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Interaction of nutrition and infection: a factor important to African development.

The combination of malnutrition and infection is the leading cause of morbidity and mortality in developing countries and among the poorer populations of the developed nations. Because of their physiologic state and increased nutritional requirements the most vulnerable to malnutrition and infection are the pregnant and lactating woman the developing fetus the young child and the adolescent particularly if pregnant. Focus in this discussion of the interaction of nutrition and infection is on how infections affect nutritional status how the malnourished person handles infection common examples of the interaction of nutrition and infection (measles "weanling diarrhea" parasitic infestations and malnutrition and tuberculosis); and practical implications for African development. A synergistic relationship between nutrition and infection has been well established in animal studies and in well controlled human field studies. Infections have an adverse effect on nutritional status and malnutrition adversely affects the ability of the host to withstand infection. Antagonism to infection particularly to viral infection in animals can occur when a nutrient deficiency or metabolic disturbance produced by a deficiency has a greater effect on the agent than on the host. In humans deficiencies severe enough to cause antagonism frequently result in an overall decreased resistance to infection. All infections have a nutritional cost to the host. The obvious effects of infections are through the symptoms they cause. Possibly most dangerous is the rise in nitrogen loss from the body that occurs even with mild infections and even with live virus immunizations. Among the bodys mechanical barriers against infection whose integrity depends on good nutritional status are the connective tissue the mucosal surfaces of gums and oral cavity and the epithelial coverings of the eye respiratory tree and gastrointestinal tract. Any break in the integrity of these tissues provides a portal of entry for the disease-causing agents. Measles is one of the most serious "conditioning" infectious diseases among young children in developing areas. It also can be devastating to nutritional status. Governments and policy planners in Africa need to be made fully aware of both the devastating immediate effects and the longterm sequelae of this synergism. Comprehensive approaches toward improving the nutritional status of a population include efforts directed to environmental sanitation immunization programs and early treatment of infections. Services to deal with infectious diseases and with malnutrition need to be integrated and to have sufficient outreach to peripheral rural populations.