Nutrisi pada Penyakit Infeksi

Rahmania, S.Gz, MPH

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