Fakultas Kedokteran UNTAN Nutrition and Infectious Diseases
Infection losses of some nutrients from the body and
redistribution of other nutrients depends on the severity and duration Single orran system is attacked metabolic & nutritional responses E.g. Diarrheal infection fluid & electrolytes, paralytic infection bone & muscle wasting Measles
Most people recover well from measles, but malnutrition
increased risk of complication Poor diet & poverty malnourished more severe cases & higher mortality One study in Zaire severely vitamin A–deficient children 3x more likely to die of measles than children with better vitamin A status before infection Vitamin A supplementation has shown to reduce morbidity and mortality of measles among preschool children Malaria
extent of transmission and illness species of the
Anopheles vector, human immunity, and climate higher temperature & humid conditions ↑ transmision older literature have reported that malnutrition, specifically protein-energy malnutrition, is protective against malaria refeeding after famine ↑ risk of malaria, especially carriers Malaria
Newer comrehensive reviews better nutritional status
have less severe malaria and lower risk of death Vit A supplementation in clinical trial in Papua New Guinea significantly reduced the incidence of malaria attacks by about 20% to 50% for all except those with extremely high levels of parasitemia Malaria
Zinc supplementation show reduction in the incidence of
clinical malaria episodes, attacks and mortalty in Gambia and Papua New Guinea. But insignificant in Burkina Faso study more research Iron supplements in endemic areas higher parasite count Diarrheal Disease
Micronutrient malnutrition may impair some of host defenses
Diarrhea lead to dehydration, electrolyte imbalance, malabsorption of both macronutrients and micronutrients Deficiencies during diarheal disease Vitamins A, D, B12, copper, folate, iron, magnesium, zinc, and selenium Frequent diarrheal disease damage to the lining of the gut. disrupt normal gut flora colonization further exacerbate poor nutrition status and immune function Diarrheal disease
Exclusive breastfeeding reduce severity and the
incidence of diarrhea among infants Zinc upplementation faster recovery, shorter episode, reduced severity, lower rate of treatment failure, lower death WHO & UNICEF recom. Zinc used for theraphy Lactobacillus GG and S. boulardii-in the treatment of acute watery diarrhea, and particularly those due to rotavirus dose dependent and strain dependent Diarrheal Disease
rise in antibiotic use has led to an increase in antibiotic-
associated diarrhea (AAD) severe diarrhea restoring fluid and electrolyte oral rehydration solution, soups and broths, vegetable juices, and isotonic liquids progressed Diarrheal Disease
limit large amounts of hyperosmotic carbohydrates that may
be maldigested or malabsorbed, foods that stimulate secretion of fluids, and foods that speed the rate of GI transit Large amount of sugar e.g. Lactose, fructose, sucrose worsen osmotic diarrhea Acute diarrhea early refeeding liquid food or semisolid diet Hookworm Infection
Hookworm infection anemia and protein malnutrition
iron and other micronutrient deficiencies combination of hookworm treatment and iron supplementation was associated with improved cognitive performance and growth Malnutrition on the Pulmonary System
Malnutrition affects lung structure, elasticity, and function;
respiratory muscle mass, strength, and endurance; lung immune defense mechanisms; control of breathing Low levels of calcium, magnesium, phosphorus, and potassium compromise respiratory muscle function at the cellular level. Hypoalbuminemia development of pulmonary edema by decreasing colloid osmotic pressure body fluids to move into the interstitial space decreased surfactant level alveoli collapsed Acute Respiratory Infections
zinc supplementation reduced the incidence of ARIs and
pneumonia among children in zinc-defficient popul. zinc supplementation in infants & young childern reduced the morbidity of severe acute lower respiratory infection and severe pneumonia Tuberculosis
constitutional symptoms fever, night sweats, and
weight loss Active TB associated with deficiencies vitamins A, B complex, C, D, E, and selenium rates of TB transmission are highest among impoverished and malnourished populations Malnutrition also can lower the effectiveness of the anti-TB drug regime High energy high protein diet, 35-40 kcal/kg IDB, protein up to 1.2 – 1.5 g/kg IDB Supplementation 50 – 150 % RDA Add sunlight and vit D prone to Vit D deficiency HIV/AIDS
During HIV infection nutritional intake affected by
anorexia, central nervous system disease, dysphagia, and odynophagia deceased food intake weight loss Untreated HIV diarrhea and malabsorption of fats, carbohydrates, and vitamin B12 Diarrhea Jejunal and duodenal villous atrophy passive leak of ions, substrates, and water HIV/AIDS
Increase energy requirement 20 – 30 % in adult, 50- 100 %
in children malnutrition & infection Higher REE 14% and 20% for HIV/AIDS in studies Antioxidant e.g. carotenoids, tocopherols, vitamin C, and selenium implicating HIV pathogenesis infection Vit A growth and function of T and B cells, antibody responses,m aintenance of mucosal epithelium : respiratory, gastrointestinal, and genitourinary tracts HIV/AIDS
Zinc growth, development, function of neutrophils,
macrophages, natural killer cells, T and B lymphocytes Micronutrient supplement lower viral loads, slower HIV progression, improved overall survival Higher inake of omega-3 fa might be beneficial HIV AIDS Nutrition Management
Complete nutrition assessment 2-6 times/year.
• Emphasize importance of early/ongoing nutritional intervention • Promote adequate intake of nutrients and fluids • Emphasize importance of food and water safety and sanitation • Emphasize regular exercise and physical activity HIV AIDS Nutrition Management
• If psycho-social economic barriers to food, give
resources • Dietary multiple vitamin and mineral supplements • Inform patient of possible side effects, symptoms, and/or complications • Monitor/manage metabolic abnormalities HIV AIDS Nutrition Management
• Small, frequent, nutrient-dense meals
• If mouth ulcers present, foods made need to bemashed or ground • Appetite stimulants if necessary • Parenteral nutrition if necessary • Anabolic therapies Thank You
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