NUTRITION AND INFECTIONS

Interactions of Nutrition and Infection in children:
Data from national surveys have shown that in India nearly half the preschool children are underweight or stunted and nearly a fifth are wasted(1-4). Data from NFHS-3(5) indicate that majority of infants in the age of 0-2 months are exclusively breast fed. Exclusive breast feeding protects these babies from undernutrition. Undernutrition in 1st 3 months of life seems to be related to low birth weight. Low birth weight rates in India are about 30%. Between 3-6 months of age, prevalence of undernutrition rises due to early weaning and introduction of milk substitutes which may be inadequate for the child. Infact exclusive breast feeding till 6 months of age is enough to maintain nutrition in the child. Between 6-12 months of age, complementary feeds introduced may be inadequate increasing prevalence of undernutrition in this age group. Further increase in undernutrition between 12-23 months is due to low calorie food intake due to lesser quantity, poor nutrient value of food leading to Micronutrient deficiency and unbalanced food leading to rising prevalence of undernutrition in these young child(6).

Between 20-30% of preschool children are suffering from morbidity due to infections (5). Diarrhea and fever are the most common infections in preschoolers (6). Undernutrition is associated with impaired immune function and consequent increased susceptibility to infections; infections aggravate undernutrition - thus a vicious cycle sets in (6). Stunting and wasting are significant effects of malnutrition. Stunting is seen with chronic malnutrition whereas as wasting is seen with acute malnutrition. Malnutrition affects the epithelial and mucosal integrity, mucociliary clearance, immunoglobulin synthesis, lymphocyte differentiation and thus lead to impaired immunity which leads to recurrent infections (7). Stunting has an inverse correlation with intellectual development in children and adults whereas wasting is closely linked to child mortality. Infact relative risk of morbidity due to infections is higher in children with low BMI and in children with wasting. The small group of children who have stunting with wasting have the highest relative risk of morbidity due to infection (6).

There are several nutrients that have a role in maintaining health and preventing disease. Thus balanced supply of both macronutrients and micronutrients is essential to prevent wasting and thus risk of infection.

References
1. National Nutrition Monitoring Bureau (NNMB) NNMB Reports, Hyderabad: National Institute of Nutrition; 1979-2006.
2. National Family Health Survey (NFHS-1). Available at: http://www.nfhsindia.org/india1.html. Accessed on December 24 2008.
3. National Family Health Survey (NFHS-2). Available at: http://www.nfhsindia.org/india2.html. Accessed on December 24 2008.
4. District Level household Survey. Available at: http://www.rchiips.org. Accessed on 24 December 2008.
5. National Family Health Survey (NFHS-3). Available at: http://www.mohfw.nic.in/nfhsfactsheet.htm. Accessed on 24 December 2008.
6. Ramachandran P, Gopalan HS. Undernutrition and risk of infections in preschool children. Indian J Med Res. 2009; 130: 579-583.
7. Chandra RK, Kumari S. Nutrition and immunity: an overview. J Nutr 1994; 24:1435
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