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CHAIN Publications

The impact of malnutrition on childhood infections

Judd L. Walson and James A. Berkley

 

Purpose of review

Almost half of all childhood deaths worldwide occur in children with malnutrition, predominantly in sub- Saharan Africa and South Asia. This review summarizes the mechanisms by which malnutrition and serious infections interact with each other and with children’s environments.

Recent findings

It has become clear that whilst malnutrition results in increased incidence, severity and case fatality of
common infections, risks continue beyond acute episodes resulting in significant postdischarge mortality.
A well established concept of a ‘vicious-cycle’ between nutrition and infection has now evolving to
encompass dysbiosis and pathogen colonization as precursors to infection; enteric dysfunction constituting
malabsorption, dysregulation of nutrients and metabolism, inflammation and bacterial translocation. All of
these interact with a child’s diet and environment. Published trials aiming to break this cycle using
antimicrobial prophylaxis or water, sanitation and hygiene interventions have not demonstrated public
health benefit so far.

Summary
As further trials are planned, key gaps in knowledge can be filled by applying new tools to re-examine old questions relating to immune competence during and after infection events and changes in nutritional status; and how to characterize overt and subclinical infection, intestinal permeability to bacteria and the role of antimicrobial resistance using specific biomarkers.

Keywords
clinical trial, children, colonization, dysbiosis, environmental, growth, malnutrition, mortality, survival,
susceptibility, undernutrition

Full article on: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6037284/

 

 

 

 

 

 

Severe childhood malnutrition

AUTHORS: Zulfiqar A. Bhutta, James A. Berkley, Robert H. J. Bandsma, Marko Kerac, Indi Trehan and André Briend

Use the term ‘severe malnutrition’ to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood.

The impact of rickets on growth and morbidity during recovery among children with complicated severe acute malnutrition in Kenya: A cohort study.

Investigated the associations of clinically diagnosed rickets with life-threatening events and anthropometric recovery during 1 year following inpatient treatment for complicated SAM. This was a secondary analysis of clinical trial data among non-human immunodeficiency virus-infected Kenyan children with complicated SAM (2-59 months) followed for 1 year posthospital discharge (ClinicalTrials.gov ID NCT00934492).

 

Severe malnutrition in infants aged <6 months-Outcomes and risk factors in Bangladesh: A prospective cohort study.

argue that severe acute malnutrition (SAM) affects ~4 million infants under 6 months (u6m) worldwide, but evidence underpinning their care is “very low” quality. To inform future research and policy, the objectives of our study were to identify risk factors for infant u6m SAM and describe the clinical and anthropometric outcomes of treatment with current management strategies. We conducted a prospective cohort study in infants u6m in Barisal district, Bangladesh. One group of 77 infants had SAM (weight-for-length Z-score [WLZ] <-3 and/or bipedal oedema); 77 others were “non-SAM” (WLZ ≥-2 to <+2, no oedema, mid-upper-arm circumference ≥125 mm). All were enrolled at 4-8 weeks of age and followed up at 6 months. Maternal education and satisfaction with breastfeeding were among factors associated with SAM. Duration of exclusive breastfeeding was shorter at enrolment (3·9 ± 2.1 vs. 5.7 ± 2.2 weeks, P < 0.0001) and at age 6 months (13.2 ± 8.9 vs. 17.4 ± 7.9 weeks; P = 0.003) among SAM infants. Despite referral, only 13 (17%) reported for inpatient care, and at 6 months, 18 (23%) infants with SAM still had SAM, and 3 (3.9%) died. In the non-SAM group, one child developed SAM, and none died. We conclude that current treatment strategies have limited practical effectiveness: poor uptake of inpatient referral being the main reason. World Health Organization recommendations and other intervention strategies of outpatient-focused care for malnourished but clinically stable infants u6m need to be tested. Breastfeeding support is likely central to future treatment strategies but may be insufficient alone. Better case definitions of nutritionally at-risk infants are also needed.

 

KEYWORDS:

breastfeeding; infants under 6 months; moderate acute malnutrition; mortality; risk factors; severe acute malnutrition