Effect of infections and environmental factors on growth and nutritional status in developing countries
Effect of infections and environmental factors on growth and nutritional status in developing countries
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DOI：
10.1097/01.mpg.0000255846.77034.ed
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发表时间：
2006-12-01
影响因子：
2.9
通讯作者：
Bhutta, Zulfiqar Ahmed
中科院分区：
文献类型：
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作者：
Bhutta, Zulfiqar Ahmed
尽管在全球儿童健康方面取得了许多进展和改善，但营养不良仍然是一个主要问题，在儿童死亡中占很大比例。营养不良造成的大部分隐性负担表现为普遍的单一和多种微量营养素缺乏症。一些因素可能会影响发展中国家的微量营养素缺乏，包括出生时身体储存不良、饮食不足和大量摄入植酸盐等吸收抑制剂，以及身体损失增加。尽管摄入量不足和微量营养素需求增加的影响得到了很好的描述，但急性和慢性感染对人体微量营养素状态的潜在影响却没有得到很好的认识。更令人费解的是，免疫刺激和并发感染对微量营养素分布和体内平衡的潜在影响。因此，相对较高的微量营养素缺乏率与传染病之间的联系可能既反映了缺乏人口感染的易感性增加，也反映了感染本身对微量营养素状况指标的直接影响。最近，锌和铜等微量营养素损失的增加与急性腹泻的关系已经被认识到，在持续性腹泻的儿童的锌代谢研究中，锌的净负平衡已经被显示出来。人们还认识到，志贺氏菌病儿童可能会在尿液中失去大量维生素A，从而进一步加重先前存在的亚临床维生素A缺乏症。鉴于微量营养素缺乏与腹泻之间的流行病学联系，在流行地区采取补充策略是合理的。越来越多的证据表明，补锌在加快发展中国家腹泻病康复的关键作用方面发挥着关键作用，这支持在公共卫生战略中使用补锌。
Despite numerous advances and improvements in child health globally, malnutrition remains a major problem and underlies a significant proportion of child deaths. A large proportion of the hidden burden of malnutrition is represented by widespread single and multiple micronutrient deficiencies. A number of factors may influence micronutrient deficiencies in developing countries, including poor body stores at birth, dietary deficiencies and high intake of inhibitors of absorption such as phytates and increased losses from the body. Although the effects of poor intake and increased micronutrient demands are well described, the potential effects of acute and chronic infections on the body's micronutrient status are less well appreciated. Even more obscure is the potential effect of immunostimulation and intercurrent infections on the micronutrient distribution and homeostasis. The association therefore of relatively higher rates of micronutrient deficiencies with infectious diseases may be reflective of both increased predisposition to infections in deficient populations as well as a direct effect of the infection itself on micronutrient status indicators. Recently the association of increased micronutrient losses such as those of zinc and copper with acute diarrhea has been recognized and a net negative balance of zinc has been shown in zinc metabolic studies in children with persistent diarrhea. It is also recognized that children with shigellosis can lose a significant amount of vitamin A in the urine, thus further aggravating preexisting subclinical vitamin A deficiency. Given the epidemiological association between micronutrient deficiencies and diarrhea, supplementation strategies in endemic areas are logical. The growing body of evidence on the key role of zinc supplementation in accelerating recovery from diarrheal illnesses in developing countries supports its use in public health strategies.