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ABSTRACT Publication of the WHO monograph, Interactions of Nutrition and Infection, in 1968 by Scrimshaw,
Taylor and Gordon stimulated many scientists to pursue further research on these issues. With regard to the
relationships between diarrhea and malnutrition, the research conducted since 1968 can be categorized in one of
three major areas: 1) the impact of diarrhea on nutritional status, particularly in young children; 2) nutritional risk
factors for diarrhea; and 3) appropriate dietary therapy for patients during and after enteric infections. The results
of these studies have prompted a number of changes in the clinical treatment of patients with diarrhea and in public
health policies regarding its prevention. J. Nutr. 133: 328S332S, 2003.
It is personally very gratifying to be able to contribute to Thus began my personal and professional odyssey in quest of
this symposium, which revisits the 1968 treatise by Scrimshaw, greater knowledge on these topics.
Taylor and Gordon entitled, Interactions of Nutrition and The comprehensive monograph Interactions of Nutri-
Infection (1), because this publication had a major impact on tion and Infection stimulated many scientists to pursue
my own thinking and career development. For individuals like further research on these issues, and in this presentation I
me who were U.S. university students at the time, the year will highlight some of the resulting studies on diarrhea and
1968 was notable for the growing distrust of the military nutrition. In general, the research conducted on this topic
industrial complex, the widespread resistance to the war in since 1968 can be categorized in one of three major areas:
Vietnam, and the reawakened social concern for disenfran- 1) the impact of diarrhea on nutritional status, particularly
chised peoples, both in the United States and elsewhere. At in young children; 2) nutritional risk factors for diarrhea;
the same time, Timothy Leary was counseling students and and 3) appropriate dietary therapy for patients during and
other members of the love generation to turn on, tune in, and after enteric infections. Notably, the results of these studies
drop out (2); and the hippie movement was reaching its peak. prompted a number of changes in the clinical management
As a graduating senior confronting these competing claims on of patients with diarrhea and in public health policies
my attention, and as the recipient of a lottery number from the
regarding its prevention. For lack of time, and because of
U.S. Selective Service Board that all but ensured my inscrip-
my own personal interests and experience, my comments
tion into the U.S. Army immediately after graduation unless
other options were pursued, I chose instead to enroll in med- will focus primarily on epidemiological and clinical studies
ical school until I could decide what I really wanted to do with that were conducted in humans. I will not attempt to
my life. Because I had originally hoped to join the Peace Corps provide a comprehensive treatment of the literature; rather,
after finishing my undergraduate studies, once in medical I will highlight those studies that I believe have exerted the
school I began to explore opportunities for practicing medicine greatest influence on current thinking.
and/or conducting biomedical research in the developing
world; and I soon discovered the series of publications by
Scrimshaw, Gordon and colleagues on weanling diarrhea (3) Overview of diarrhea and nutrition
and the interactions between infection and nutrition (4,5).
As articulated by Scrimshaw, Taylor and Gordon in their
1
1968 review, the relationship between infection and malnu-
Presented as part of the symposium Nutrition and Infection, Prologue and
Progress Since 1968 given at the 2002 Experimental Biology meeting on April 23,
trition is bidirectional (Fig. 1). Infection adversely affects
2002, New Orleans, LA. The symposium was sponsored by The American Society nutritional status through reductions in dietary intake and
for Nutritional Sciences. The proceedings are published as a supplement to The intestinal absorption, increased catabolism and sequestration
Journal of Nutrition. Guest editors were Nevin S. Scrimshaw, Massachusetts
Institute of Technology, Cambridge, MA, and Food and Nutrition Programme, of nutrients that are required for tissue synthesis and growth.
United Nations University, Tokyo, Japan, and William R. Beisel, Department of On the other hand, malnutrition can predispose to infection
Microbiology and Immunology, Johns Hopkins School of Hygiene and Public because of its negative impact on the barrier protection af-
Health, Baltimore, MD.
2
To whom correspondence should be addressed. forded by the skin and mucous membranes and by inducing
E-mail: khbrown@ucdavis.edu. alterations in host immune function.
328S
DIARRHEA AND MALNUTRITION 329S
LITERATURE CITED
1. Scrimshaw, N. S., Taylor, C. E. & Gordon, A.J.E. (1968) Interactions of
Nutrition and Infection. WHO monograph series no. 57. World Health Organiza-
tion, Geneva, Switzerland.
2. Leary, T. (1965) The Politics of Ecstasy. Putnam, New York, NY.
3. Gordon, J. E., Chitkara, I. D. & Wyon, J. B. (1963) Weanling diarrhea.
Am. J. Med. Sci. 245: 129 160.
4. Scrimshaw, N. S., Guzman, M. A. & Gordon, J. E. (1967) Nutrition and
infection field study in Guatemalan villages, 1959 1964. I. Study plan and exper-
imental design. Arch. Environ. Health 14: 657 662.
5. Gordon, J. E., Ascoli, W., Mata, L. J., Guzman, M. A. & Scrimshaw, N. S.
(1968) Nutrition and infection field study in Guatemalan villages, 1959 1964. VI.
Acute diarrheal disease and nutritional disorders in general disease incidence.
Arch. Environ. Health 16: 424 437.
6. Mata, L. J., Kronmal, R. A., Garcia, B., Butler, W., Urrutia, J. J. & Murillo,
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332S SUPPLEMENT
study into the role of infection in determining nutritional status in Gambian village ern Ghana: effects on clinic attendances, hospital admissions, and child mortality.
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