Infections

Longitudinal studies have shown that infections, especially diarrheal diseases, are associated with growth faltering due to anorexia and/or malabsorption. However, the effect of acute infections on growth is transient, at least in children older than 6 months of age, and no longer apparent after a few weeks. The lack of a long-term effect on growth can be explained by the lower proportion of energy and nutrients needed for growth after 6 months of age, which facilitates catch-up growth after an acute disease. However, chronic infections, even if asymptotic, may lead to anorexia and malabsorption. The frequently observed inverse correlation between markers of chronic infection—such as elevated white blood cell, lymphocyte and platelet counts, C-reactive protein, and gut permeability—and growth supports this hypothesis. A similar mechanism may also explain the delayed growth observed in children infested with worms and the undernutrition observed in adults with chronic diseases, such as HIV infection and tuberculosis.

The edematous form of severe malnutrition, kwa-shiorkor, has been hypothesized to be due to oxida-tive stress resulting from insufficient intake of antioxidant nutrients, including selenium, vitamins E, C, and B2, niacin, and sulfur amino acids. This suggests that infections, leading to an increased production of free radicals, can be one cause of this form of severe undernutrition.

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