Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229, USA.
Curr Opin Infect Dis. 2011 Oct;24(5):496-502. doi: 10.1097/QCO.0b013e328349287d.
This review highlights recent progress toward understanding complex interactions between diarrhea, pneumonia, and undernutrition among children in low-income and middle-income countries.
New studies parallel earlier reports that diarrhea and pneumonia impair children's growth and that underlying malnutrition is a major risk factor for these conditions. Episodes of diarrhea may predispose to pneumonia in undernourished children. Additional studies support breastfeeding and micronutrient supplementation for the prevention and control of diarrhea and pneumonia. Malnutrition may partially account for the reduced efficacy of oral rotavirus vaccines in low-income countries. Immunization of pregnant women against influenza also appears to reduce intrauterine growth retardation. Immunization of infants against Streptococcus pneumoniae may improve their growth. New genetic studies indicate that polymorphisms in apolipoprotein E or the leptin receptor modulate children's risk for diarrhea and Entamoeba histolytica infection, respectively, thereby linking two genes important for lipid metabolism to enteric infections.
Significant advances have been made in understanding the vicious cycle of malnutrition, diarrhea, and pneumonia in developing countries. Future challenges will be to translate this progress into effective and widely accessible public health measures.
本文重点介绍了在理解低收入和中等收入国家儿童腹泻、肺炎和营养不良之间复杂相互作用方面的最新进展。
新的研究与早期报告平行，表明腹泻和肺炎会影响儿童的生长，而潜在的营养不良是这些疾病的主要危险因素。腹泻发作可能使营养不良的儿童更容易患肺炎。此外，研究支持母乳喂养和补充微量营养素，以预防和控制腹泻和肺炎。营养不良可能部分解释了低收入国家口服轮状病毒疫苗效果降低的原因。孕妇接种流感疫苗也似乎减少了宫内发育迟缓。婴儿接种肺炎链球菌疫苗可能会改善他们的生长。新的遗传研究表明，载脂蛋白 E 或瘦素受体的多态性分别调节儿童腹泻和溶组织内阿米巴感染的风险，从而将两个对脂质代谢很重要的基因与肠道感染联系起来。
在理解发展中国家营养不良、腹泻和肺炎的恶性循环方面取得了重大进展。未来的挑战将是将这一进展转化为有效和广泛适用的公共卫生措施。
