Synergism between Malnutrition and Infection in Infants

Abstract

Nearly all infections have detectable adverse effects on the nutritional status of infants, and malnutrition increases the severity of infection. During the incubation period of an infection the negative nitrogen balance and increased utilization of amino acids occurs. After this the following infection responses affect the nutritional status: 1) fever and sweating cause energy loss, and loss of fluid, electrolytes, and amino acids, resulting in loss of body weight; 2) anorexia, nausea, and vomiting cause a reduction in food intake; 3) lower calorie foods are consumed during this time; 4) there is reduced nutrient absorption caused by the direct effects of bacterial toxins and the presence of intestinal parasites; and 5) infection triggers catabolism, wasting of muscle, and weight loss. During the convalescent period megaloblastic anemia from fish tapeworm becomes more severe, and the diet should correct the negative nitrogen balance sustained during the active phase. The period of accelerated growth rate during recuperation may be disrupted when there are additional episodes of acute infection, resulting in impairment of physical growth and development. Protein-calorie malnutrition can cause marasmus, and acute protein loss can cause kwashiorkor, characterized by edema, skin lesions, hair changes, apathy, anorexia, and enlarged liver. Septicemia is also a frequent complication. It has also been shown that children with kwashiorkor are unable to develop normal inflammatory response, and that there is slower antibody response to stimulus; malnourished infants and children also do not show any interference of phagocytic function. Chemotaxis and engulfment also have decreased complement values which accounts in part for the increase in susceptibility to and severity of infection.