Electrolyte disturbances in Liberian children with kwashiorkor

Workshop no. 2. Parasitic infection and host nutrition

Even if we do not always acknowledge the fact, nutrition is a fundamental aspect of symbiosis and parasitism. (1) The significance of nutrition often forms a basic feature in schemos of classification of the various associations between living organisms (see Read, 1908; Whitfield, 1979). (2) The growth and reproduction of different parasites appear to Vary in response to the nutrition of the host (see Mettrick & Podesta, 1974; Nesheim, Crompton, Arnold & Barnard, 1977; 1978; Parshad, Crompton & Nesheim, 1980). (3) The course of a parasitic infection may also vary in response to the nutritional status of the host and perhaps such variations are the result of the affocts of nutrition on the host's immune response (Chandra & Nowberne, 1977; Chandra, 1980). (4) Finally, parasitic disease is well known to be much more scrious in undernourished hosts (see Chandra & Newberne, 1977); when man's the deprived host, the impact of infections and parasitic disease on young children is Particularly severe and distressing (Latliam, 1975).

[Trace elements in serum of malnourished and well-nourished children living in Lubumbashi and Kawama]

Introduction

La place des éléments traces métalliques essentiels en nutrition humaine ne peut plus être ignorée. Les déficits d'apports, les carences secondaires souvent sous – estimées, et les carences iatrogènes font le lit de pathologies telles que les infections et autres. D'où leurs dosages ont une importance particulière pour en évaluer la gravité et faciliter une prise en charge précoce ou améliorer le régime alimentaire. Cette étude a eu pour objectif de déterminer le profil sanguin en éléments traces (cuivre, sélénium, zinc, fer, chrome, cobalt, etc) chez les enfants malnutris et biens nourris dans un milieu minier à Lubumbashi.

Méthodes

Trois cents onze cas ont été colligés, 182 malnutris et 129 biens nourris, dans une étude descriptive transversale, effectuée de juillet 2013 à décembre 2014. Pour lequel un échantillonnage exhaustif a été réalisé. Le dosage des métaux dans le sérum s'est fait à l’ ICP-OES (spectrométrie de masse à plasma gon induit) au laboratoire de l'Office Congolais de Contrôle de Lubumbashi.

Résultats

Les oligoéléments essentiels (cuivre, zinc, sélénium et fer) se retrouvent à des concentrations très basses chez les enfants malnutris comme chez les biens nourris. L'arsenic, le cadmium, le magnésium et le manganèse se présentent à des concentrations normales par rapport aux valeurs de références chez les enfants biens nourris. L'antimoine, le chrome, le plomb et le cobalt se retrouvent élevés chez les malnutris et biens nourris. Le nickel est normal chez les malnutris et les biens nourris. Le magnésium, manganèse se sont présentés à des taux très bas chez les enfants malnutris.

Conclusion

Les enfants malnutris et biens nourris présentent une malnutrition aux oligo-éléments essentiels associés aux éléments traces métalliques. Ce qui permet de supposer qu'une carence en micronutriments essentiel favorise l'absorption des métaux lourds.

Potassium supplementation in kwashiorkor

BACKGROUND

Kwashiorkor is an edimatous form of severe malnutrition and is the predominant form of childhood malnutrition in Malawi. Potassium depletion is common and contributes to the high mortality. The aim of this study was to determine if high potassium supplementation improves the outcome of kwashiorkor treatment.

METHODS

We performed a randomised, double-blind, placebo-controlled, clinical trial of high potassium supplementation in 99 children with kwashiorkor. Controls (n = 51) received a standard potassium intake of 4.7 mmol/kg/day. The intervention group (n = 48) received 7.7 mmol/kg/day. All cases (intervention and control groups) were treated in the hospital-based Nutrition Rehabilitation Center and received a standard treatment regime of mild feeds, mineral and vitamin supplements, and antibiotics.

RESULTS

There was no significant difference in length of hospitalization, or time for resolution of oedema between groups. The case-fatality rate was reduced by 33% in the high potassium intervention group (13/48) compared to controls (21/51). There was a significant reduction in late deaths (13 in controls vs 3 in intervention group; odds ratio 5.3, 95% confidence interval 1.2-31.0) but no difference in early deaths (0-5 days). The intervention group also had significantly fewer presumed septic episodes (3 vs 18, odds ratio 8.9, confidence interval 2.2-50.9), respiratory symptoms, and new skin ulcerations than controls.

CONCLUSIONS

The high potassium supplementation reduced mortality and significant morbidity in kwashiorkor. This may be due to improved myocardial and immune function from earlier repletion of intracellular potassium. We recommend that the standard potassium supplement for the initial phase of treatment of kwashiorkor be increased from 4 to 8 mmol/kg/day.

Lasting effects of acute dehydration and post-weaning undernourishment on cortical spreading depression in adult rats

Acute dehydration (D) early in life made adult rats less susceptible to cortical spreading depression (SD) than control (C) rats. Post weaning undernourished (U) rats tended to be more susceptible than controls. The association of D and U (DU group) made rats more susceptible to SD than U-rats. It is suggested that this association gives rise to a more complex pathological state than that which would result from the summation of the effects of its components.