Transcobalamin II in protein-energy malnutrition among residents of the Kivu area

Transcobalamin II, the crucial transport protein for vitamin B12, was measured in protein-energy malnutrition patients and healthy controls. No significant difference between these two groups was observed. Treated patients showed higher concentrations than those on admission. The striking observation was, however, that all African subjects studied in Lwiro, Zaïre, had very high transcobalamin II levels compared to Europeans living either in Brussels or in Lwiro, and compared to Africans living in Brussels. This observation seems therefore not simply related to genetic or to environmental factors. No evident explanation is yet available.

Plasma zinc status of protein energy malnourished children

The plasma zinc status, albumin level and alkaline phosphatase activity of 44 protein energy malnourished Nigerian children were compared with those of 10 normal children. Results were classified according to the type and degree of malnutrition. Plasma zinc levels were low in the malnourished groups and tended to vary with the degree of malnutrition as indicated by the level of growth retardation. Levels in the 'normal' group of children suggest a possible presence of marginal zinc nutrition among Nigerian children.

[3H]Ouabain binding to human erythrocytes in protein-énergy malnutrition

[3H]Ouabain binding to erythrocytes was determined in normal children and in children suffering from kwashiorkor or marasmus. Scatchard plot analysis of [3H]ouabain binding displayed straight lines with linear slopes in all subjects indicating the presence of a single species of ouabain binding sites on erythrocytes. The number of ouabain binding sites per cell was 385 +/- 26 (mean +/- SEM, n = 3) in normal, 891 +/- 102 (n = 8) (p less than 0.001) in kwashiorkor and 316 +/- 45 (n = 3) in marasmic children. The equilibrium dissociation constant (Kd) for ouabain binding in kwashiorkor (16 nmol/1) was similar to that in control (12 nmol/1). The specific activity of Na+, K+ -ATPase of erythrocyte membrane has been shown to be higher in kwashiorkor children as compared to normal children [3]. This increase in enzyme activity may be considered as a consequence of increase in the enzyme content as indicated by the increased number of ouabain binding sites on red cells. Elevation in the level and activity of erythrocyte Na+, K+ -ATPase in kwashiorkor might represent a compensatory mechanism in response to a primary membrane abnormality, to effect prevention of Na+ accumulation and K+ depletion inside the cell.

Plasma alpha-tocopherol (vitamin E) levels and tocopherol-lipid ratio among children with protein-energy malnutrition (PEM)

The fat-soluble vitamin E (alpha-tocopherol) status of 47 malnourished children was assessed and compared with that of a control group of ten age-matched normal children. Plasma levels of alpha-tocopherol, total lipid and the ratio of alpha-tocopherol to total lipid were determined. The plasma vitamin E level was low, with a value of less than 11.61 mumol/l (500 micrograms/dl) in 40 (85%) of the malnourished children while the remaining seven (15%) children had values that ranged between 11.61 and 17.20 mumol/l (500-741 micrograms/dl). On the other hand, the tocopherol/total lipid ratio was less than 0.8 mg/g of total lipid in only seven of the malnourished children. The remaining 40 (85%) subjects had values that ranged between 0.8 and 1.96 mg/g of total lipid, whereas in the control group, both the plasma tocopherol levels and the tocopherol/lipid ratio were greater than 11.61 mumol/l (500 micrograms/dl) and 0.8 mg/g of plasma total lipid respectively.

Circulating gonadotropin profile in severe cases of protein calorie malnutrition

The circulating levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and prolactin (PRL) were studied in children of both sexes between 2 and 14 years of age who were suffering from severe protein calorie malnutrition (PCM), namely, kwashiorkor, marasmic kwashiorkor, and marasmus. LH and FSH levels in all the age groups and in all forms of PCM were found to be significantly lowered, thereby explaining the possible delay in the onset of puberty in these children. Circulating PRL levels, on the other hand, were significantly raised in all patients with PCM studied, with values in children with kwashiorkor and marasmic kwashiorkor higher than in children with marasmus, possibly accounting for the presence of edema in the former cases. The present work, therefore, proposes a possible correlation between gonadotropin levels and PCM in children.

Plasma zinc and copper levels during the acute phase of protein-energy malnutrition (PEM) and after recovery

The fasting plasma levels of zinc and copper during the acute phase of protein-energy malnutrition (PEM) and after recovery have been measured in 51 malnourished children and 10 healthy control subjects. Recovery time was four weeks after the initial presentation when oedema had disappeared and both appetite and temperament had improved. There was no statistically significant difference between the zinc and copper values, both initially and at recovery in all the malnourished children; besides all these values were significantly lower than those for the control group. The evidence was that the dietary intake of these two trace elements was inadequate. It is suggested that in order to hasten catch-op growth during recovery from PEM, both zinc and copper should be added to the rehabilitating diets.

Febrile and plasma iron responses of rabbits injected with endogenous pyrogen from malnourished patients

The ability of human endogenous pyrogen (EP) harvested from malnourished patients (marasmic or kwashiorkor-like) to induce fever and a simultaneous hypoferremia in rabbits is described. Human peripheral blood leukocytes were obtained from malnourished adult patients before total parenteral nutrition support, and after 1 and 7 days on this therapeutic regime; the leukocytes were stimulated to produce EP in vitro and EP was injected into each rabbit. EP obtained from the leukocytes of patients with predominant protein deprivation syndromes (kwashiorkor) before nutritional support produced an attenuated fever (0.23 degrees C over 4 h) and a relatively unchanged plasma iron concentration (delta Fe = -15 microgram/100 ml over 4 h) in the rabbits. When EP was harvested from these same patients after 7 days of nutritional support therapy and was injected into rabbits, normal 4 h fevers (1.10 degrees C) and reduction in plasma iron levels (delta Fe = -97 micrograms/100 ml) occurred in the rabbits. Human EP obtained from patients with marasmus (predominant calorie deprivation syndromes) produced relatively normal fevers and changes in plasma iron levels in the rabbits, regardless of whether the samples were taken pre-total parenteral nutrition or after 1 and 7 days of total parenteral nutrition. These observations suggest that the synthesis of endogenous pyrogen by human peripheral leukocytes is sensitive to the availability of key substrates and that nutritional support therapy restores the capacity of these cells to produce EP in vitro.

[Zinc in protein-calorie malnutrition. I. Concentration in serum of children with the clinical types, kwashiorkor and marasmic kwashiorkor]

Zinc concentration was measured in the serum of 10 children with protein-energy malnutrition (eight with clinical signs of kwashiorkor, and two with marasmic-kwashiorkor) on the first, 15th and 30th day after admission. The zinc levels were significantly lower for these patients on the first day than those observed for children with good nutritional status. No significant increase in zinc concentration occurred in the serum of these patients during initial period of recovery of nutritional status. The possibility of zinc supplementation for malnourished children during recovery is discussed.

Effect of intramuscular vitamin A injection on plasma levels of vitamin A and retinol-binding protein in malnourished children

1. Serum levels of retinol-binding protein (RBP), total vitamin A and retinyl ester were measured in twenty-four malnourished children with corneal lesions and nine normal children. 2. Initially, the RBP and vitamin A levels were significantly lower in malnourished children than in normal children. 3. After intramuscular injection of 30000 microgram of aqueous vitamin A, serum levels of total vitamin A were increased significantly at 24 h and tended to fall within 5 d of treatment in both groups. 4. Before treatment, retinyl ester accounted for less than 10% of the vitamin in circulation. After vitamin A injection, it increased to 30%, a level much lower than that reported in patients with hypervitaminosis A. 5. There was no significant difference between the two groups of children and none of them showed clinical signs of toxicity. These observations indicate that administration of massive doses of vitamin A over a short period will not produce toxic effects even in malnourished children.

Red blood cells amino-acid pattern in protein energy malnutrition and the effect of oral dosing with single amino acids

R.B.C.'s amino acid pattern was investigated in control and PEM subjects. The effect of oral dosing with cysteine, tryptophan and lysine on total amino acid nitrogen level of R.B.C.s was also studied. Results revealed that in moderate and severe kwashiorkor the total essential and non-essential R.B.C.'s amino acids were decreased. In 2nd grade marasmus the total R.B.C.'s amino acids in general showed lower values than normal. After oral administration of the tested amino acids, the transport index calculated as the level of maximum value of the total R.B.C.'s amino acids reached to the fasting level was lower in malnourished cases relative to controls except in 2nd grade marasmic cases given tryptophan or lysine. This criteria was considered to indicate lower rate of amino acid transport to R.B.C.s due to lower concentration in plasma or shift of transport mechanism from active transport to exchange diffusion.

Plasma thyroxine binding prealbumin as an index of mild protein-energy malnutrition in Nigerian children

Weight, height, midarm circumference (AC), midarm muscle circumference (AMC), triceps skinfold thickness (TSF), and plasma thyroxine binding (TBPA) were measured in 73 children free from any clinical evidence of disease and in 15 severe protein-energy malnourished (PEM) (marasmus, marasmic kwashiorkor, and kwashiorkor) Nigerian preschool children. The children were divided into various groups according to both Wellcome and Waterlow's classification. All measurements made on them were then compared between the various groups within each classification. It was found that plasma TBPA values were not only able to distinguish various grades of PEM but was the only parameter studied which can distinguish mild PEM from normals when weight, height, TSF, AC, and AMC were not sensitive enough to do so. TBPA was also found to be significantly related to body weight, deficit in weight for age, AC, and AMC. Both marasmic and kwashiorkor groups had significantly lower TBPA levels than undernourished group. The marasmic children also had significantly lower body weight but higher TBPA levels than kwashiorkor, while the TBPA values for marasmic kwashiorkor children were in between the two. Considerable overlapping of individual TBPA values were found between normals and undernourished in Wellcome classification but very little overlapping was found between normals and mild PEM in Waterlow's classification.

Albumin and nutritional oedema

The nature of the association between plasma albumin and nutritional oedema has been examined by observing the changes in albumin during loss of oedema in patients on a restricted diet. Since there was no difference in the concentration of plasma albumin before and after loss of oedema, the association is not causal. These results provide no support for the assertion that nutritional oedema should be treated with a high-protein diet or an albumin infusion.

Plasma zinc and the clinical features of malnutrition

Human protein-energy malnutrition and zinc deficiency have common clinical features. These were related to the plasma zinc concentrations in 42 severely malnourished children. A low plasma zinc concentration was strongly associated with nutritional edema but not with the degree of edema or the plasma albumin concentration. In the absence of edema, there were significant relationships between plasma zinc concentrations and stunting, skin ulceration, and wasting. Infection was not necessarily associated with a lower zinc concentration. From these data it can be predicted that a malnourished child with edema, skin ulceration, stunting, or severe wasting, will have a low plasma zinc concentration.

Antithrombin activities in childhood malnutrition

Antithrombin activities in 30 severely malnourished children and 40 normal children were estimated in clotting tests by thrombin neutralisation as anti-Xa and by a heparin antithrombin assay; and by immunodiffusion as alpha 2-globulin and alpha 1-antitrypsin. The patients' mean alpha 2-globulin was severely depressed, and there were less marked depletions in mean values for thrombin neutralisation, anti-Xa, and in the heparin antithrombin assay (which showed the flat curve thought to reflect a thrombotic tendency). The alpha 1-antitrypsin values were normal. The findings support the concept of antithrombin as the summation of alpha 2-globulin and alpha 1-antitrypsin (with alpha 2-macroglobulin); and the low values may be related to the high incidence of thrombosis reported in childhood malnutrition, although it was not seen in these patients.