Malnutrition is a major cause of immune deficiency that leads to greater frequency of common infections, increasing their severity and impeding clinical resolution. Infection also imposes a metabolic stress through activation of the acute phase response that is more difficult to resolve in malnutri tion. The combination often produces a vicious cycle, which leads to chronic infection. Malnutrition is a leading cause of death in children less than 5 years of age in less-developed countries. Where lack of food availability, poor sanitation, lack of safe water, endemic infections and general poverty are widely prevalent, malnutrition is generally appreciated as a major cause of clinical infection. Although food is apparently available in wealthy industrialized societies, primary malnutrition is not uncommon due to poverty, lack of education, food allergies, inappropriate or limited diet, or eating disorders and should be considered as a possible root cause or cofactor in frequent infection or failure to resolve infection. Furthermore, children comprise a significant part of the increasingly large immigrant populations in industrialized urban settings where they may live in impoverished circumstances and have less access to health care. Such children are especially vulnerable to the effects of nutrient deficiency. For infants and toddlers, adequate nutrition is critically important for the development of the immune system, immune response to environmental antigens and pathogens, and for the maintenance of host defense. In children with congenital anomalies or medical conditions affecting growth, poor nutrient status will have a disproportionate effect on development, immunity, and susceptibility to infection. For children with secondary malnutrition, specific macronutrient and micro-nutrient supplements are an essential part of disease management, due to the additional metabolic burden associated with chronic illness, as indicated by inflammation, anemia, and altered gastrointestinal (GI) function.
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