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PubMed1991

Differential regulation of the insulin-like growth factors (IGF-I and -II) and IGF binding proteins during malnutrition in the neonatal rat.

Insulin-like growth factor (IGF)-I and -II are known to play a major role in fetal and early postnatal growth. The IGF binding proteins (IGFBPs) are thought to be important in modulating the actions of the IGFs. In this paper, the effect of malnutrition in the neonatal rat on serum IGFs and IGFBPs and hepatic IGFBP messenger (m) RNA was examined. Control (C) dams (n = 9) were allowed ad libitum intake, whereas restricted (R) dams (n = 9) were limited to 50% of ad libitum intake throughout lactation, which results in decreased milk production and malnutrition of pups suckling on restricted dams. A subset of pups were cross-fostered from the R-dams to the C-dams from days 15-19 postpartum (PP) to investigate the effect of nutritional repletion (refed). Pups were killed on days 8, 12, 15, and 19 PP and liver and blood collected. Serum IGF-I and -II concentrations were measured by RIA after acid-chromatography to remove IGFBPs. Serum IGFBPs were characterized by Western ligand blot. Hepatic mRNA for IGFBP-1, -2, and -3 were determined by northern analysis. Body weight (BW) of R-pups was significantly less than C-pups by day 10 PP (P less than or equal to 0.05), and mean BW at day 19 was 56% of the C-pups. Refeeding from days 15-19 resulted in a significantly greater rate of growth vs. R-pups (3.2 vs. 0.9 g/day), and mean BW of refed pups at day 19 PP was 75% of C-pups. Malnutrition caused a significant reduction in both serum IGF-I and -II after day 12 PP, while causing an elevation in serum IGFBP-2. IGFBP-1 and IGFBP-2 mRNA expression were not significantly affected at days 8 and 12, but were elevated in livers of day 15 and 19 pups. Malnutrition caused a delay in the development shift from IGFBP-2 to IGFBP-3, which normally occurs between day 15 and 19 in the rat. Refeeding raised serum IGF-I and -II levels to those found in the C-pups and a trend toward normalization of IGFBP profiles. In conclusion, IGFs and IGFBPs are differentially regulated during neonatal malnutrition. The decrease in IGF peptide and induction of IGFBP-1 and -2 may provide protective mechanisms by inhibiting growth during malnutrition.

Animals↗
PubMed1976

[Malnutrition as an international problem (author's transl)].

The importance of malnutrition as an international problem is illustrated by some examples. Attention is mainly focussed on the bipolarity of this problem: malnutrition, both qualitative and quantitative, as the main nutritional problem of most of the developing countries of the Third World, overfeeding nowadays so associated with qualitative malnutrition - as the most important alimentary problem in the Federal Republic of Germany, but applying equally to other highly industrialized and civilized countries in Western Europe, the United States and Australia. Perhaps it would be more to the point to speak of prosperous countries or populations because these diseases found in technically highly developed countries increasingly occur also in developing countries among those social classes who believe they are able to afford a "better" nutrition and fall from one extreme of malnutrition into the other. Correct nutrition considered to be a privilege or a direct consequence of social prosperity is certainly not justified. The improvement in the standard of living as such by no means guaranties well-balanced nutrition. To quote an example: in developing countries when people live by trading with certain limited products, alimentary habits tend to change when the prices of the products go up. However, this is by no means invariably a change for the better, but quite often for the worse. It has repeatedly been found that in tropical countries where copra is the staple trading product, nutrition did not improve as the copra price rose. On the contrary, nutrition deteriorated because the people increasingly turned from the self-cultivated "natural products" to imported, refined food stuffs and tinned foods purely for reasons of increased prestige associated with such a diet. The consequences of malnutrition in the developing countries are dealt with in greater detail. In dealing with the consequences of malnutrition in highly industrialized countries a restriction to a few pointers was necessary because this subject is discussed in the following paper.

Adult↗
PubMed1999

[Infant malnutrition and associated maternal factors in a secondary city south of Benin, Ouidah].

BACKGROUND: The aim of this study was to find the needs and priorities for interventions to improve children's nutritional state in a secondary city in Bénin. It addressed the issues of the magnitude and distribution of infant malnutrition and related maternal factors. It also aimed to identify an easy to use and low cost, but valid, technique to diagnose malnutrition in children. METHOD: First of all, the prevalence of infant malnutrition was assessed with a representative sample of 492 children aged less than 36 months, in all four communities of the city. Then the sensitivity and specificity of arm circumference were studied and the associations between the children's anthropometric indices were assessed. Secondly in a sub-group of 200 couples of mothers and children, an analysis was conducted to show the links between the indices of mothers' nutritional status, some of their social and economical variables, and the children's anthropometric indices. RESULTS: The prevalences of wasting and stunting and all other forms confounded among children aged 0-3 years were respectively 5.7%, 22% and 25.9%. They represented 44.7% for the arm circumference. Wasting was more prevalent among children aged 6-23 months (9.6%) than those aged less than 6 months (1.1%) and those of 24 to 36 months (5.2%). The boys had a higher prevalence of stunting (25.1%; p = 0.049) than the girls (18.1%). The correlation between children arm circumference and their indices weight/height, weight/age and height/age were all significant (p < 0.001), but they were higher for weight/age (r = 0.48) and weight/height (r = 0.36) than for height/age (r = 0.30). Low, but significant correlation (r ranged from 0.17 to 0.25) were observed between anthropometric indices of mothers and children. Mothers' instruction level had a tendency to be associated positively and significantly with children z-score weight/height. The effect of socio-economic level on children's nutritional status was significant only at p < 0.10. Unlike the condition observed in the big cities of under-developed countries in general, the central area of Ouidah was more affected by infant malnutrition than peripheral area recently urbanized. CONCLUSIONS: Infant malnutrition appears to be a really public health problem in this town and children at weaning age are more affected. The interventions to improve children's nutritional status must concern, not only children with malnutrition, but also their mothers. Those interventions must also improve mother's knowledge and practices about weaning foods and their instruction and socioeconomic levels. The cut-off-point 12.5 cm of arm circumference seems to be more appropriate to diagnose wasting among children aged less than 12 months; 13.5 cm is better for 12-36 months aged children.

Adult↗
PubMed2000

Inequity and health. Is malnutrition really caused by poor nutrition?

OBJECTIVE: To look at inequities leading to malnutrition and from the wider picture to find root causes and deal with them in order to alleviate malnutrition. METHOD: Literature review. RESULTS: The health of the population is adversely affected by the inequities in the country. Women and children being most vulnerable are worst affected. The prevalence of Protein Energy Malnutrition (P.E.M.) in children under five years of age is 51 percent. Such a magnitude of malnutrition in a country, where availability of food per capita is more than adequate, points towards the fact that the inequities within the country are at the root of the problem. Poor income is not the only predictor of malnutrition, gender, urban-rural differences in access, utilization and quality of health care also influence health. In addition, there are some underlying factors such as illiteracy, unawareness of the mother about healthy behaviors, lack of decision-making power of women, along with deep-rooted cultural values of a patriarchal system. CONCLUSION: Malnutrition is caused by a multitude of factors, some of which are biological, others are environmental, cultural or social. Education of the invisible half of the population, who actually look after the children and the family, is an important strategy to alleviate this problem.

Culture↗
PubMed2000

Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries.

INTRODUCTION: Recent estimates suggest that malnutrition (measured as poor anthropometric status) is associated with about 50% of all deaths among children. Although the association between malnutrition and all-cause mortality is well documented, the malnutrition-related risk of death associated with specific diseases is less well described. We reviewed published literature to examine the evidence for a relation between malnutrition and child mortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% of deaths in children worldwide. METHODS: MEDLINE was searched for suitable review articles and original reports of community-based and hospital-based studies. Findings from cohort studies and case-control studies were reviewed and summarized. RESULTS: The strongest and most consistent relation between malnutrition and an increased risk of death was observed for diarrhoea and acute respiratory infection. The evidence, although limited, also suggests a potentially increased risk for death from malaria. A less consistent association was observed between nutritional status and death from measles. Although some hospital-based studies and case-control studies reported an increased risk of mortality from measles, few community-based studies reported any association. DISCUSSION: The risk of malnutrition-related mortality seems to vary for different diseases. These findings have important implications for the evaluation of nutritional intervention programmes and child survival programmes being implemented in settings with different disease profiles.

Child, Preschool↗
PubMedDate not supplied

[Patients at risk for malnutrition in primary care. Social and health study].

GOALS: The worsening nutritional condition of certain population segments is an ever more frequent situation. Malnutrition also has considerable consequences, both in healthy individuals and in patients, leading to an increase in morbidity/mortality among the general population. The purpose of the present study is to learn the opinion of doctors in primary health care about the frequency of patients at risk of malnutrition attending their clinics; the most common forms of diagnostic technique used, the groups of population and situations that show the greatest risk of malnutrition as well as the therapeutic actions undertaken. MATERIALS AND METHODS: The present study effected 1819 opinion polls of primary health care doctors, distributed in proportion to the provincial distribution of doctors throughout Spain. With a margin of error of +/- 2.3% and a confidence interval of 95.5% (K-2). RESULTS: Of the patients seen in primary health care centres, 11% are at risk of malnutrition and approximately 61% of the total are detected at the medical clinic. The situations with the greatest risk are advanced age (71%), marginalized population (drug abusers, alcoholics) (56%), anorexia (50%), patients with mental disorders (42%), oncological pathologies (41%) and prolonged confinement in bed (39%). The therapeutic attitudes considered most appropriate by primary health care practitioners are a greater attention to diets and the use of nutritional supports in cases of established malnutrition. CONCLUSIONS: The present study reflects a high incidence of malnutrition risk among patients attending primary health care clinics (11%); and highlights the importance, from the point of view of preventive medicine, of improving nutritional education among professionals, as well as the availability of simple therapeutic actions and support measures that might help to avoid larger-scale problems with a large social and financial cost.

Humans↗
PubMedDate not supplied

[Frequency and risk factors associated with malnutrition in children with congenital cardiopathy].

OBJECTIVES: To assess the frequency and risk factors of malnutrition among children with congenital heart disease (CHD). MATERIAL AND METHODS: Between August 1997 and May 1998, a cross-sectional survey was conducted among 244 children, at the congenital heart disease ward of the Cardiology Hospital, National Medical Center "Siglo XXI", Mexican Institute of Social Security, in Mexico City. Study subjects were male and female children younger than 17 years, diagnosed with CHD and without any other congenital malformation. Weight/Age (W/A), Height/Age (H/A) and Weight/Height (W/H) were used to measure nutritional status; Z scores greater than -2 was the case definition of malnutrition. Risk factors investigated were age, sex, perinatal history, dietary factors and nutritional supplementation, socioeconomic status, and family composition and functionality. Four CHD groups were studied: acyanotic with and without pulmonary hypertension (APH, AWPH) and, cyanotic with and without pulmonary hypertension (CPH, CWPH). Statistical analysis consisted of the chi-squared, Mann Whitney's U, and Kruskal-Wallis tests. Confounding variables were controlled for with a logistic regression model; odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. RESULTS: APH was the most frequent CHD (62.7%), followed by CWPH (15.6%), AWPH (11.5%), and CPH (10.2%). Malnutrition was identified in 40.9% children with the W/A index, in 24.6% with the H/A index; and in 31.1% with the W/H index. Infants and the CPH group had the worst nutritional status. Risk factors associated with malnutrition were: having a cyanotic CHD (OR 2.54; 95%CI, 0.98-6.58), lack of nutritional supplementation (OR 2.38; 95%CI, 1.06-5.34), and a greater number of family members (OR, 1.42; 95%CI, 0.99-2.05). Older children were more likely to be well-nourished (OR 0.92; 95%CI, 0.89-0.96). CONCLUSIONS: Malnutrition is frequent among children with CHD; it is more common in younger children and in those with cyanotic CHD. Educational programs directed to the families of these children are needed to prevent and decrease the frequency of malnutrition. The English version of this paper is available at: http://www.insp.mx/salud/index.html

Adolescent↗
PubMedDate not supplied

[Management of malnutrition in preschool children: the role of primary health care services].

Although the prevalence of malnutrition in developing countries is decreasing, it is still a major problem for many children under five. As socio-economic conditions are the main determinants, a final solution for this problem can only be envisaged in the long run. Still, short-term strategies need to be defined in order to relieve the sufferings of individual children and their families. Understanding the problem and consequently formulating intervention programs at the local level remains a complex and difficult issue. The first reason being that the process of malnutrition expresses itself in different forms and with variable consequences. A second reason making malnutrition a complex problem is that the primary causes -- the interaction between insufficient food supply and the frequent recurrence of infectious diseases -- are determined by a multitude of factors of different natures. This complexity -- of its expressions, effects, and causality -- makes it difficult to get a global vision and understanding of the problem, which clearly impedes the definition of rational and integrated intervention strategies. Nevertheless, a better understanding of the pathophysiology of malnutrition and of the factors that influence the growth process in preschool age, will help to better direct actions. To this effect, a conceptual model will be built, based on recent insight in the process of malnutrition within this age group. From this model, two lines of action for increasing the chances of preschool children to express their initial growth potential, become apparent. A first series of activities could tackle the process that, via wasting and recurrence of infections, leads to an increased mortality risk. As timely intervention reduces the risk of depletion of energy reserves, these activities would also have an indirect impact on physical development. Elaborating strategies for secondary prevention and for treating severe cases belongs to the specific competence of the health sector. In the second line of action, the aim is to intervene before reserves are depleted. Here, primary prevention and health promotion are choice activities. This frame of reference will be used for analysing existing health programs for preschool children and how they propose to improve the management of malnutrition. This analysis will show that primary health care services can play a much more important role than usually attributed to them. Identifying these gaps and elaborating alternatives is the purpose of this article.

Child Development↗
PubMedDate not supplied

[Predictive and diagnostic factors of malnutrition in hemodialysis patients].

The relationship between malnutrition and inflammation is by now well established. IL-6 and, probably, other proinflammatory cytokines (mainly IL-1 and TNF) may represent the link between these two entities since these interleukins may promote loss of appetite, muscle protein breakdown and reduced hepatic synthesis of "negative" acute phase proteins like albumin, prealbumin and transferrin. IL-6 also stimulates up to 1000 fold the hepatic synthesis of "positive" acute phase proteins, mainly C-reactive Protein (CRP) and Serum Amyloid A. The association between CRP and cardiovascular mortality in the general population, as well as in haemodialysed uraemic patients, is well established. These crucial interrelationships have modified the interpretation of serum albumin concentration in the diagnosis of malnutrition; a reduced serum albumin concentration, in fact, in the presence of high CRP values should point towards a diagnosis of inflammation, though the inflammation may often induce weight loss or a condition of malnutrition. After switching most patients to a more biocompatible dialysis membrane and improvement of the quality of the dialysis fluid (by adopting hydrophobic filters at the water entry of dialysis devices and bicarbonate powder cartridges) nephrologists have focused their attention on other sources of inflammation (e.g. artificial vascular protheses, presence of infected thrombi, Clamidiae, Helicobacter Pilori, dental granulomas etc.). Starting from these assumptions the diagnosis of malnutrition, once focused mainly on serum albumin reduction, must be based on other parameters (clinical history of body mass wasting, dietary and anthropometric assessment, subjective global assessment, bioimpedance analysis etc.). All these investigations, however, must be examined together to obtain suitable information on the risk of malnutrition in dialysis patients. A comprehensive approach to malnutrition-inflammation in dialysis patients is the object of the present nephrology conference.

Acute-Phase Proteins↗
PubMedDate not supplied

[Detection of malnutrition on admission to hospital].

In view of the high prevalence of malnutrition in hospitals as shown by some studies and in the light of its direct impact on the increase in morbidity and mortality among hospitalized patients, it is necessary to ensure the early identification of this condition. This would allow appropriate nutritional treatment to be instituted as soon as possible for patients at risk who require it. The present multi-centric study included the participation of hospitals in the northern region of the country which have a Nutrition Unit, with use of the Overall Subjective Assessment and a few basic parameters. The study analyzed the nutritional status on admission of 620 patients hospitalized in the Internal Medicine and General Surgery areas during the months of December, 1999, January, February and March, 2000. We detected moderate malnutrition or suspected malnutrition in 20% of the patients studied and severe malnutrition in 18.2%, with a greater incidence in Internal Medicine. Malnutrition was mainly evidenced by weight loss of more than 5% and a reduction in subcutaneous fat and muscle mass. In addition, there are functional limitations on performing everyday activities. Changes in dietary intake were present in 40.8% of the patients. The associated gastro-intestinal symptoms included anorexia, which affected 37.7% of the group studied. Malnutrition is most frequently linked with infectious diseases, problems in circulation and with the digestive apparatus. We feel that the Overall Subjective Assessment, together with the measurement of height and weight, should be used systematically with patients on admission, as it is a simple and effective method for the identification of patients with nutritional risk.

Adipocytes↗
PubMed1990

Is diarrhoea a major cause of malnutrition among the under-fives in developing countries? A review of available evidence.

To evaluate whether, at the community level, diarrhoea is a major cause of malnutrition or inversely whether the association between diarrhoea and growth retardation can be explained by a higher susceptibility of malnourished children to diarrhoea, all recent studies examining the relationship between diarrhoea and malnutrition in the community were reviewed. It was determined, for each of these two hypotheses, to what extent four standard causality criteria were met, viz., (i) lack of temporal ambiguity, (ii) consistency of findings, (iii) strength of association and (iv) biological plausibility. That malnutrition predisposes to diarrhoea seems likely: this is supported by a series of studies which adequately fulfil the examined causality criteria and seems biologically plausible. On the other hand, it is not clear whether diarrhoea is a major cause of malnutrition. Some studies examine the effect of diarrhoea on nutritional status over short time intervals and it cannot be determined whether diarrhoea-induced growth faltering is transient or sustained. Other studies examining this effect over longer periods do not show clearly that diarrhoea precedes malnutrition. Inconsistencies between studies and lack of evidence supporting a biologically plausible mechanism also question the importance of diarrhoea as a cause of malnutrition.

Child, Preschool↗
PubMed1989

Influence of malnutrition on social maturity, visual motor coordination & memory in rural school children.

The social competence, visual motor coordination and memory functions of 1336 rural primary school children in the age group 6-8 yr were studied in relation to their nutritional status and socio-environmental factors. Children with grades, I, II and III malnutrition scored 4.4, 8.5 and 11.8 points lower respectively as compared to those in normal nutrition for the total social quotient. The effect was more marked in stunted wasted children. These rural children performed poorly on areas; communication, socialization and occupation, in grades II and III malnutrition their scores being below average (less than 90). Environmental factors like family size and type, economic sufficiency, and father's education also played a significant role in determining the social competence in girls. The scores for visual motor coordination (Bender Gestalt test) increased with severity of malnutrition (scores normal, 9.9 and grade III, 11.3) being statistically significant (P less than 0.01). Observations on memory test indicated that malnutrition had a significant but very weak relationship with immediate and delayed memory. The boys in grade II malnutrition had significantly lower immediate memory scores, as compared to normal boys for all the 3 modes of presentation (P less than 0.05, P less than 0.05; and P less than 0.001 respectively). In the girls, this was true only with respect to pictures. Further, for delayed memory, boys in grade II malnutrition scored poorly for pictures and words (P less than 0.05 for both).

Child↗
PubMedDate not supplied

[Malnutrition in geriatric patients: the Bethanien nutritional study].

Demographic developments in the Federal Republic of Germany indicate a future marked increase in the aged population. With this, there will be an increase in elderly patients. Malnutrition can contribute to disease as well as result from it. While most urgent nutritional problems of the population in general reside in the areas of increased intakes of energy and certain nutrients, nutritional deficiencies are frequent in older citizens, and in particular, geriatric patients. These deficiencies may result from psycho-social factors such as isolation, depression, or chronic brain failure, as well as from clinical factors (diseases which increase nutritional requirements or utilization of nutrients, drug/nutrient-interactions, etc.). The following questions are addressed: 1) How frequent is malnutrition in geriatric patients and which forms of malnutrition can be found? 2) What are the causes of malnutrition? 3) What is the relationship between malnutrition and mortality? 4) Which strategies for prevention and treatment of malnutrition can be developed from the above findings? The study is performed in Bethanien-Hospital, Heidelberg, FRG, a geriatric hospital and day clinic. Three hundred patients aged 75 years or older (representative sample) were included. Nutrition and nutritional status are determined and related to health, drug therapy and other psycho-social conditions in the very old. The prospective part of the study is planned for 18 months and this will also be the duration of the intervention phase.

Aged↗
PubMed1987

Ineffective breathing pattern related to malnutrition.

This article has highlighted the problem of malnutrition in the stable COPD patient and the critically ill, hypercatabolic patient, and has reviewed resultant mechanisms which influence the alteration of breathing pattern. These complex patients present a challenge for the nurse. Table 1 briefly summarizes the manifestations of malnutrition, goals, interventions and expected outcomes of the nursing diagnosis, ineffective breathing pattern related to malnutrition. The goal of the interventions is to modify the cause (malnutrition) of the nursing diagnosis (altered breathing pattern). The success of the interventions will lead to the achievement of expected outcome As expected outcomes are achieved, relief of signs and symptoms related to the nursing diagnosis will occur. The nurse caring for the patient with actual or potential malnutrition must be knowledgeable about the physiology of malnutrition and effect on breathing pattern. It is essential that the nurse assess and provide appropriate nutritional support and evaluate progress toward expected outcomes. In the event that expected outcomes are not achieved, reassessment with modification of interventions is necessary. Nurses play a key role in the total health care delivery to these complex patients. Further study will strengthen the research base of nursing interventions.

Anthropometry↗
PubMed1994

Maternal and socioeconomic factors and the risk of severe malnutrition in a child: a case-control study.

OBJECTIVE: To examine the relation of maternal and socioeconomic factors with the development of severe malnutrition in young children. DESIGN: A case-control study. SETTING: A large diarrhoea treatment centre in a metropolitan city. SUBJECTS: Cases were 125 severely malnourished children, aged < 36 months, having weight-for-age < 55% of the United States National Center for Health Statistics (NCHS) median values. Controls (n = 125) were recruited concurrently matching for gender, disease type (i.e. diarrhoea or dysentery) and age stratum, having weight-for-age > 60% of NCHS median values. INTERVENTION: Mothers of the children were interviewed to record personal history and various socioeconomic variables and examined for height and weight. RESULTS: Maternal factors such as illiteracy, mothers' employment outside, lack of breastfeeding and maternal malnutrition (as indicated by low body mass index, weight or height); and selected socioeconomic indicators such as poor family income, use of unprotected surface water or unhygienic latrine were found to be significantly associated with severe malnutrition in their children. In multivariate analysis, maternal illiteracy and lack of breastfeeding were associated with approximately fourfold increased risk of severe malnutrition in their children. A strong positive association of employment of mothers outside homes with fivefold increased risk was surprising and may reflect a complex social problem of poor urban mothers; malnourished mothers were 2.5 times more likely to have severely malnourished children. CONCLUSION: The findings confirm the well-known association of lack of maternal education and breastfeeding with severe malnutrition of their children. Maternal malnutrition may be a useful indicator to identify at-risk families with severely malnourished children. However, its causal association, though plausible, cannot be inferred from the study.

Breast Feeding↗
PubMedDate not supplied

[Prevalence of malnutrition in minors under 5 years of age in Tabasco].

OBJECTIVE: To evaluate malnutrition prevalence in children under five years-old in Tabasco, Mexico, during 1996, and their evolution in 1991-1996. MATERIAL AND METHODS: A cross-sectional study, including 1,256 children under five years-old in 593 communities (31 urban and 562 rural) from 17 sanitary districts. RESULTS: The weight/age indicator for malnutrition in children under five years old showed 59% of children had normal nutrition and 41% with malnutrition, distributed as follows: 26.12% slight, 12.62% moderate and 2.39% severe. In children between 1-5 years old, malnutrition prevalence was 45%. CONCLUSIONS: The number of children with malnutrition in Tabasco during the study period (1991-1996) has decreased in proportion to the increase of those with normal nutrition. Based on the health system activities, the number of health districts with critical malnutrition indicators decreased from 6 to 4.

Child, Preschool↗
PubMed2005

Metabolic changes in malnutrition.

This paper is concerned with malnutrition caused by inadequate intake of all the major nutrients rather than deficiency diseases relating to a single micronutrient. Three common situations are recognised: young children in third world countries with protein-energy malnutrition; adults in the same countries who are chronically adapted to subsisting on marginally inadequate diets; and patients who become malnourished as a result of chronic diseases. In all these situations infectious diseases are often also present, and this complicates the interpretation of biochemical and physiological observations. The metabolic response to starvation is primarily concerned with maintaining a supply of water-soluble substrates to supply energy to the brain. Thus there is an initial rise in metabolic rate, reflecting gluconeogenic activity. As fasting progresses, gluconeogenesis is suppressed to minimise muscle protein breakdown and ketones become the main fuel for the brain. With chronic underfeeding the basal metabolic rate per cell appears to fall, but the mechanistic basis for this is not clear. The main adaptation to chronic energy deficiency is slow growth and low adult body size, although the reduction in energy requirement achieved by this is partially offset by the preservation of the more metabolically active organs at the expense of muscle, which has a lower metabolic rate. The interaction between malnutrition and the metabolic response to trauma has been studied using an animal model. The rise in energy expenditure and urinary nitrogen excretion following surgery were significantly attenuated in malnourished rats, suggesting that malnutrition impairs the ability of the body to mobilise substrates to support inflammatory and reparative processes. However, the healing process in wounded muscle remained unimpaired in malnutrition, suggesting that this process has a high biological priority.

Adult↗
PubMed1992

Protein-calorie malnutrition in liver cirrhosis.

The purpose of this article is to present detailed data on the nutritional assessment in cirrhotic patients. The exact frequency and types of malnutrition, its associations with the aetiology of liver disease, liver dysfunction and clinical staging in liver cirrhosis are unknown. A new classification system is presented which may help to suggest some interventional guidelines. Physical (anthropometry, 24-h urinary creatinine excretion, bioelectrical impedance analysis (BIA), total body potassium counting, ultrasound examination) and metabolic (indirect calorimetry) assessment of nutritional status was therefore performed in 123 patients with liver cirrhosis, who were considered as potential candidates for liver transplantation. Data were related to the clinical, biochemical, histological and prognostic data of liver disease. Of our patients 65% showed some signs of protein-calorie malnutrition as indicated by low body cell mass, reduced serum albumin concentrations or abnormal skinfold thickness. Of these 34% were considered as "kwashiorkor-like" (normal body composition, serum albumin less than 35 g/l), and 18% were "marastic" (reduced body weight, body cell mass, and fat mass). However, 49% of the malnourished group had reduced body cell mass in association with increased fat mass and frequently presented with a normal body weight ("mixed" or "obese" type). Protein-calorie malnutrition did not correlate with the aetiology of the disease and biochemical parameters of liver function. Malnutrition was observed at all clinical stages but was more frequently seen at advanced stages. We conclude that malnutrition associated with liver cirrhosis is not a clear phenomenon. Its clinical presentation is heterogenous and not reflected by the histological or biochemical parameters of liver disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗