Plasma carnitine levels in children with protein-calorie malnutrition before and after rehabilitation

Plasma carnitine and albumin levels were measured in children suffering from protein-calorie malnutrition, before and after rehabilitation, and in apparently healthy controls. Both the constituents were lower in malnourished children and improved after treatment. Plasma carnitine showed significant positive correlation with plasma albumin.

A study of enocrine function in protein-energy malnutrition

Serum concentration of cortisol, growth hormone, thyroxine, thyroid stimulating hormone, follicle stimulating hormone and luteinising hormone, together with triiodothyronine uptake have been measured in Nigerian children with kwashiorkor and marasmus and compared with controls. In both types of malnutrition the cortisol and growth hormone concentrations are raised, whereas those of thyroxine and thyroid stimulating hormone are lowered compared with the controls. Triiodothyronine uptake is lowered in malnutrition but there is no apparent effect on follicle stimulating hormone or luteinising hormone in this age group.

Protein calorie malnutrition (PCM) in Egypt: comparative study of the electrolyte pattern in plasma and erythrocytes

The electrolytes sodium, potassium, calcium and magnesium were determined in both plasma and erythrocytes of 300 PCM subjects and 26 parallel healthy controls. The results obtained revealed that: The level of plasma sodium was lower than normal in all PCM cases except in marasmic kwashiorkor. The RBC's sodium content was more or less not affected. Plasma potassium level was markedly lower than normal in all groups of malnourished subjects. RBC's potassium was significantly lower than normal in severe K.W.O. and marasmic kwashiorkor, while it was high in 3rd grade marasmus. Magnesium level was lower than normal in both plasma and RBC's in all malnourished subjects. Calcium level dropped in plasma and was elevated in RBC's. Estimation of RBC's minerals may be useful in reflecting the concerned changes in tissues of PCM subjects.

Quantitative immunodiffusion assay of serum protein patterns in protein calorie malnutrition (PCM)

Serum protein components were evaluated by the specific radial immunodiffusion technique in a number of protein energy malnourished infants and young children, as well as in a group of parallel controls. Results show a drop in both serum prealbumin and albumin in concordance with the severity of the condition in both KWO and marasmus. Serum level of varies as 1-acidic glycoprotein was elevated, being more marked in KWO than in marasmus. Serum oc1-antitrypsin, haemopexin, ceruloplasmin and transferrin were all reduced but to a varying extent in both KWO and marasmus. The levels of serum IgA and IgM were above normal in all disease entities except for a slight decrease of IgA in 2nd grade marasmus. On the other hand, serum IgG was reduced in the majority of cases. The ratio of serum cerutoplasmin to transferrin in KWO was found to be of diagnostic value in different grades of the disease.

Metabolic and hormonal responses to a protein-glucose meal in normal infants and in marasmus and marasmic kwashiorkor

Blood sugar and plasma free fatty acids (FFA), immunoreactive insulin (IRI), and growth hormone (GH) responses to a protein-glucose meal were determined in normal infants and those with marasmus and marasmic kwashiorkor. Among the normal subjects, fasting blood sugar (BS), peak BS and IRI, and the IRI/BS ratio tended to decrease as age increased. Peak IRI was at least 13muU/ml above fasting in 21 of 24 infants. Fasting GH levels were high 38.5 +/- 13.6 (SD) and 26.3 +/- 14.0 ng/ml, in the two youngest groups (under 1 year) and were comparable with those of the late newborn period. They were slightly lower, 20.8 +/- 22.1, in those 12.5-18.5 months of age. Suppressions of FFA and subsequent rebounds were in close temporal relation to BS and IRI peaks and lows, but not the GH levels. GH was promptly suppressed by the meal, and in most infants secondary elevations were seen. Untreated marasmic infants had normal or low BS, correspondingly normal or low IRI, markedly elevated FFA (1,821 +/- 588 muEq/liter), and GH levels comparable with those of the control subjects. There was some delay in BS elevation and disappearance and poor insulin release after the meal, with only two of nine having elevations of at least 13 muU /ml The BS elevations and IRI responses, however, were adequate to block FFA release. GH levels were poorly suppressed by the meal but some infants had further elevations, possibly in response to protein. After partial rehabilitation, fasting BS and FFA and BS elevations after the meal were normal. A slight improvement in insulin release was apparent. Fasting GH levels and responses to the meal were normal. Fasting, minimally treated children with marasmic kwashiorkor (MK) had normal or low BS, normal or low IRI, normal FFA, and probably normal GH levels. There was considerable delay in BS elevation, moderately delayed glucose disappearance, and very poor or unmeasurable insulin release after the test meal; FFA and GH were poorly suppressed. After partial rehabilitation, fasting BS was normal, FFA levels were (630 +/- 163 muEq/l), IRI was still low, BS elevations and disappearance improved. IRI responses modestly improved, and GH responses were normal.

Serum cholesterol esterifying activity in kwasiorkor

Serum lipid levels were determined in 30 children with kwashiorkor and in 30 healthy children of comparable age. The serum concentrations of unesterified and esterified cholesterol, albumin and the cholesterol esterifying activity (CEA) were also measured in children with kwashiorkor before treatment and after recovery. All serum lipid fractions were significantly lower in kwashiorkor than in the normal children. After treatment and recovery, serum lipid levels were comparable to those observed in normal children. There was also a significant increase in serum cholesterol esterifying activity (CEA) following recovery from kwashiorkor.

Serum albumin and transferrin protein-energy malnutrition. Their use in the assessment of marginal undernutrition and the prognosis of severe undernutrition

1. Deficits in weight- and length-for-age, and serum albumin and transferrin concentrations were determined for children who were either marginally undernourished (twenty-five children) or suffering from either marasmus (thirty-two children) or kwashiorkor (twenty-six children) defined according to the Wellcome Classification (Waterlow, 1972). The measurements were also made in eight children with kwashiorkor after the loss of oedema, and in sixteen children who were recovering from either marasmus or kwashiorkor. 2. The mean concentration of serum albumin was similar for children from the 'under-nourished' group and from the group with marasmus, but was significantly reduced in those with kwashiorkor. 3. The concentration of serum transferrin was significantly reduced in both the group of children with marasmus and those with kwashiorkor. The serum transferrin concentration was significantly lower in children with kwashiorkor when compared with the level in those with marasmus. 4. Seventeen children (seven with kwashiorkor and ten with marasmus) died. These children were neither lighter nor shorter than the severely malnourished children who survived. The concentration of serum albumin was not lower in the children who died than in those who survived. 5. In contrast to the results for serum albumin concentrations, the children who died had significantly lower levels of serum transferrin than those who survived. 6. There was a significant linear relationship between serum transferrin concentrations and the deficits in length-for-age (P less than 0-05) and weight-for-length (P less than 0-001) in the marginally undernourished children. The deficit in weight-for-length was also linearly related to the serum transferrin concentrations (P less than 0-001) in children recovering from severe malnutrition. 7. It is suggested that the measurement of serum transferrin concentrations provides an index of severity in severely malnourished children, and should prove useful in field assessments of nutritional status.

Hypoglycaemia associated with severe kwashiorkor

A study was designed to investigate the hypoglycaemia of severe kwashiorkor. The findings of significant stores of hepatic glycogen suggests that glycogenolysis was impaired. Plasma glucagon levels were relatively low, and it is suggested that this might be secondary to either a pancreatic alpha-cell defect, or inadequate sympathetic stimulation.

Pharmacology of malnutrition III: binding of digoxin to normal and kwashiorkor serum

Digoxin binding to normal and kwashiorkor serum was studied and found to be inferior in the latter. Digoxin should be used with care in hypoalbuminemic patients.

Dietary effects in the early recovery phase of kwashiorkor. Plasma levels of triglycerides, FFA, D-beta-hydroxybutyrate, glycerol, postheparin lipoprotein lipase (LPL), glucose and insulin

The fatty liver often found in untreated kwashiorkor has been associated with highly variable concentration of circulating lipids. The effect on lipid metabolism of two isocaloric diets--one synthetic monomolecular (Vivonex) and one standard (Casilan)--which both initiated satisfactory clinical improvement was studied in 21 Ethiopian children with kwashiorkor during the first weeks of rehabilitation. Before treatment mean fasting values of all biochemical parameters were within normal ranges except for moderately elevated triglycerides--an unexpected finding-and low insulin. Individual values varied greatly; triglyceride between 0.39 and 3.49 mmol/1. FFA correlated both to glycerol, D-beta-hydroxybutyrate and triglyceride values. During treatment insulin, glucose and glycerol remained essentially unchanged and were similar in both dietary groups. In the Vivonex group only there was an initial marked, parallel fall of FFA and D-beta-hydroxybutyrate suggesting greater availability of carbohydrate and enhanced glucose utilization. This pattern of response seemed to occur without comparable inhibition of lipolysis. Triglycerides--like serum albumin--increased faster in the Casilan group. The highest mean triglyceride value was reached by day 8 in the Casilan group and by day 15 in the Vivonex group. Ten minutes following heparin injection triglycerides declined, FFA and glycerol increased indicating release of in vivo active lipase. LPL activity assayed in vitro was similar and unaffected by 2 weeks of dietary treatment in both groups. LPL activity was inversely correlated to triglycerides providing--beside the type of diet--another possible explanation for the wide variations seen in circulatory triglycerides.

Fine structural studies of peripheral blood leucocytes from children with kwashiorkor: morphological and functional properties

This is the first report of electron microscopic observation on circulating leucocytes from children with kwashiorkor, Neutrophils showed evidence of immaturity, prominent Golgi zones, granule pleomorphism; strands of endoplasmic reticulum and Döhle bodies were frequent. Although an in vitro microbicidal defect occurs with S. aureus, E. coli and C. albicans, the postphagocytic morphological events, including vacuole formation and degranulation, were normal. In mononuclear cell pellets plasmacytoid cells were frequently observed, and rare lymphoblasts occurred. The findings suggest activation of the phagocytic system and stimulation of humoral immunity in children with kwashiorkor. These fine structural observations are comparable to those which occur in trauma or thermal injury, both conditions associated with tissue breakdown and extensive antigenic stimulation.

Plasma lipids and lipoproteins in protein-calorie malnutrition

Plasma triglycerides, phospholipids and total cholesterol estimations and lipoprotein electrophoresis on agarose gel were done in control, Kwashiorkor, and marasmic kwashiorkor children. The beta lipoprotein percentage in both conditions is reduced to a statistically significant extent, whereas there is a statistically significant increase in plasma triglycerides in both conditions. Pre-beta fraction was present in all cases, and even increased in marasmic kwashiorkor, which is found to be significant. The results do not support the hypothesis that fatty liver in kwashiorkor is due to impaired release of triglycerides from liver.

Serum colloidal osmotic pressure in the development of kwashiorkor and in recovery: its relationship to albumin and globulin concentrations and oedema

1. Serum colloidal osmotic pressure was measured in children 'at risk' to kwashiorkor, in other with frank signs of the disease and during recovery. Simultaneous estimations of serum albumin and globulin concentrations and assessments of the extent of oedema were also made. 2. During the development of kwashiorkor, serum colloidal osmotic pressure did not decrease significantly until albumin concentration was 25-1--27-5 g/l. Above 30-0 g/1, colloidal osmotic pressure was maintained at normal levels during which time a significant reciprocal relationship existed between albumin and globulin concentrations. These findings provide support for suggestions that there may be on oncotic regulation of albumin synthesis. 3. Low albumin concentrations were mainly responsible for the low colloidal osmotic pressures found in children with kwashiorkor and in agreement and previous findings the threshold for the formation of oncotic oedema was found to be about 2-35--2-65 kN/m2. 4. Values for colloidal osmotic pressure calculated from serum albumin and gobulin concentrations using emprical formulas did not agree well with measured values and no constant correction factor suitable over the whole range of albumin concentrations found in rural Ugandan children could be devised. In many hypoalbuminaemic children ony direct measurement of serum colloidal pressure will indicate the true extent of risk to an episode of oedema.

Triiodothyronine and thyroid-stimulating hormone in protein-calorie malnutrition in infants

Protein-calorie malnutrition (P.C.M.) in a group of 43 Senegalese children aged eighteen to thirty months was characterised by a sharp fall in serum-triiodothyronine (T3) concentration to 25-3% of the mean value in healthy age-matched controls. This decrease in T3 was significantly (P less than 0-001) more pronounced in kwashiorkor of recent onset than in long-term P.C.M., a finding which suggests that impaired thyroxine (T4) monodeiodination in the liver was responsible for the fall in serum-T3 concentration rather than a reduction in the secretion of T3 by the thyroid. Serum-T3 concentrations became normal in both malnourished groups after two weeks of appropriate nutrition. Serum-T3 concentrations in healthy, euthyroid, Senegalese children were higher than in White children. In frank kwashiorkor in Senegalese children, serum-thyroid-stimulating-hormone (T.S.H.) concentrations were within the normal range throughout the entire course of dietary therapy, indicating that the children remained euthyroid. In contrast, protracted P.C.M. led to impairment of the T.S.H./T3 feedback mechanism and to a condition resembling hypophysectomy, which required two weeks' dietary therapy for its correction.

Plasma renin activity in oedematous and marasmic children with protein energy malnutrition

Plasma renin activity was measured by bio-assay in 52 children with kwashiorkor, in 28 with marasmus and in 21 healthy children. Plasma renin activity was significantly increased in children with kwashiorkor and marasmus, compared with healthy children, and in children who died, compared with survivors. No strict causal relationship could be found between plasma renin activity and the degree of oedema in kwashiorkor. Increased renin activity probably results from a terminal change in cardiovascular function.

Cortisol and growth hormone in kwashiorkor and marasmus

Cortisol and growth hormone concentrations in the plasma were determined in 26 children with kwashiorkor, 13 with marasmus, and 21 controls. Cortisol levels were high in babies with kwashiorkor and marasmus, but higher in the former, in relation to a constant body mass. The concentration of plasma cortisol correlated positively with the body mass deficit in kwashiorkor (r = 0,66) and in children with low mass for age (r = 0,75). Growth hormone levels were elevated in both kwashiorkor and marasmus. The proposed role of these hormones in metabolic adaptation to malnutrition is discussed.

Serum-albumin as a prognostic indicator in oedematous malnutrition

Examination of the records of 340 children admitted to hospital in Uganda with oedematous malnutrition (kwashiorkor) showed that the serum-albumin concentration at admission was closely related to mortality-rates. Furthermore, in this series, it was not possible to show a simple relation between mortality-rates and the degree of wasting present. The results further emphasise the need to include serum-albumin concentration in international classification systems for the assessment of protein-energy malnutrition, especially that of the kwashiorkor type.