The acute phase response to an infection is muted in severe protein-energy malnutrition in part of a process referred to as 'reductive adaptation,' whereby the structure and function of cells or tissues cannot be maintained due to the limited supply of energy resulting from decreased nutritional intake. Protein synthesis from amino acids is highly energy-dependent and proteins have a wide variety of structural and functional roles in the body, including the cytokines that initiate the acute phase reaction (IL-1, Il-6, tumor necrosis factor (TNF-a)). Severely malnourished individuals are therefore immunocompromised, in that they cannot produce an adequate immune response to infection. The generalized responses to infection such as fever and increased pulse, as well as localized responses such as inflammation and delayed cutaneous hyper-sensitivity, may also not manifest. Silent infections must therefore always be suspected and treated in severe malnutrition.
Table 1 Major infections: their effect on nutritional status and ways in which these infections may be modulated by nutrition
Nutritional modulation Infection Nutritional effects
Table 1 Major infections: their effect on nutritional status and ways in which these infections may be modulated by nutrition
Nutritional modulation Infection Nutritional effects
• |
Zinc: # incidence and morbidity |
Acute Respiratory |
• | |
• |
Ascorbic acid: may have protective effect |
infections (ARI) |
• |
Dysphagia |
(conflicting results) | ||||
• |
Vitamin A: # incidence of diarrhea |
Diarrheal diseases |
• |
Nutrient losses |
• |
Breast feeding: ^incidence of diarrhea |
• |
Intestinal damage and malabsorption | |
• |
Malnutrition ! # epithelial integrity and |
• |
Dehydration | |
" diarrhea |
• |
Electrolyte imbalance | ||
• |
Zinc: # duration and mortality |
• |
Nutrient deficiencies (e.g., vitamin A) | |
• |
Vitamin A: # morbidity and mortality in |
Human |
• |
Anorexia |
HIV + children |
immunodeficiency |
• |
Wasting syndrome | |
• |
# plasma selenium associated with " HIV |
virus (HIV) |
• |
When treated with HAARTb can lead to metabolic |
severity |
changes and lipodystrophy | |||
• |
Ascorbic acid: may # HIV viral load | |||
• |
Zinc supplementation ! conflicting results in | |||
HIV | ||||
• |
Vitamin A: in lactation may " MTCTa | |||
Intestinal parasites |
• |
Nutrient losses | ||
• |
Malabsorption | |||
• |
Anorexia | |||
• |
Anemia (in hookworm and Trichuris) | |||
• |
Impaired growth and weight loss | |||
• |
Vitamin A: # malaria-anemia |
Malaria |
• |
Anemia |
• |
Iron: # malaria-anemia but may " morbidity |
• |
" Protein metabolism | |
• |
Anorexia | |||
• |
Fever ! " energy needs | |||
• |
# Plasma retinol | |||
• |
Malaria in pregnancy ! low-birth-weight baby | |||
• |
Vitamin A: " measles specific Ab in response |
Measles |
• |
Anorexia |
to measles vaccination |
• |
Buccal mucosal lesions ! # intake | ||
• |
Vitamin A: # morbidity |
• |
" Catabolism ! growth faltering and weight loss | |
• |
# Plasma retinol | |||
Tuberculosis (TB) |
• | |||
• |
" Protein breakdown | |||
• |
Anorexia | |||
• |
Anemia |
aMTCT: mother to child transmission. bHAART: highly active anti-retroviral therapy.
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We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.