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

Zinc: # incidence and morbidity

Acute Respiratory

Anorexia

Ascorbic acid: may have protective effect

infections (ARI)

Dysphagia

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