Relationships between undernutrition,infection, and growth and development

Interactions between undernutrition, infection, and growth and development are complex, and are reviewed in this article. Anthropometry is a common means of nutritional assessment, but the relationship between food availability and anthropometric status is at best very loose, at least at the national level. This suggests that anthropometric assessment is less a measure of nutritional status than of the totality of environmental factors that influence growth, including infectious disease. The effects of diet, nutrition and infection on the nutritional status of a child can vary according to the disease ecology, the age of the child, patterns of feeding and types of food consumed. There are two possible ways in which this relationship can begin; one in which poor nutritional status leads to impaired immunocompetence and reduced resistance to infection, and the other in which exposure to infectious disease can lead to appetite loss and anorexia, malabsorption, and elevated metabolism of energy and other nutrients. Once started, the interactions between these two major environmental stressors becomes increasingly complex, with the nature of the disease ecology influencing the balance of immunoparesis and adaptive immunity its effect on subsequent disease experience, and the extent, if any, of anorexia, fever, and malabsorption during infectious episodes which has an impact on nutritional status. Specific nutritional deficiencies can subsequently influence immune status and responsiveness, and adaptive immunity. In addition, cultural factors can influence patterns of disease management and sickness behaviour, which can in turn affect the incidence, severity and duration of infection, and their effects on nutritional status, while deficiencies of vitamins and trace elements can have major effects on immune responsiveness.     

Growth of nomadic and settled Turkana infants of northwest Kenya

Turkana tribespeople reside in a semi-arid savanna ecosystem in northwest Kenya. For over a decade, Ngisonyoka Turkana nomads have been studied within a multidisciplinary framework that embraces ecology, anthropology, and human population biology. Original research objectives of the South Turkana Ecosystem Project were to study nomads longitudinally and within the context of the dry savanna ecosystem. These objectives have been expanded to incorporate settled Turkana who were nomads in the recent past, but who, for a variety of reasons, have taken up a life of sedentary cultivation. The research described here focused on comparisons of growth patterns of nomadic and settled infants from birth to 24 months of age. Infants were measured (recumbent length, weight, head circumference, arm and calf circumference, and selected skinfolds) in 1989 and 1990. Settled infants were slightly longer, but nomadic infants were heavier and fatter. Head circumferences were the same. Some variation was observed by season and year of measurement (from comparative surveys). Both groups showed pronounced weight faltering after 6 months of age when compared with U. S. NCHS reference values. Head circumference faltering was moderate and recumbent length faltering was only slight after 12 months of age. Comparisons of Turkana infant growth in the two populations can contribute indirectly to a better understanding of infant nutritional status, probable morbidity, and other factors, some of which may be linked to female reproduction. © 1993 Wiley-Liss, Inc.     

Nutritional status and physical work capacity

The functional consequences of nutritional intake and resulting nutritional status are reviewed in terms of maximal oxygen consumption, physical work capacity, heart rate response to exercise, work productivity, and endurance at submaximal work loads. The results of both acute “laboratory” and chronic “naturally occurring” malnutrition are considered as well as the effects of dietary supplementation and recovery from previously existing undernutrition. Obesity and anemia are also treated as separate but related nutritional entities.     

Childhood malnutrition and growth in a rural area of Western Kenya

An anthropometric survey was carried out on 1,383 school students aged 5-17 years in Suba district (a rural area of western Kenya). Body size and proportion were computed from height, weight, sitting height, arm circumference, and skinfolds. The aim of the study was to evaluate patterns of growth and nutritional status of the Luo population by assessment of the prevalence and trends of malnutrition among children and adolescents. Very few age-groups show significant sex differences for height, body weight, and arm muscle area. However, there are several differences in skinfold thicknesses and arm circumference, always with higher mean values in girls. Analysis of the nutritional status (weight-for-age, height-for-age, and BMI-for-age) shows significant differences among the age-groups in both sexes. Boys present lower Z-scores than girls and there are higher percentages of malnourished subjects (stunted and underweight) among the males. The Luo data were compared with those of other African populations. Their body dimensions, nutritional status, and growth are similar to those of the other sub-Saharan samples. In conclusion, the Luo children are generally undernourished at the older ages: adolescents (11-16 years of age) show the most severe undernutrition and the highest percentages of undernourished subjects. In addition to the higher risk of undernutrition in teenagers, an emerging problem of over-nutrition is evident among the younger age-groups, with a higher prevalence in females. These findings are discussed in light of sexual dimorphism in sensitivity to adverse environmental conditions.     

Behavioral, environmental, metabolic and intergenerational components of early life undernutrition leading to later obesity in developing nations and in minority groups in the U.S.A

Nutritional transition, urbanization, and physical inactivity are primary factors responsible for the worldwide epidemic of overweight/obesity (OW/OB). However, these factors fail to explain the epidemic of OW/OB in developing countries and in recent-migrants to developed countries. Among these, OW/OB is associated with short/stunted stature and coexists with undernutrition at much higher rates than is statistically expected. Changes in metabolic pathways toward reduced fat oxidation and increased metabolism of carbohydrate may explain, in part, this phenomenon. Also, intergenerational consequences of malnutrition and poor health of the mothers may lead to impaired phenotypes in their offspring. We propose a novel methodology to assess the history of early life malnutrition by assessing the sitting height ratio of the mothers. The degree of "short leggedness" reflects undernutrition when the mother was an infant/child. Collectively, behavioral, environmental, metabolic and intergenerational components of early life undernutrition may provide a more satisfactory explanation for later life obesity.     

Resultados de la aplicación de un protocolo de valoración nutricional en un centro sociosanitario

The aim of this study was to determine nutritional status in 83 residents of a nursing home and to evaluate outcomes after the application of a nutritional assessment protocol designed by the Department of Social Welfare of the autonomous community of Valencia (Spain).The sample was classified according to body mass index (BMI), hypoalbuminemia and application of the geriatric nutritional risk index. Nutritional interventions consisted of applying general recommendations and follow-up in residents without malnutrition, providing adequate powdered diets in residents with chewing and swallowing disorders and risk of bronchoaspiration, adjusting total enteral nutrition in residents with nasogastric feeding tubes and initiating vitamin supplementation in residents with severe malnutrition.After 3 months, the mean BMI showed a nonsignificant increase (P=.168), reducing the number of residents with malnutrition from 29% to 23%. The number of residents who received nutritional supplements without indication also decreased, resulting in an estimated saving of 965 euros. Active participation of the multidisciplinary team in the coordinated and continuous follow-up of nutritional status in residents contributed to achieving adequate nutritional status and improved the rational use of artificial nutrition in the nursing home.     

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India.

INTRODUCTION: In India, approximately 20 percent of children under the age of four suffer from severe malnutrition, while half of all the children suffer from undernutrition. The contributions of knowledge and attitudes of nutrition-conscious behaviors of the mothers to childhood malnutrition has been unclear. The purpose of this study was to explore maternal knowledge of the causes of malnutrition, health-care-seeking attitudes and socioeconomic risk factors in relation to children''s nutritional status in rural south India. METHODS: A case-controlled study was conducted in a rural area in Tamil Nadu, India. Thirty-four cases and 34 controls were selected from the population of approximately 97,000 by using the local hospital''s list of young children. A case was defined as a mother of a severely malnourished child under four years of age. Severe malnutrition was defined as having less than 60 percent of expected median weight-for-age. A control had a well-nourished child and was matched by the location and the age of the child. Interviews obtained: (1) socioeconomic information on the family, (2) knowledge of the cause of malnutrition and (3) health-care-seeking attitudes for common childhood illnesses, including malnutrition. RESULTS: Poor nutritional status was associated with socioeconomic variables such as sex of the child and father''s occupation. Female gender (OR = 3.44, p = .02) and father''s occupation as a laborer (OR = 2.98, p = .05) were significant risk factors for severe malnutrition. The two groups showed a significant difference in nutrition-related knowledge of mild mixed malnutrition (OR = 2.62, p = .05). No significant difference was apparent in health-care-seeking attitudes. Based on their traditional beliefs, the mothers did not believe that medical care was an appropriate intervention for childhood illnesses such as malnutrition or measles. DISCUSSION: The results suggested that the gender of the child and socioeconomic factors were stronger risk factors for malnutrition than health-care availability and health-care-seeking attitudes. The father''s occupation was a more accurate indicator for malnutrition than household income. These results suggest a need for intensive nutritional programs targeted toward poor female children and their mothers.     

Infant and juvenile growth in ancestral Pueblo Indians

The present study examines patterns of infant and juvenile growth in a diachronic sample of ancestral Pueblo Indians (AD 1300-1680) from the American Southwest. An assessment of growth patterns is accompanied by an evaluation of pathological conditions often considered to be indicators of nutritional deficiencies and/or gastrointestinal infections. Growth patterns and the distribution of pathological conditions are interpreted relative to culturally relevant age categories defined by Puebloan rites of passage described in the ethnographic literature. A visual comparison of growth distance curves revealed that relative to a modern comparative group our sample of ancestral Pueblo infant and juveniles exhibited faltering growth beginning soon after birth to about 5 years of age. A comparison of curves describing growth relative to adult femoral length, however, indicated reduced growth occurring later, by around 2 years of age. Similar to previous studies, we observed a high proportion of nonsurvivors exhibiting porotic cranial lesions during the first 2 years of life. Contrary to expectations, infants and juveniles without evidence of porotic cranial lesions exhibited a higher degree of stunting. Our study is generally consistent with previous research reporting poor health and high mortality for ancestral Pueblo Indian infants and juveniles. Through use of a culturally relevant context defining childhood, we argue that the observed poor health and high mortality in our sample occur before the important transition from young to older child and the concomitant initial incorporation into tribal ritual organization.     

Growth and nutritional status of male adolescent laborers in Ankara, Turkey

Undernutrition, pathogenic agents, and poor living conditions are of primary importance in the evaluation of adverse environmental conditions' effects on human growth; but child labor (an equally significant factor, especially in underdeveloped countries) is generally overlooked or ignored. The aim of this study is to focus on this subject and clarify the effects of labor on the physical growth and nutritional status of child and adolescent laborers. In this study, the height and weight of 532 male adolescent laborers aged 13.5-18.5 years and their non-laboring peers (n = 451) (the control group) were measured by standard anthropometric techniques and equipment. The individuals of both groups come from lower socioeconomic strata and share similar living conditions. Data were transformed to z-scores, using the US Center for Disease Control and Prevention's 2000 growth charts. The analyses show that the z-scores for height-for-age, weight-for-age, and body mass index (BMI)-for-age were negative in both groups. The z-scores of laborers' height-for-age and weight-for-age values lie below the controls', but there is no significant difference between the two groups' BMI-for-age scores. In the laboring group, the percentages of stunting (-2 SD of height-for-age), underweight (-2 SD of weight-for-age), and wasting (-2 SD of BMI-for-age) were 14.3, 2.6, and 0.2, respectively. These values suggest that malnutrition is not a common problem among adolescent laborers living in Ankara; but laboring is an important cause of faltering in growth, particularly in linear growth, in less or underdeveloped economic environments.     

Ethnic expansions and between-group differences in children's health: a case study from the Rukwa Valley, Tanzania

The Sukuma ethnic group appears to be expanding across Tanzania at a rate far greater than other ethnic groups in the area. In this paper, the household-level dynamics that may be fueling this expansion are explored by comparing measures of infant mortality and child health with another Tanzanian ethnic group, the Pimbwe. Consistent with expectations, the Sukuma appear to have comparable levels of fertility but lower child mortality. As predicted, compared to the Pimbwe, Sukuma children are also heavier and taller for their age, suggesting better nutritional status. Four hypotheses about why the Sukuma are so successful in this area are addressed. Surprisingly, the results show that household food security and wealth are not related to children's nutritional status, nor can maternal effects account for the observed health differences. Several lines of evidence suggest that different patterns of infant feeding practices may underlie the differences in children's nutritional status.     

Three‐dimensional analysis of sexual dimorphism in human thoracic vertebrae: Implications for the respiratory system and spine morphology

Research suggests that nonmaternal caregivers (allomothers) offer essential assistance through caregiving and provisioning, helping to support lengthy child development. Here, we examine the role of allomothers and the broader social and sharing network on Aka forager children's anthropometrics. We hypothesize that nonmaternal investors strategically target their assistance when it is most needed and when it will have the greatest effect. We evaluate children's nutritional status using WHO standards [weight‐for‐age (WAZ), height‐for‐age (HAZ), and weight‐for‐height (WHZ)] during four periods of child development [early infancy (birth to <9 months), mobility to weaning (9 to <36 months), early childhood (36 to <72 months), and middle childhood (72 to <120 months); N = 127]. We explore the effects of allomothers and the social network across these different risk periods and examine whether the broader social network buffers the loss of a primary allomother. ANOVA results suggest that girls may be experiencing some growth faltering, while boys start smaller and remain small across these stages. We used OLS multiple regression models to evaluate the effects of sex, camp composition, risk periods, and allomothers' presence on WAZ, HAZ, and WHZ. Grandmothers are the most influential allomother, with their effect most evident during the 9 to <36 month period. Camp size was also associated with greater WAZ, suggesting that children residing in small camps may be disadvantaged. Our findings also indicate that, under specific residence patterns, cooperative child rearing networks buffer the loss of a grandmother. Overall, our results suggest the importance of social networks to children's nutritional status and that individuals target investment to critical phases. Am J Phys Anthropol 153:513–525, 2014. © 2014 Wiley Periodicals, Inc.     

Effect of Short-Term Supplementation with Ready-to-Use Therapeutic Food or Micronutrients for Children after Illness for Prevention of Malnutrition: A Randomised Controlled Trial in Nigeria

Background

Globally, Médecins Sans Frontières (MSF) treats more than 300,000 severely malnourished children annually. Malnutrition is not only caused by lack of food and poor infant and child feeding practices but also by illnesses. Breaking the vicious cycle of illness and malnutrition by providing ill children with nutritional supplementation is a potentially powerful strategy for preventing malnutrition that has not been adequately investigated. Therefore, MSF investigated whether incidence of malnutrition among ill children <5 y old could be reduced by providing a fortified food product or micronutrients during their 2-wk convalescence period. Two trials, one in Nigeria and one in Uganda, were conducted; here we report on the trial that took place in Goronyo, a rural region of northwest Nigeria with high morbidity and malnutrition rates.

Methods and Findings

We investigated the effect of supplementation with ready-to-use therapeutic food (RUTF) and a micronutrient powder (MNP) on the incidence of malnutrition in ill children presenting at an outpatient clinic in Goronyo during February to September 2012. A three-armed, partially-blinded, randomised controlled trial was conducted in children diagnosed as having malaria, diarrhoea, or lower respiratory tract infection. Children aged 6 to 59 mo were randomised to one of three arms: one sachet/d of RUTF; two sachets/d of micronutrients or no supplement (control) for 14 d for each illness over 6 mo. The primary outcome was the incidence of first negative nutritional outcome (NNO) during the 6 mo follow-up. NNO was a study-specific measure used to indicate occurrence of malnutrition; it was defined as low weight-for-height z-score (<−2 for non-malnourished and <−3 for moderately malnourished children), mid-upper arm circumference <115 mm, or oedema, whichever came first.Of the 2,213 randomised participants, 50.0% were female and the mean age was 20.2 (standard deviation 11.2) months; 160 (7.2%) were lost to follow-up, 54 (2.4%) were admitted to hospital, and 29 (1.3%) died. The incidence rates of NNO for the RUTF, MNP, and control groups were 0.522 (95% confidence interval (95% CI), 0.442–0.617), 0.495 (0.415–0.589), and 0.566 (0.479–0.668) first events/y, respectively. The incidence rate ratio was 0.92 (95% CI, 0.74–1.15; p = 0.471) for RUTF versus control; 0.87 (0.70–1.10; p = 0.242) for MNP versus control and 1.06 (0.84–1.33, p = 0.642) for RUTF versus MNP. A subgroup analysis showed no interaction nor confounding, nor a different effectiveness of supplementation, among children who were moderately malnourished compared with non-malnourished at enrollment. The average number of study illnesses for the RUTF, MNP, and control groups were 4.2 (95% CI, 4.0–4.3), 3.4 (3.2–3.6), and 3.6 (3.4–3.7). The proportion of children who died in the RUTF, MNP, and control groups were 0.8% (95% CI, 0.3–1.8), 1.8% (1.0–3.3), and 1.4% (0.7–2.8).

Conclusions

A 2-wk supplementation with RUTF or MNP to ill children as part of routine primary medical care did not reduce the incidence of malnutrition. The lack of effect in Goronyo may be due to a high frequency of morbidity, which probably further affects a child’s nutritional status and children’s ability to escape from the illness–malnutrition cycle. The duration of the supplementation may have been too short or the doses of the supplements may have been too low to mitigate the effects of high morbidity and pre-existing malnutrition. An integrated approach combining prevention and treatment of diseases and treatment of moderate malnutrition, rather than prevention of malnutrition by nutritional supplementation alone, might be more effective in reducing the incidence of acute malnutrition in ill children.

Trial Registration

clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01154803","term_id":"NCT01154803"}}NCT01154803     

Dissociation of immune capacity from nutritional status by triiodothyronine supplements in severe protein deficiency

Weanling mice were fed ad libitum from age 23 to 37 days either an 18 or an 0.6% protein diet. Half the animals in each dietary group received supplemental triiodothyronine (T3, 0.2 mg/kg diet). T3 increased the primary in vivo antibody response of protein-deficient mice to sheep red blood cells, as measured by both splenic plaque-forming cells (PFC) per 10(6) nucleated spleen cells and serum hemagglutinin titers. T3 also increased PFC/spleen in well-nourished mice. The effect on protein-deficient animals was achieved although nutritional status in these animals, as estimated by weight loss and carcass composition, was further impaired by T3 supplementation. These results support the hypothesis that immune functions can be improved independently of nutritional status in severe (wasting) malnutrition. Insofar as T3 was effective in a model of malnutrition that does not reduce serum total or free T3 levels, the phenomenon appears to represent a pharmacological action of the hormone.     

Environmental temperature and human growth in early life

A link between adult human body size and environmental temperature, evolved through adaptation to heat stress, was first recognized a century ago and is now well accepted in human biology. Increasing heat stress favours smaller body size and an increased ratio of surface area to mass. However, possible effects of temperature on growth in early life have not been considered. Many developing country populations inhabit relatively hot environments compared to industrialized populations, but growth faltering in developing countries is invariably attributed to the combination of poor nutrition and infection. The aim of this study was to model the theoretical effect of growth faltering on cooling capacity in early life. Data on weight, length and total energy expenditure were selected from the literature. Three types of growth (normal growth, stunting and wasting) were considered, and the relationship between body size and heat production investigated. Relative to normal growth, stunting causes little increase in the area-to-mass ratio until 2 years of age, and results in little increase in cooling capacity during infancy. Wasting increases the area-to-mass ratio by > 15% in early infancy, and by 10% thereafter, equivalent to a similar increase in cooling capacity. These findings demonstrate theoretically that growth faltering can relieve heat stress in both infancy and childhood. The hypothesis that heat stress plays a role in human growth faltering in hot environments therefore merits empirical investigation.     

Physical growth and nutritional status of Tsimane' Amerindian children of lowland Bolivia

This study examines patterns of growth and nutritional status of indigenous Tsimane' children under 9 years of age (n = 199 boys and 210 girls), based on a cross-sectional sample from 58 villages from the Beni Deparment of lowland Bolivia. Compared with US children, Tsimane' children are quite short, with linear growth tracking at or below the US 5th centile in both sexes. The prevalence of low height-for-age ("stunting;" HA Z-scores 相似文献   

Contextual risk factors for maternal malnutrition in a food-insecure zone in southern Ethiopia

This study examined the nutritional status of mothers in one of the most populous food-insecure zones in southern Ethiopia, the Sidama zone. The study used primary data collected from 1094 households with a child under 24 months located in ten kebeles (the smallest administrative district). Households were selected using multi-stage probability sampling techniques. The mothers' nutritional status was estimated using both body mass index (BMI) and mid-upper-arm circumference (MUAC). The results from the BMI analysis revealed that 28.1% of the women were malnourished (BMI <18.5) and 67.5% were normal (BMI 18.5 to <25.0), while the remaining small proportion (4.5%) fell in the overweight or obese categories. Similarly, the computation of maternal nutritional status by MUAC analysis showed that 31.4% of the women were malnourished (MUAC <22). Further analysis of the main predictors of maternal malnutrition using logistic regression showed that three individual-level variables and three household-level variables predicted maternal malnutrition: woman's age, duration of breast-feeding, literacy status, marital form, land size and intra-household food distribution. The study concludes that maternal malnutrition is a serious problem in the study area and that there are contextual risk factors that could be addressed to partially tackle the problem.     

Nutrition and immune responses

Clinical and epidemiologic data suggest a causal relationship between nutritional deficiency and infection. Among other factors, impaired immune responses secondary to malnutrition increase susceptibility to infectious illness. Protein-energy undernutrition and deficiencies of iron, zinc, pyridoxine, and other nutrients depress a variety of immunity functions. Cell-mediated immunity, complement system, microbicidal activity of phagocytes, secretory antibody response, and antibody affinity are often decreased. Recent studies have revealed many metabolic and hormone alterations as well as changes in the number and function of lymphocyte subpopulations. Obesity also is associated with impaired cellular immune functions. Dietary factors may play a critical role in host resistance to disease.     

Maternal nutrition in pregnancy. Part II: the implications of previous gastrointestinal operations and bowel disorders.

Pregnant patients who have undergone a gastrointestinal operation for morbid obesity or who have active inflammatory bowel disease or hyperemesis gravidarum run a risk of undernutrition or even severe malnutrition with an increased risk of spontaneous abortion or fetal damage. This article reviews the medical and nutritional management of these gastrointestinal conditions.     

Effects of protein malnutrition and ascorbic acid levels on drug metabolism

The duration of action of drugs (or other environmental chemicals) is dependent on their rate of metabolic deactivation and elimination from the body. Termination of activity is achieved either through excretion of the drug via the kidney and bile or, more commonly, through metabolic deactivation by enzymes of the liver and other tissues. In recent years, it has become increasingly obvious that nutritional status is one of the major factors capable of modifying the pharmacological effect of drugs. Numerous studies have indicated that the process of drug metabolism may be affected by acute starvation, undernutrition, protein nutrition, and deficiencies of minerals, vitamins, and lipids. Although most of the evidence concerning the effects of nutrition on the metabolism of drugs has been derived from studies on experimental animals, there is significant fragmentary human data to show that the same effects may occur in man. This paper will discuss the influence of nutritional status with particular references to protein and ascorbic acid on the metabolism of foreign compounds including drugs. The interrelationships of nutrition and the metabolism of drugs are an important consideration in view of the widespread recurrence of primary malnutrition in the developing countries, and of secondary malnutrition in more affluent societies, especially in debilitated chronically ill patients, in postoperative patients, and in those whose dietary manipulations are carried out in weight-reducing regimens. The effects of nutrition on drug metabolism may be viewed as an extension of the search for one of the environmental factors that modify drug action.     

Effect of undernutrition on deciduous tooth emergence among Rajput children of Shimla District of Himachal Pradesh, India

This article examines the influence of nutritional status on the emergence of deciduous dentition in a cross-sectional sample of 510 rural Rajput children from the Jubbal and Kotkhai Tehsils, Shimla District, Himachal Pradesh, India. The nutritional status of each child was evaluated using Z-scores of height/supine length-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). The effects of sex and side on deciduous dental emergence were not statistically significant. Partial correlation indicates that the number of emerged teeth (T) was more strongly correlated with height than with other anthropometric variables. In most age groups, the stunted boys and girls (HAZ <-2) had fewer emerged teeth than nonstunted age peers (HAZ >-2). The mean T in underweight children was also less than that of the normal children, with a few exceptions. The stunted children have a significantly greater likelihood of delayed emergence of deciduous dentition. Measures of linear growth status are more closely related to dental development than measures of growth in mass. The findings indicate that even moderate undernutrition can delay deciduous tooth emergence.