Amount and rate of disappearance of liver fat in malnourished infants in Jamaica

The fat content of the liver has been measured in 163 biopsy specimens taken from 95 malnourished children in Jamaica within a few days of admission to hospital and at various stages of recovery. The fat content was also measured in 38 samples from children who died. Severe degrees of fatty infiltration, up to 50% of the wet weight, were found. Fatty liver of this degree of severity may be a cause of death. The increase in fat was accompanied by an increase in water content. This may be the result of breakdown in the energy-dependent regulation of water content. Repeat biopsies were done within 6 weeks of admission in 26 children. The average rate of clearance of fat expressed as a fraction of the amount present at any time was 5.5% per day. An attempt was made by more frequent biopsies to determine whether the rate of decrease was influenced by the protein content of the diet, but the results were inconclusive.

The short-term prognosis of severe primary infantile malnutrition

1. Among a series of 343 children with severe primary malnutrition there were 248 for whom, on admission, there were reliable records of age, weight, height, liver size, severity of oedema, skin lesions and angular stomatitis, and concentration of total serum protein, haemoglobin and sodium. For eighty-four of these children the serum bilirubin concentration was also known.

2. The correlations of these characteristics of the children on admission, with mortality, and with the rate of recovery were investigated.

3. Age, weight, oedema and haemoglobin concentration were not significantly related to mortality or to rate of recovery. A multiple regression analysis showed that an increased serum bilirubin concentration and a decreased serum sodium concentration indicated a bad prognosis, and these two factors contributed almost the whole of the multiple correlation coefficient of 0.63 with respect to mortality and 0.59 with respect to speed of rccovery.

4. We conclude that in our series of children death was more closely associated with liver failure or overhydration than with protein depletion, and suggest that the administration of ton much protein or water to an acutely ill malnourished child may precipitate death.

5. This analysis shows that the mortality observed in our series cannot be adequately explained by any combination of the characteristics considered above; there must, therefore, be other factors of importance for which we do not have suitable measurements.