Doctor Steve Abel

Severe Malnutrition and Reductive Adaptation

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

aMTCT: mother to child transmission. bHAART: highly active anti-retroviral therapy.

Breaking Bulimia

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.

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