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It is argued that the impact of infectious disease episodes on growth is not very impressive. In a study of Guatemalan children only 10% of the weight deficit could be attributed to disease, and in The Gambia, Rowland found that only diarrhea! diseases had a significant effect on growth in height. Also in Khartoum, only a small portion of the growth deficit of children could be accounted for by infection. Perhaps this should not astonish us, because the cost of recovery is, of course, relatively small in comparison to total energy requirements.
The classification of infectious disease episodes according to pathogen, severity and duration has not been very precise in most studies. Besides the infectious disease episode itself, we also have to take into consideration reactions of the child's caretakers. In many areas it is customary to withhold food from a child suffering from measles and/or diarrhea! disease. In Guatemala, wherever this custom could be reversed, catch-up in weight was two to six times greater.
Factors controlling growth are only partially understood and one could well imagine that metabolic changes induced by infection could influence growth-hormone levels. Infections could also produce imbalanced nutrient losses. Repleting such deficits may be difficult and only possible at the cost of some wastage in energy.