.TLC positively correlated with BMI (r = .680, p<.001), IGF-I (r = .609 p<.001), and zinc (r = .589, p<.001). The CD41 T-lymphocyte (CD4) proportion correlated negatively with BMI (r = –.301, p = .05) and IGF-I (r = 2.346, 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 μg/dL) had critically low CD4 counts of less than 200 cells/μL.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. © 2007 by Wiley Periodicals, Inc.