Annie B Cunning Lecture – Nutrition and infections in Australian Aboriginal children*

Malnutrition is prevalent amongst children in many parts of the world, particularly in the so-called developing countries. Scrimshaw et el. in their pioneering studies helped to delineate the contribution of infectious diseases to the aetiology of childhood malnutrition. This role was reinforced by longitudinal field-based studies in rural areas of Central America' and Bangladesh3 which documented the contribution particularly of episodes of diarrhoea, to acute and chronic malnutrition, and high rates of death in infants and young children in such environments. We now understand that, because of the negative impact of malnutrition on humoral, mucosal and cellular immune defence mechanisms4 children from vulnerable backgrounds become enmeshed in a vicious cycle of 'malnutritioninfectionmalnutrition'. Infectious diarrhoeas are particularly important in this context because of anorexia, vomiting, gastrointestinal losses of fluids, nutrients and electrolytes, loss of body weight and the negative effect of infection on energy balance. Furthermore, this situation is often complicated by co-existing diseases such as respiratory tract infections, intestinal parasites and, in many parts of the world, malaria. Despite intense local and international efforts over recent years, malnutrition, vaccine-preventible diseases and other infections kill millions of infants and children annually around the world.s