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Pham TPT, Alou MT, Golden MH, Million M, Raoult D. Difference between kwashiorkor and marasmus: Comparative meta-analysis of pathogenic characteristics and implications for treatment. Microb Pathog 2021; 150:104702. [PMID: 33359074 DOI: 10.1016/j.micpath.2020.104702] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022]
Abstract
Kwashiorkor and marasmus are two clinical syndromes observed in severe acute malnutrition. In this review, we highlighted the differences between these two syndromes by reviewing the data comparing kwashiorkor and marasmus in literature, combined with recent microbiological findings and meta-analysis. Depletion of antioxidants, vitamins and minerals were more severe in kwashiorkor than marasmus. This was consistent with the severe and uncontrolled oxidative stress associated with the depletion of gut anaerobes and the relative proliferation of aerotolerant gut pathogens. This relative proliferation and invasion of gut microbes belonging to the aerotolerant Proteobacteria phylum and pathogens suggested a specific microbial process critical in the pathogenesis of kwashiorkor. Liver mitochondrial and peroxisomal dysfunction could be secondary to toxic microbial compounds produced in the gut such as ethanol, lipopolysaccharides and endotoxins produced by Proteobacteria, particularly Klebsiella pneumoniae, and aflatoxin produced by Aspergillus species. The gut-liver axis alteration is characterized by oedema and a fatty and enlarged liver and was associated with a dramatic depletion of methionine and glutathione, an excessive level of free circulating iron and frequent lethal bacteraemia by enteric pathogens. This was consistent with the fact that antibiotics improved survival only in children with kwashiorkor but not marasmus. The specific pathogenic characteristics of kwashiorkor identified in this review open new avenues to develop more targeted and effective treatments for both marasmus and/or kwashiorkor. Urgent correction of plasma glutathione depletion, alongside supply of specific essential amino acids, particularly methionine and cysteine, early detection of pathogens and an antibiotic more efficient than amoxicillin in supressing gut Proteobacteria including K. pneumoniae, and probiotics to restore the human gut anaerobic mature microbiota could save many more children with kwashiorkor.
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Affiliation(s)
- Thi-Phuong-Thao Pham
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - Maryam Tidjani Alou
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - Michael H Golden
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, Scotland, UK
| | - Matthieu Million
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France
| | - Didier Raoult
- Aix-Marseille Univ, IRD, APHM, MEPHI, Marseille, France; IHU Méditerranée Infection, Marseille, France.
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2
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Shokry E, Sadiq K, Soofi S, Habib A, Bhutto N, Rizvi A, Ahmad I, Demmelmair H, Uhl O, Bhutta ZA, Koletzko B. Impact of Treatment with RUTF on Plasma Lipid Profiles of Severely Malnourished Pakistani Children. Nutrients 2020; 12:nu12072163. [PMID: 32708260 PMCID: PMC7401247 DOI: 10.3390/nu12072163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 12/22/2022] Open
Abstract
(1) Background: Little is known on impacts of ready-to-use therapeutic food (RUTF) treatment on lipid metabolism in children with severe acute malnutrition (SAM). (2) Methods: We analyzed glycerophospholipid fatty acids (FA) and polar lipids in plasma of 41 Pakistani children with SAM before and after 3 months of RUTF treatment using gas chromatography and flow-injection analysis tandem mass spectrometry, respectively. Statistical analysis was performed using univariate, multivariate tests and evaluated for the impact of age, sex, breastfeeding status, hemoglobin, and anthropometry. (3) Results: Essential fatty acid (EFA) depletion at baseline was corrected by RUTF treatment which increased EFA. In addition, long-chain polyunsaturated fatty acids (LC-PUFA) and the ratio of arachidonic acid (AA)/linoleic acid increased reflecting greater EFA conversion to LC-PUFA, whereas Mead acid/AA decreased. Among phospholipids, lysophosphatidylcholines (lyso.PC) were most impacted by treatment; in particular, saturated lyso.PC decreased. Higher child age and breastfeeding were associated with great decrease in total saturated FA (ΣSFA) and lesser decrease in monounsaturated FA and total phosphatidylcholines (ΣPC). Conclusions: RUTF treatment improves EFA deficiency in SAM, appears to enhance EFA conversion to biologically active LC-PUFA, and reduces lipolysis reflected in decreased ΣSFA and saturated lyso.PC. Child age and breastfeeding modify treatment-induced changes in ΣSFA and ΣPC.
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Affiliation(s)
- Engy Shokry
- Department of Pediatrics, Ludwig-Maximilians-University Paediatrics, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, 80337 Munich, Germany; (E.S.); (H.D.); (O.U.)
| | - Kamran Sadiq
- Department of Pediatrics & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan; (K.S.); (S.S.)
| | - Sajid Soofi
- Department of Pediatrics & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan; (K.S.); (S.S.)
- Center of Excellence in Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan; (A.H.); (N.B.); (A.R.); (I.A.)
| | - Atif Habib
- Center of Excellence in Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan; (A.H.); (N.B.); (A.R.); (I.A.)
| | - Naveed Bhutto
- Center of Excellence in Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan; (A.H.); (N.B.); (A.R.); (I.A.)
| | - Arjumand Rizvi
- Center of Excellence in Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan; (A.H.); (N.B.); (A.R.); (I.A.)
| | - Imran Ahmad
- Center of Excellence in Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan; (A.H.); (N.B.); (A.R.); (I.A.)
| | - Hans Demmelmair
- Department of Pediatrics, Ludwig-Maximilians-University Paediatrics, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, 80337 Munich, Germany; (E.S.); (H.D.); (O.U.)
| | - Olaf Uhl
- Department of Pediatrics, Ludwig-Maximilians-University Paediatrics, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, 80337 Munich, Germany; (E.S.); (H.D.); (O.U.)
| | - Zulfiqar A. Bhutta
- Center of Excellence in Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan; (A.H.); (N.B.); (A.R.); (I.A.)
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Correspondence: (Z.A.B.); (B.K.); Tel.: +17-573248424 (Z.A.B.); +49-89-44005-2826 (B.K.); Fax: +49-89-44005-7742 (B.K.)
| | - Berthold Koletzko
- Department of Pediatrics, Ludwig-Maximilians-University Paediatrics, Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, 80337 Munich, Germany; (E.S.); (H.D.); (O.U.)
- Correspondence: (Z.A.B.); (B.K.); Tel.: +17-573248424 (Z.A.B.); +49-89-44005-2826 (B.K.); Fax: +49-89-44005-7742 (B.K.)
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Hosios AM, Hecht VC, Danai LV, Johnson MO, Rathmell JC, Steinhauser ML, Manalis SR, Vander Heiden MG. Amino Acids Rather than Glucose Account for the Majority of Cell Mass in Proliferating Mammalian Cells. Dev Cell 2016; 36:540-9. [PMID: 26954548 DOI: 10.1016/j.devcel.2016.02.012] [Citation(s) in RCA: 422] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/15/2016] [Accepted: 02/09/2016] [Indexed: 01/01/2023]
Abstract
Cells must duplicate their mass in order to proliferate. Glucose and glutamine are the major nutrients consumed by proliferating mammalian cells, but the extent to which these and other nutrients contribute to cell mass is unknown. We quantified the fraction of cell mass derived from different nutrients and found that the majority of carbon mass in cells is derived from other amino acids, which are consumed at much lower rates than glucose and glutamine. While glucose carbon has diverse fates, glutamine contributes most to protein, suggesting that glutamine's ability to replenish tricarboxylic acid cycle intermediates (anaplerosis) is primarily used for amino acid biosynthesis. These findings demonstrate that rates of nutrient consumption are indirectly associated with mass accumulation and suggest that high rates of glucose and glutamine consumption support rapid cell proliferation beyond providing carbon for biosynthesis.
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Affiliation(s)
- Aaron M Hosios
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vivian C Hecht
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Laura V Danai
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Marc O Johnson
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jeffrey C Rathmell
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Matthew L Steinhauser
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Scott R Manalis
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Matthew G Vander Heiden
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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4
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Babirekere-Iriso E, Lauritzen L, Mortensen CG, Rytter MJH, Mupere E, Namusoke H, Michaelsen KF, Briend A, Stark KD, Metherel AH, Friis H. Essential fatty acid composition and correlates in children with severe acute malnutrition. Clin Nutr ESPEN 2016; 11:e40-e46. [PMID: 28531425 DOI: 10.1016/j.clnesp.2015.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/30/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Severe acute malnutrition (SAM) is a common condition in children living in low-income countries and may be associated with reduced polyunsaturated fatty acids (PUFA) blood levels. The purpose of this study was to describe whole blood fatty acid composition and correlates of PUFA in children admitted with SAM. METHODS We conducted a cross-sectional study among children admitted with SAM at Mulago National Referral Hospital and healthy controls. Whole blood fatty acid composition was measured and correlated with clinical data such as oedema, levels of haemoglobin, C-reactive protein and HIV-infection status. Multiple linear regression analyses were used to identify correlates of PUFA. RESULTS The relative contribution of saturated fatty acid to the fatty acids in whole blood (FA%) were lower in 108 children with SAM compared to 24 well-nourished controls whereas most monounsaturated fatty acids were higher in children with SAM. Total and all n-6 PUFA including linoleic (18:2n-6, LA) and arachidonic acid (20:4n-6, AA), as well as total n-3 PUFA and docosahexaenoic acid (22:6n-3, DHA) were lower in children with SAM. The n-6:n-3 PUFA ratio was also lower in the children with SAM. Haemoglobin was a positive correlate of AA, n-3 docosapentaenoic acid (22:5n-3, n-3 DPA), DHA, total n-6 long chain (LC) PUFA and total n-3 LCPUFA. HIV infected children had 0.87 (0.47; 1.58) %-points less n-6 LCPUFA and 0.61 (0.03; 1.19) %-points less AA than the un-infected children. CONCLUSION Children with SAM presented with lower FA% of LCPUFA. HIV infection and low haemoglobin were also associated with lower FA% of LCPUFA, which may be related to lower numbers of blood cells. Nutrition rehabilitation interventions need to pay more attention to the intake of PUFA.
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Affiliation(s)
- Esther Babirekere-Iriso
- Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago Hospital, Kampala, Uganda; Department of Nutrition, Exercise and Sports, University of Copenhagen, Faculty of Science, Copenhagen, Denmark.
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Faculty of Science, Copenhagen, Denmark.
| | - Charlotte Gylling Mortensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Faculty of Science, Copenhagen, Denmark.
| | | | - Ezekiel Mupere
- Makerere College of Health Sciences, Department of Paediatrics, Kampala, Uganda.
| | - Hanifa Namusoke
- Mwanamugimu Nutrition Unit, Department of Paediatrics, Mulago Hospital, Kampala, Uganda.
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Faculty of Science, Copenhagen, Denmark.
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Faculty of Science, Copenhagen, Denmark.
| | - Ken D Stark
- Department of Kinesiology, University of Waterloo, Canada.
| | | | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Faculty of Science, Copenhagen, Denmark.
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Jones KDJ, Ali R, Khasira MA, Odera D, West AL, Koster G, Akomo P, Talbert AWA, Goss VM, Ngari M, Thitiri J, Ndoro S, Knight MAG, Omollo K, Ndungu A, Mulongo MM, Bahwere P, Fegan G, Warner JO, Postle AD, Collins S, Calder PC, Berkley JA. Ready-to-use therapeutic food with elevated n-3 polyunsaturated fatty acid content, with or without fish oil, to treat severe acute malnutrition: a randomized controlled trial. BMC Med 2015; 13:93. [PMID: 25902844 PMCID: PMC4407555 DOI: 10.1186/s12916-015-0315-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/09/2015] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Ready-to-use therapeutic foods (RUTF) are lipid-based pastes widely used in the treatment of acute malnutrition. Current specifications for RUTF permit a high n-6 polyunsaturated fatty acid (PUFA) content and low n-3 PUFA, with no stipulated requirements for preformed long-chain n-3 PUFA. The objective of this study was to develop an RUTF with elevated short-chain n-3 PUFA and measure its impact, with and without fish oil supplementation, on children's PUFA status during treatment of severe acute malnutrition. METHODS This randomized controlled trial in children with severe acute malnutrition in rural Kenya included 60 children aged 6 to 50 months who were randomized to receive i) RUTF with standard composition; ii) RUTF with elevated short chain n-3 PUFA; or iii) RUTF with elevated short chain n-3 PUFA plus fish oil capsules. Participants were followed-up for 3 months. The primary outcome was erythrocyte PUFA composition. RESULTS Erythrocyte docosahexaenoic acid (DHA) content declined from baseline in the two arms not receiving fish oil. Erythrocyte long-chain n-3 PUFA content following treatment was significantly higher for participants in the arm receiving fish oil than for those in the arms receiving RUTF with elevated short chain n-3 PUFA or standard RUTF alone: 3 months after enrollment, DHA content was 6.3% (interquartile range 6.0-7.3), 4.5% (3.9-4.9), and 3.9% (2.4-5.7) of total erythrocyte fatty acids (P <0.001), respectively, while eicosapentaenoic acid (EPA) content was 2.0% (1.5-2.6), 0.7% (0.6-0.8), and 0.4% (0.3-0.5) (P <0.001). RUTF with elevated short chain n-3 PUFA and fish oil capsules were acceptable to participants and carers, and there were no significant differences in safety outcomes. CONCLUSIONS PUFA requirements of children with SAM are not met by current formulations of RUTF, or by an RUTF with elevated short-chain n-3 PUFA without additional preformed long-chain n-3 PUFA. Clinical and growth implications of revised formulations need to be addressed in large clinical trials. TRIAL REGISTRATION Clinicaltrials.gov NCT01593969. Registered 4 May 2012.
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Affiliation(s)
- Kelsey D J Jones
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
- Centre for Global Health Research and Section of Paediatrics, Imperial College, Norfolk Place, London, W2 1PG, UK.
| | - Rehema Ali
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | | | - Dennis Odera
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | - Annette L West
- Faculty of Medicine, University of Southampton, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - Grielof Koster
- Faculty of Medicine, University of Southampton, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - Peter Akomo
- Valid Nutrition, Cuibín Farm, Derry Duff, Bantry, Co., Cork, Republic of Ireland.
| | | | - Victoria M Goss
- Southampton National Institute of Health Research Respiratory Biomedical Research Unit, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - Moses Ngari
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | | | - Said Ndoro
- Kilifi County Hospital, Ministry of Health, Kilifi, 230-80108, Kenya.
| | - Miguel A Garcia Knight
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK.
| | - Kenneth Omollo
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | - Anne Ndungu
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | - Musa M Mulongo
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
| | - Paluku Bahwere
- Valid International, 35 Leopold Street, Oxford, OX4 1TW, UK.
| | - Greg Fegan
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK.
| | - John O Warner
- Centre for Global Health Research and Section of Paediatrics, Imperial College, Norfolk Place, London, W2 1PG, UK.
| | - Anthony D Postle
- Faculty of Medicine, University of Southampton, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - Steve Collins
- Valid Nutrition, Cuibín Farm, Derry Duff, Bantry, Co., Cork, Republic of Ireland.
- Valid International, 35 Leopold Street, Oxford, OX4 1TW, UK.
| | - Philip C Calder
- Faculty of Medicine, University of Southampton, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
- National Institute of Health Southampton Biomedical Research Centre, Southampton General Hosptial, Tremona Road, Southampton, SO16 6YD, UK.
| | - James A Berkley
- KEMRI-Wellcome Trust Research Programme, Kilifi, 230-80108, Kenya.
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine & Global Health, University of Oxford, Old Road Campus, Roosevelt Drive, Oxford, OX3 7FZ, UK.
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Teixeira A, Pase C, Boufleur N, Roversi K, Barcelos R, Benvegnú D, Segat H, Dias V, Reckziegel P, Trevizol F, Dolci G, Carvalho N, Soares F, Rocha J, Emanuelli T, Bürger M. Exercise affects memory acquisition, anxiety-like symptoms and activity of membrane-bound enzyme in brain of rats fed with different dietary fats: impairments of trans fat. Neuroscience 2011; 195:80-8. [DOI: 10.1016/j.neuroscience.2011.08.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 07/28/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
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Smit EN, Muskiet FAJ, Boersma ER. The possible role of essential fatty acids in the pathophysiology of malnutrition: a review. Prostaglandins Leukot Essent Fatty Acids 2004; 71:241-50. [PMID: 15301795 DOI: 10.1016/j.plefa.2004.03.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2003] [Accepted: 03/17/2004] [Indexed: 10/26/2022]
Abstract
Biochemical evidence of essential fatty acid deficiency (EFAD) may exist in protein-energy malnutrition (PEM). EFAD is characterised by low 18:2omega6, often in combination with low 20:4omega6 and 22:6omega3, and high 18:1omega9 and 20:3omega9. Some PEM symptoms, notably skin changes, impaired resistance to infections, impaired growth rate and disturbed development may at least partly be explained by EFAD. One or more of the following factors could induce EFAD in PEM: low EFA intake, poor lipid digestion, absorption, transport, desaturation and increased EFA beta-oxidation and peroxidation. EFAD may perpetuate itself by decreasing lipid absorption and transport, and aggravate PEM by impairing nutrient absorption and dietary calorie utilisation. Micronutrient deficiencies may contribute to the impaired EFA bioavailability and metabolism. Nutritional rehabilitation strategies in PEM may consider adequate intakes of EFA and micronutrients, e.g. by promoting breastfeeding. More research is required to gain detailed insight into the role of EFAD in PEM.
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Affiliation(s)
- Ella N Smit
- Department of Pathology and Laboratory Medicine, c/o Prof. Dr. Frits A.J. Muskiet, CMC-V, Y1.147, Groningen University Hospital, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
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8
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Trebble TM, Wootton SA, May A, Erlewyn-Lajeunesse MDS, Chakraborty A, Mullee MA, Stroud MA, Beattie RM. Essential fatty acid status in paediatric Crohn's disease: relationship with disease activity and nutritional status. Aliment Pharmacol Ther 2003; 18:433-42. [PMID: 12940929 DOI: 10.1046/j.1365-2036.2003.01707.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Active paediatric Crohn's disease is associated with nutritional deficiencies and altered nutrient intake. The availability of essential fatty acids (linoleic and alpha-linolenic acids) or their derivatives (arachidonic and eicosapentaenoic acids) may alter in plasma and cell membrane phospholipid in protein-energy malnutrition in children and in Crohn's disease in adults. AIM To investigate the relationship of fatty acid phospholipid profiles with disease activity and nutritional status in paediatric Crohn's disease. METHODS The fatty acid (proportionate) composition of plasma and erythrocyte phosphatidylcholine was determined in 30 patients (10.3-17.0 years) stratified into active and quiescent Crohn's disease (paediatric Crohn's disease activity index) and high and low body mass (body mass index centile). RESULTS In plasma phosphatidylcholine, active disease activity was associated with a lower level of alpha-linolenic acid compared with that in quiescent disease (P < 0.05). A body mass index below the 50th centile was associated with active Crohn's disease, low linoleic and alpha-linolenic acids and high arachidonic acid (P < 0.05) in plasma phosphatidylcholine, and low alpha-linolenic acid in erythrocyte phosphatidylcholine. These findings could not be explained through differences in habitual dietary fat intake. CONCLUSION In paediatric Crohn's disease, a low body mass index centile and high disease activity are associated with altered profiles of essential fatty acids and their derivatives, which may reflect altered metabolic demand.
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Affiliation(s)
- T M Trebble
- Institute of Human Nutrition, School of Medicine, University of Southampton, Southampton, UK.
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9
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Decsi T, Koletzko B. Effects of protein-energy malnutrition and human immunodeficiency virus-1 infection on essential fatty acid metabolism in children. Nutrition 2000; 16:447-53. [PMID: 10869902 DOI: 10.1016/s0899-9007(00)00283-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This report summarizes data on the availability of essential fatty acids (EFAs) and their long-chain polyunsaturated fatty acid (LCPUFA) metabolites in protein-energy malnutrition (PEM), in human immunodeficiency virus-1 (HIV-1) infection for which less information is available, and the combination of both PEM and HIV-1. The contribution of different EFAs and LCPUFAs to the fatty-acid composition of plasma and erythrocyte membrane lipids was found to be reduced in children with PEM in comparison with well-nourished children. In addition to limited dietary EFA supply, reduced bioconversion of EFAs to their respective LCPUFA metabolites and/or peroxidative degradation of LCPUFAs may contribute to the reduction of LCPUFA status in malnourished children. Restoration of normal energy, protein, and EFA intakes does not appear to readily correct abnormalities of plasma and erythrocyte membrane LCPUFA values. Enhanced dietary supply of LCPUFAs and/or improved supply of antioxidant vitamins may represent novel therapeutic modalities in severe PEM. With and without PEM, HIV infection was related to altered availability of various EFAs and LCPUFAs in HIV-seropositive children. The plasma total lipid fatty-acid profiles seen in well-nourished children with HIV infection were compatible with an HIV infection-related enhancement of the metabolic activity of the conversion of EFAs to their respective LCPUFA metabolites. However, the plasma phospholipid EFA and LCPUFA profiles seen in severely malnourished children with HIV infection more closely resembled those seen in children with PEM but without HIV infection than in those in children with HIV infection but no PEM. Metabolic studies using stable isotope-labeled fatty acids may contribute to better understanding of the HIV-related changes in EFA metabolism and clearly are needed before therapeutic conclusions can be drawn.
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Affiliation(s)
- T Decsi
- Division of Metabolic Disorders and Nutrition, Department of Pediatrics, Dr. von Haunersches Kinderspital, Ludwig-Maximilians University, Munich, Germany
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10
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Smit EN, Dijkstra JM, Schnater TA, Seerat E, Muskiet FA, Boersma ER. Effects of malnutrition on the erythrocyte fatty acid composition and plasma vitamin E levels of Pakistani children. Acta Paediatr 1997; 86:690-5. [PMID: 9240874 DOI: 10.1111/j.1651-2227.1997.tb08569.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Erythrocyte fatty acids and plasma vitamin E concentrations were determined in 47 grade 2 and 21 grade 3 malnourished Pakistani children (ages 4-56 months). Data were compared with those of 26 age- and sex-matched apparently healthy controls. Evaluation with three statistical approaches revealed that both grade 2 and grade 3 malnourished children had decreased erythrocyte omega6 fatty acids and to a lesser extent decreased omega3 fatty acids. These decreases were compensated for by increased omega9 fatty acids. The patients tended to have lower plasma vitamin E concentrations. We conclude that malnourished Pakistani children have low essential fatty acid status, notably those of the omega6 series. The combination of low erythrocyte 22:6omega3 and a low 22:5omega6/22:4omega6 ratio in grade 2 patients suggests low delta4-desaturation activity, which may be due to impaired peroxisomal beta-oxidation.
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Affiliation(s)
- E N Smit
- Department of Obstetrics and Gynaecology, University Hospital, Groningen, The Netherlands
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11
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VanderJagt DJ, Glew RH, Bizzozero OA, Saha AK, Omene JA. Altered fatty acid composition of serum phospholipids in protein-malnourished Nigerian children. Nutr Res 1996. [DOI: 10.1016/0271-5317(96)00139-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Leichsenring M, Sütterlin N, Less S, Bäumann K, Anninos A, Becker K. Polyunsaturated fatty acids in erythrocyte and plasma lipids of children with severe protein-energy malnutrition. Acta Paediatr 1995; 84:516-20. [PMID: 7633146 DOI: 10.1111/j.1651-2227.1995.tb13685.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The fatty acid composition of plasma cholesterol esters, plasma phospholipids, erythrocyte phosphatidylcholine and erythrocyte phosphatidylethanolamine was investigated in severely malnourished Nigerian children with kwashiorkor (n = 12) and marasmus (n = 32). Normally nourished children from the same area (n = 23) served as controls. The malnourished children showed a significant reduction of highly polyunsaturated fatty acids in cholesterol esters, phospholipids and phosphatidylcholine. No differences between the groups were found in erythrocyte phosphatidylethanolamine. Children with kwashiorkor had lower levels of linoleic acid metabolites and docosahexaenoic acid than marasmic children. The results suggest that the kwashiorkor syndrome is associated with impaired desaturation and elongation of PUFA and/or increased lipid peroxidation.
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Affiliation(s)
- M Leichsenring
- University of Children's Hospital, Division of Tropical Pediatrics, Heidelberg, Germany
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13
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Cederholm TE, Berg AB, Johansson EK, Hellström KH, Palmblad JE. Low levels of essential fatty acids are related to impaired delayed skin hypersensitivity in malnourished chronically ill elderly people. Eur J Clin Invest 1994; 24:615-20. [PMID: 7828633 DOI: 10.1111/j.1365-2362.1994.tb01113.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Essential fatty acid (FA) deficiency, which may accompany protein-energy malnutrition (PEM), has been associated with impaired inflammatory reactions. We evaluated this relationship by analysing FA profiles and delayed cutaneous hypersensitivity in 20 malnourished elderly non-cancer patients and in 20 age-matched control patients. As indicated by serum cholesterol and serum triglycerides, the lipid levels were decreased by about one-third in the subjects with PEM. In comparison with the controls, there was a reduction in the omega 3 FA (e.g. eicosapentanoate) in total serum lipids (mg l-1) and serum phospholipids (%) of 40% and 47%, respectively. Reductions in serum omega 6 FA (e.g. linoleate and arachidonate) levels corresponded to the drop in total FA concentrations (30%). The cutaneous hypersensitivity was impaired in 14 of the malnourished patients. The magnitude of the skin reaction was positively correlated (P < 0.05) to the concentrations of eicosapentanoate in serum lipids and serum phospholipids, as well as to the linoleate concentration in total serum lipids. Six of the malnourished patients took part in a nutritional intervention programme for 3 months. In parallel with an improvement in the nutritional status there was a 35% increase (P < 0.05) in the total omega 3 FA serum concentration. Negative skin tests became positive and the median skin induration enlarged threefold (P < 0.05). Thus, deficiency of omega 3 FA might be one factor contributing to cutaneous anergy in elderly malnourished patients.
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Affiliation(s)
- T E Cederholm
- Karolinska Institute, Department of Medicine, Stockholm Söder Hospital, Sweden
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14
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Bouziane M, Prost J, Belleville J. Dietary protein deficiency affects n-3 and n-6 polyunsaturated fatty acids hepatic storage and very low density lipoprotein transport in rats on different diets. Lipids 1994; 29:265-72. [PMID: 8177019 DOI: 10.1007/bf02536331] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fatty livers and the similarity between the skin lesions in kwashiorkor and those described in experimental essential fatty acid (EFA) deficiency have led to the hypothesis that protein and EFA deficiencies may both occur in chronic malnutrition. The relationship between serum very low density lipoprotein (VLDL) and hepatic lipid composition was studied after 28 d of protein depletion to determine the interactions between dietary protein levels and EFA availability. Rats were fed purified diets containing 20 or 2% casein and 5% fat as either soybean oil rich in EFA, or salmon oil rich in eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, or hydrogenated coconut oil poor in EFA. Animals were divided into six groups, SOC (20% casein + 5% soybean oil), SOd (2% casein + 5% soybean oil), COC (20% casein + 5% hydrogenated coconut oil), COd (2% casein + 5% hydrogenated coconut oil), SAC (20% casein + 5% salmon oil) and SAd (2% casein + 5% salmon oil). After 28 d, liver steatosis and reduced VLDL-phospholipid contents (P < 0.001) were observed in protein-deficient rats. In protein deficiency, triacylglycerol and phospholipid fatty acid compositions in both liver and VLDL showed a decreased polyunsaturated-to-saturated fatty acid ratio. This ratio was higher with the salmon oil diets and lower with the hydrogenated coconut oil diets. Furthermore, independent of the oil in the diet, protein deficiency decreased linoleic and arachidonic acids in VLDL phospholipids. Conversely, despite decreased proportions of EPA at low protein levels, DHA levels remained higher in rats fed salmon oil diets.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Bouziane
- Unité de Recherches de Nutrition Cellulaire et Métabolique, Université de Bourgogne, Faculté des Sciences Mirande, Dijon, France
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Narce M, Poisson JP, Belleville J, Chanussot B. Depletion of delta 9 desaturase (EC 1.14.99.5) enzyme activity in growing rat during dietary protein restriction. Br J Nutr 1992; 68:627-37. [PMID: 1493132 DOI: 10.1079/bjn19920121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effects of protein restriction on delta 9 desaturase (EC 1.14.99.5) activity were studied in growing rats. A control group was fed on a balanced diet (200 g casein/kg; BD) for 28 d. The experimental group was fed on the low-protein diet (20 g casein/kg; LP) for 26 d, then refed the balanced diet (BD-R) for 2 d. Rats were born to and suckled from normally fed dams. The enzyme activity was measured after 2 and 14 d of LP, and 26 d of LP plus 2 d of BD-R, by incubations in vitro of hepatic microsomal pellets with [1-14C]steric acid. The results indicated a decreased delta 9 desaturase activity after 2 and 14 d of LP of -33 and -43% respectively. Refeeding for 2 d was sufficient to super-repair this activity (+66%). The fatty acid composition of total liver lipids and microsomal phosphatidylethanolamines (PE) and phosphatidylcholines (PC) were also investigated; 18:0 decreased in total liver lipids at 14 d of LP, when 18:1n-9 increased. Stearic acid (18:0) increased in PC at 2 d of LP and in PE at 14 d of LP; oleic acid (18:1n-9) did not change. Therefore, it is concluded that a defect occurred in the bioconversion of 18:0 into 18:1n-9 by delta 9 desaturation during protein depletion. As oleic acid is accumulated in total liver lipids during LP, we speculate that this is due to a decreased oxidation or transport of this fatty acid.
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Affiliation(s)
- M Narce
- Unité de Recherches en Nutrition Cellulaire et Métabolique, Faculté des Sciences Mirande, Dijon, France
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Payne-Robinson HM, Brown R. The effect of malnutrition on insulin binding to rat erythrocytes. Br J Nutr 1992; 67:279-86. [PMID: 1596500 DOI: 10.1079/bjn19920031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Insulin binding to erythrocyte receptors was compared in malnourished and control rats. Percentage specific insulin binding to malnourished rat erythrocytes was significantly lower than to control erythrocytes (P less than 0.001). The low insulin binding in the malnourished rat erythrocytes was accompanied by low insulin receptor affinity (P = 0.035).
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Affiliation(s)
- H M Payne-Robinson
- Tropical Metabolism Research Unit, University of the West Indies, Kingston, Jamaica
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