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Malnutrition and Infection − a Review − Nutrition Policy Discussion Paper No Malnutrition and Infection − A review − Nutrition policy discussion paper No. 5 Table of Contents Malnutrition and Infection − A review − Nutrition policy discussion paper No. 5.......................................1 ACKNOWLEDGEMENTS.......................................................................................................................2 FOREWORD..........................................................................................................................................3 INTRODUCTION AND OPERATIONAL IMPLICATIONS.......................................................................3 INTRODUCTION..............................................................................................................................3 OPERATIONAL IMPLICATIONS.....................................................................................................6 MALNUTRITION AND INFECTION − by Andrew Tomkins and Fiona Watson....................................12 1. THE NUTRITION CYCLE..........................................................................................................13 2. THE INFECTION CYCLE...........................................................................................................15 3. INFECTION AND RISK OF MALNUTRITION............................................................................17 4. MALNUTRITION AND RISK OF INFECTION............................................................................24 5. LOW BIRTH WEIGHT AND RISK OF INFECTION....................................................................33 6. CONCLUSIONS.........................................................................................................................34 7. BIBLIOGRAPHY........................................................................................................................35 8. ALPHABETICAL LISTING OF REFERENCES IN BIBLIOGRAPHY..........................................95 9. NUTRITION AND INFECTION RE−EXAMINED: A RETROSPECTIVE COMMENT BY NEVIN S SCRIMSHAW........................................................................................................107 i ii Malnutrition and Infection − A review − Nutrition policy discussion paper No. 5 UNITED NATIONS NATIONS UNIES ADMINISTRATIVE COMMITTEE ON COORDINATION/SUBCOMMITTEE ON NUTRITION by Andrew Tomkins1 and Fiona Watson2 1. Currently Professor of International Child Health Department of International Child Health, Institute of Child Health University of London, Guildford Street, London WC1N 1EH 2. Currently Consultant Nutritionist, c/o Department of International Child Health, Institute of Child Health. Address as above. Formerly at the Clinical Nutrition Unit London School of Hygiene and Tropical Medicine with discussion by N S Scrimshaw and an introduction by the ACC/SCN Secretariat October 1989 reprinted June 1993 with assistance from the Government of the Netherlands UNITED NATIONS ADMINISTRATIVE COMMITTEE ON COORDINATION − SUBCOMMITTEE ON NUTRITION (ACC/SCN) The ACC/SCN is the focal point for harmonizing the policies and activities in nutrition of the United Nations system. The Administrative Committee on Coordination (ACC), which is comprised of the heads of the UN Agencies, recommended the establishment of the Sub−Committee on Nutrition in 1977, following the World Food Conference (with particular reference to Resolution V on food and nutrition). This was approved by the Economic and Social Council of the UN (ECOSOC). The role of the SCN is to serve as a coordinating mechanism, for exchange of information and technical guidance, and to act dynamically to help the UN respond to nutritional problems. The UN members of the SCN are FAO, IAEA, IFAD, ILO, UN, UNDP, UNEP, UNESCO, UNFPA, UNHCR, UNICEF, UNRISD, UNU, WFC, WFP, WHO and the World Bank. From the outset, representatives of bilateral donor agencies have participated actively in SCN activities. The SCN is assisted by the Advisory Group on Nutrition (AGN), with six to eight experienced individuals drawn from relevant disciplines and with wide geographical representation. The Secretariat is hosted by WHO in Geneva. The SCN undertakes a range of activities to meet its mandate. Annual meetings have representation from the concerned UN agencies, from 10 to 20 donor agencies, the AGN, as well as invitees on specific topics; these meetings begin with symposia on subjects of current importance for policy. The SCN brings certain such matters to the attention of the ACC. The SCN sponsors working groups on inter−sectoral and sector−specific topics. The SCN compiles and disseminates information on nutrition, reflecting the shared views of the agencies concerned. Regular reports on the world nutrition situation are issued, and flows of external resources to address nutrition problems are assessed. State−of−the−Art papers are produced to summarize current 1 knowledge on selected topics. SCN News is normally published twice per year. As decided by the Sub−Committee, initiatives are taken to promote coordinated activities − inter−agency programmes, meetings, publications − aimed at reducing malnutrition, primarily in developing countries. ACC/SCN documents may be reproduced without prior permission, but please attribute to ACC/SCN. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the ACC/SCN or its UN member agencies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Information on the ACC/SCN State−of−the−Art Series, as well as additional copies of papers, can be obtained from the ACC/SCN Secretariat. Inquiries should be addressed to: Dr John B. Mason Technical Secretary, ACC/SCN c/o World Health Organization 20, Avenue Appia CH−1211 Geneva 27 Switzerland Facsimile No: (41−22) 798 88 91 Telex No: 415416 ACKNOWLEDGEMENTS The ACC/SCN is most grateful for the extensive work by Dr A Tomkins and Miss F Watson, of the Centre for Human Nutrition, Departments of Public Health and Policy and Clinical Sciences, London School of Hygiene and Tropical Medicine (LSHTM), that went into the preparation of the Review and Bibliography that form the major part of this book. We greatly appreciated the careful review and informed comment of the working group that met in May 1988: A Chavez, FAO; N Cohen, WHO (EPI); D Haslett, Trinity College, Dublin; A Horwitz, Chairman, ACC/SCN (Chairman of Meeting); F Kaferstein, WHO (Food Safety); J Kevany, Chairman, Advisory Group on Nutrition, ACC/SCN; D Mahalanabis, ICDDR, Dhaka, Bangladesh; M Mokbel, WHO (Food Aid); A Pradilla, WHO (Nutrition). The review and comments by staff of WHO were essential for compiling the first section, on Introduction and Operational Implications: Drs H Campbell; G Clugston; N Cohen; P De Raadt; I De Zoysa; V Ivorra Cano; K Mott; A Pio; and A Pradilla. Comments from Dr J McGuire (World Bank) were also appreciated. Further help in finalising this section was appreciated from Drs G Beaton, J Kevany, and R Martorell. The Advisory Group on Nutrition of the ACC/SCN provided important guidance throughout. Assistance in drafting and editing was provided by Ms M Kelly (LSHTM) and Dr M Lotfi, as SCN consultants. We also gratefully acknowledge the skill and endurance of Mrs C Hastings and Mrs P Jamieson in word processing. J B Mason Technical Secretary, ACC/SCN October 1989 We gratefully acknowledge funding assistance from the Government of the Netherlands for the reprinting of this publication 2 FOREWORD The combination of malnutrition and infection causes most of the preventable deaths in developing countries, certainly among young children. Malnutrition increases the risk and worsens the course of infectious disease; and infection leads to malnutrition. Thus we have used the expression “malnutrition−infection complex”. Good nutrition undoubtedly is a major factor in the better health in the more developed countries and improving the diet in poor countries is a pre−requisite for achieving satisfactory health conditions in the world. Both nutrition and health need to be addressed, at the same time and as a matter of urgency. The ACC/SCN commissioned this State−of−the−Art Review by Dr A Tomkins and Ms F Watson to bring together current knowledge and give a basis for recommending on its operational implications for nutrition and health policies and programmes. With the help of a working group and of the SCN’s Advisory Group on Nutrition, some of the important operational implications have been summarised in the first section. We are particularly pleased that Dr N Scrimshaw − whose classic book on Nutrition and Infection published in 1968 provided inspiration for this review − has provided his comments, which are included in the document. Reducing the toll of malnutrition and disease in developing countries is a primary aim of the members of the ACC Sub−Committee on Nutrition, which constitutes some 17 UN agencies, and benefits from the participation of the major bilateral donors. The SCN’s purpose is to harmonise policies and methods, to more effectively improve nutrition in the world. We believe that further application of modern knowledge on malnutrition and infection in developing countries is feasible and effective, particularly at the primary health care level, and trust that this book may contribute to that cause. A Horwitz Chairman, ACC/SCN INTRODUCTION AND OPERATIONAL IMPLICATIONS 1This section was prepared by the ACC/SCN
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