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specialized primary lymphoid or- weight for- age (underweight) or
gan of the immune system. This height for- age (stunting), correla-
which compromises immunity in tions for chronic PEM. A study in
children by a long-term reduction Kenya found a significant asso-
of peripheral lymphocyte counts. ciation between HIV infection and
lower mid-upper arm circumfe-
rences and serum albumin con-
centration, another measure of
malnutrition, but found no such
association with BMI. Independent
of HIV, socioeconomic factors and
severity of tuberculosis are impor-
tant correlates of acute PEM or
wasting. Infection itself contributes

dren after the Second World War. to malnutrition. The relationship
The immunodeficiency represents of malnutrition on immune sup-
a key factor in susceptibility to in- Noma is an opportunistic infection pression and infection is compli-
fections and has therefore been in children between one and four cated by the profound effects of a
termed nutritionally acquired im- years with PEM, which occurs wor- number of infections on nutrition
munodeficiency syndrome. In ldwide, but is most common in itself. Examples of how infections
many malnourished patients, both sub-Saharan Africa. The infection can contribute to malnutrition are:
acquired immunity, where are in- evolves from gingival inflammation 1. gastrointestinal infection
volved lymphocyte functions, as to orofacial gangrene and is com- can lead to diarrhea;
well as innate host defense mecha- monly preceded by other infections 2. HIV/AIDS, tuberculosis, and
nisms, more represented by ma- such as measles, malaria, severe other chronic infections can
crophages and granulocytes, are diarrhea, and necrotising ulcerati- cause cachexia and anemia;
affected. A detuned immune fun- ve gingivitis. Noma coincides with 3. intestinal parasi-
ctions in undernourished patients the period of linear growth retar- tes can cause anemia
cause more vulnerability to in- dation in malnourished children. and nutrient deprivation.
fections, notably those by opportu- Stimulation of an immune respon-
nistic pathogens commonly preva- In addition to promoting acute and se by infection increases the de-
lent in patients with HIV/AIDS. chronic infections, PEM impairs the mand for metabolically derived
Malnutrition and nutritional altera- linear growth of children, leading anabolic energy and associated
tions are common complications to a further reduction in food in- substrates, leading to a synergistic
of HIV infection and play signifi- take, nutrient absorption, direct or vicious cycle of adverse nutritio-
cant and independent roles in catabolic nutrient losses, and in- nal status and increased suscep-
morbidity and mortality. The com- creased metabolic requirements. tibility to infection. Under inflam-
plex nature of AIDS wasting requi- It has been suggested that acute matory conditions such as sepsis,
res individualized strategies when phase response and pro inflam- mediators increase the catabolic
providing nutritional support, and matory cytokines directly affect disease state featured by enhan-
specific protocols have been deve- the bone remodelling required for ced arginine use. Furthermore, ar-
loped to assist in the diagnosis and longitudinal growth. Correlation ginase is induced during infection
treatment of malnutrition in pa- of malnutrition and growth retar- and uses up arginine as substrate.
tients with HIV infection. The op- dation allows assessment of the Supplementation and Infections
portunistic fungus Pneumocystis individual nutritional state, which It has been suggested that deple-
carinii, an extracellular protozoan, is usually measured as mid up- tion of this amino acid impairs T
is a cause of diffuse pneumonia in per arm circumference or body cell responses, and exceeding the
immunocompromised hosts, in mass index (BMI). BMIs are given body’s arginine production leads
fact is frequently diagnosed in pa- either as weight-for-height to in- to a negative nitrogen balance.
tients with AIDS, and was repeate- dicate acute PEM (wasting), or as A study in Nigeria found that the
dly identified in malnourished chil- severe metabolic demands made

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