Calder P C, Jackson A A
Institute of Human Nutrition, University of Southampton, Bassett Crescent East, Southampton SO16 7PX, UK.
Nutr Res Rev. 2000 Jun;13(1):3-29. doi: 10.1079/095442200108728981.
Undernutrition and infection are the major causes of morbidity and mortality in the developing world. These two problems are interrelated. Undernutrition compromises barrier function, allowing easier access by pathogens, and compromises immune function, decreasing the ability of the host to eliminate pathogens once they enter the body. Thus, malnutrition predisposes to infections. Infections can alter nutritional status mediated by changes in dietary intake, absorption and nutrient requirements and losses of endogenous nutrients. Thus, the presence of infections can contribute to the malnourished state. The global burden of malnutrition and infectious disease is immense, especially amongst children. Childhood infections impair growth and development. There is a role for breast-feeding in protection against infections. Key nutrients required for an efficient immune response include vitamin A, Fe, Zn and Cu. There is some evidence that provision of the first three of these nutrients does improve immune function in undernourished children and can reduce the morbidity and mortality of some infectious diseases including measles, diarrhoeal disease and upper and lower respiratory tract infections. Not all studies, however, show benefit of single nutrient supplementation and this might be because the subjects studied have multiple nutrient deficiencies. The situation regarding Fe supplementation is particularly complex. In addition to immunization programmes and improvement of nutrient status, there are important roles for maternal education, improved hygiene and sanitation and increased supply of quality water in the eradication of infectious diseases.
营养不良和感染是发展中国家发病和死亡的主要原因。这两个问题相互关联。营养不良会损害屏障功能，使病原体更容易侵入，还会损害免疫功能，降低宿主在病原体进入体内后清除它们的能力。因此，营养不良易引发感染。感染可通过饮食摄入、吸收和营养需求的变化以及内源性营养物质的流失来改变营养状况。因此，感染的存在会导致营养不良状态。营养不良和传染病的全球负担巨大，尤其是在儿童中。儿童期感染会损害生长发育。母乳喂养在预防感染方面发挥着作用。有效免疫反应所需的关键营养素包括维生素A、铁、锌和铜。有证据表明，提供这三种营养素中的前三种确实能改善营养不良儿童的免疫功能，并可降低包括麻疹、腹泻病以及上、下呼吸道感染在内的一些传染病的发病率和死亡率。然而，并非所有研究都表明单一营养素补充有好处，这可能是因为所研究的对象存在多种营养素缺乏。铁补充剂的情况尤其复杂。除了免疫规划和改善营养状况外，孕产妇教育、改善卫生和环境卫生以及增加优质水的供应在消除传染病方面也发挥着重要作用。
