However, if persistent stress is present, such as infection, malnutrition or re-operations, the usual anti-inflammatory agents [s-TNF-R1, IL-4, IL-10, IL-1 receptor antagonist (IL-1Ra), transforming growth factor beta (TGF-β)] are dysregulated; thus, the compensatory anti-inflammatory immune response (CARS) may produce adverse effects [27]. This evidence concerns the gene TGFB1 and malnutrition.