Patterns of muscle and fat mass repair during recovery from advanced infantile protein-energy malnutrition

OBJECTIVE

This paper shows the pattern of body composition within the frame three-compartment model repair during recovery from advanced infantile protein-energy malnutrition.

DESIGN

Body composition was assessed in 26 severely malnourished male infants aged 1-7 months at the time of their admission at Instituto Nacional de Pediatria in Mexico City and through the initial process of nutritional recovery (NR), by means of radiological, anthropometrical procedures and 24-h creatinine excretion at fortnightly intervals. Throughout of NR period all children were fed with milk formula (13-14% protein, 40% carbohydrates and the remainder fat).

RESULTS

There was high frequencies of children's intakes were above the median (160 kCa1/k/d), but in last period their intakes were close to child normal requirements. Repletion of weight-for-height deficit was complete in all children. Leg-muscle roentgenographic area showed significantly increment in size only the first 15 days (P < 0.05). The leg-fat area showed size increments in all 15-day intervals (P < 0.05 or P < 0.01). The leg-bone area did not show any change during NR. Body Weight as well as arm and arm-fat-free areas and calculated total muscle and fat body mass augmented significantly during nutritional rehabilitation (P < 0.01). However, the ratio of muscle to body mass increased only during the first month of NR (P < 0.05), while absolute and relative fat mass did so during the whole observation period (P < 0.05). The remainder of body organ mass (EOM) did not suffer any change during all NR period.

CONCLUSIONS

This dysrythmic repair of body compartments might offer explanation of certain features of psychomotor performance of infants recovering from severe protein-energy malnutrition.

Biotin deficiency in protein-energy malnutrition

Several of the clinical and biochemical manifestations of biotin deficiency also occur in severe protein-energy malnutrition (PEM). Average plasma biotin concentrations were lower in 16 malnourished children (10 with marasmus, 3 with kwashiorkor and 3 with marasmic kwashiorkor) than in 31 controls. Lymphocyte mitochondrial carboxylase activities were studied in 11 controls and in 10 patients with PEM; on the average, they were lower in the patients. Their activation indices (the ratio of enzyme activity in cells incubated with biotin to activity in cells incubated without the vitamin) were higher in PEM. All these differences were statistically significant. None of these parameters were age-dependent in a range between 3 and 72 months. Carboxylase activities and plasma biotin levels increased to normal during nutritional recovery in two malnourished patients who were further studied. These results suggest that there is biotin deficiency in severe PEM. Urinary biotin concentrations, expressed per g of creatinine, were higher in the patients than in the controls; this may have been caused by increased renal clearance or by the reduced creatinine excretion which occurs in malnourished individuals. It will be important in future studies to determine the relative contribution of biotin deficiency to the malnourished phenotype.