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PubMed1976

Neutrophil function in children with kwashiorkor.

Peripheral blood polymorphonuclear neutrophil (PMN) function has been investigated for 46 children with kwashiorkor (without overt infection) in the Ivory Coast, West Africa. In vitro chemotactic response, candidacidal activity, and kinetic studies of metabolism during phagocytosis have been performed. Postphagocytic morphological events were evaluated by electron microscopy. The reduction of nitroblue tetrazolium (NBT), measurement of enzyme activities, activity of glycolysis, and hexose monophosphate shunt (HMS) activity were assessed. The extent of iodide incorporation into trichloracetic acid (TCA)-precipitable protein by phagocytizing PMN'S and thyroid hormone degradation were measured. Chemotactic response was reduced at early time intervals (30, 60, and 120 minutes) and reached control values after 180 minutes. Whereas PMN's of controls killed 32.13 +/- 11.10 per cent of Candida albicans after 60 minutes, PMN's from kwashiorkor patients killed 18.55 +/- 7.74 per cent (p less than 0.01). HMS activity for resting PMN's of kwashiorkor children was higher than for controls, and during particle ingestion the extent of stimulation was comparable to controls. Electron microscopic assessment of phagocytic vacuole formation and degranulation showed no difference between PMN's from kwashiorkor and and control subjects. Incorporation of 131 I into TCA-precipitable proteins by phagocytizing PMN's from kwashiorkor children was reduced in compraison to controls, with either viable or heat-killed lactobacilli. No impairment in thyroxine (T4) degradation was observed for PMN's from kwashiorkor cases. PMS's from kwashiorkor patients show toxic granules, Dohle bodies, evidence of high baseline NBT reduction, and glucose decarboxylation. Functional studies indicate impaired kinetics of chemotaxis, diminished candidacidal activity, and reduced iodination. Enzymatic activities of resting cells are normal. Lactate production, HMS activity during phagocytosis, and morphological events are not impaired. Thus, impaired in vitro microbicidal activity, increased resting metabolism, and decreases iodination by PMN's may be related to the high incidence of infection in kwashiorkor.

Candida albicans↗
PubMed1993

The social, family and medical backgrounds of children with kwashiorkor presenting at a teaching hospital.

The social, family and medical backgrounds of 53 children hospitalised with kwashiorkor were compared with those of 106 children hospitalised for non-nutritional diseases to determine risk factors for severe nutritional disease in children presenting to a teaching hospital. The control children were matched for age, sex, race and the non-nutritional illness complicating the course of the children with kwashiorkor; in 80% of cases the reason for admission was either gastro-enteritis or pneumonia. A major difference between the groups was the educational status of the mothers. Only 57% of the mothers of the children with kwashiorkor were literate compared with 93% of the controls; 25% as opposed to 47% were married, and 36% as opposed to 72% received support from the father. There were no differences in the mothers' ages or use of contraception, or in the number of children they had. In all except 1 instance the child with kwashiorkor was the youngest or only child in the family, and the average sibling interval was 53 months. The types of dwellings occupied by the families were similar, but overcrowding was worse in the kwashiorkor group. Family income was below the household subsistence level in the vast majority of both groups, but significantly more of the kwashiorkor group had minimal cash income. Significantly fewer of the children with kwashiorkor had been breast-fed or adequately immunised, and 60% had previously been hospitalised for dehydrating diarrhoea. This study demonstrates that in an urban environment the traditional factors of large families and displacement by a younger sibling are not associated with kwashiorkor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Defects in resting metabolic rates and mitochondrial respiration in Kwashiorkor and dietary obese rats.

Resting metabolic rates have been measured and compared with hepatic mitochondrial respiration in Kwashiorkor and diet-induced obese weaned rats. In Kwashiorkor, resting metabolic rate was 21% lower than the value of controls, while that of the obese rats was 14% higher than in control animals. The resting metabolic rate for Kwashiorkor animals was 50% of the predicted basal metabolic rate (BMR), whereas that of the obese rats was 23% higher than the predicted BMR. The mitochondrial oxygen consumption patterns, using malate plus glutamate or succinate as respiratory substrates, revealed that the resting respiration (state 4) was 23.9% higher in Kwashiorkor and 29.1% higher in obese animals, while the active (state 3) respiration was 34.8% lower in Kwashiorkor and 43.3% lower in obese rats compared to controls. The respiratory control ratios (RCR) were 51.1% and 43.8% in Kwashiorkor and obese rats, respectively, relative to the values in control rats. It is concluded from these studies that Kwashiorkor disease and diet-induced obesity appear to interfere with oxygen utilization at the level of state 3 mitochondrial respiration, which is markedly decreased when compared to the values for control animals.

Animals↗
PubMed2000

The pharmacokinetics of caffeine in Nigerian children suffering from malaria and kwashiorkor.

OBJECTIVES: Caffeine-containing beverages are generally consumed by Nigerians suffering from malaria and kwashiorkor in the belief that caffeine aids early recovery from these illnesses, which are common in the tropics. However, there are no studies on the influence of these diseases on the absorption and pharmacokinetics of caffeine in Africans. MATERIALS AND METHODS: A single oral dose of caffeine was given to five healthy children and to five and seven children suffering from malaria and kwashiorkor, respectively. Caffeine and its dimethylxanthine metabolites were measured in plasma using high-performance liquid chromatography. RESULTS: The maximum plasma concentration (Cmax) of caffeine and the time of Cmax were similar (P > 0.05) in the three groups. However, the elimination half-life of caffeine was significantly longer in children with malaria (9.2 +/- 3.5 h) (P < 0.01) and kwashiorkor (13.1 +/- 7.9 h) (P < 0.05) than in the healthy controls (3.7 +/- 1.8 h). The total plasma oral clearance of caffeine of 4.4 +/- 1.9 ml/min/kg in healthy children was significantly higher (P < 0.01) than in those with kwashiorkor (2.0 +/- 0.9 ml/min/kg) and malaria (1.6 +/- 1.0 ml/min/ kg) (P < 0.05). Paraxanthine was the principal metabolite in all the three groups with Cmax significantly higher in healthy children (1.3 +/- 0.3 microg/ml) than in children with malaria (0.8 +/- 0.4 microg/ml) (P < 0.05) and kwashiorkor (0.3 +/- 0.1 microg/ml) (P < 0.0001). CYP1A2 activity, measured by the plasma ratios of paraxanthine: caffeine, was significantly lower in kwashiorkor and malaria. CONCLUSIONS: This study showed that the plasma kinetics of caffeine are significantly altered in malaria and kwashiorkor, and CYP1A2 activity was lower in these two disease groups.

Administration, Oral↗
PubMed1998

Whole-body protein kinetics in marasmus and kwashiorkor during acute infection.

Marasmus and kwashiorkor are clinically distinct manifestations of severe malnutrition. This study tested the hypothesis that rates of whole-body protein synthesis and breakdown are higher in marasmus than in kwashiorkor during acute infection. We measured whole-body protein kinetics using stable isotope tracers in eight children with marasmus and acute infection (pneumonia or malaria) to determine the rate of appearance of urea and leucine in plasma. Serum concentrations of total protein, albumin, and C-reactive protein were also measured. These findings were compared with those reported previously for 13 children with kwashiorkor (including marasmic kwashiorkor) and acute infection who were studied with the same methods. HIV infection was present in 10 of 21 children. Rates of protein breakdown and synthesis were higher in marasmus than in kwashiorkor (227 +/- 59 compared with 103 +/- 30 micromol leucine x kg(-1) x h(-1) and 216 +/- 60 compared with 97 +/- 30 micromol leucine x kg(-1) x h(-1), P < 0.001). The concentration of globulin (total protein minus albumin) was higher in marasmus than kwashiorkor (40 +/- 17 compared with 25 +/- 7 g/L, P < or = 0.01), but C-reactive protein was not different (73 +/- 79 compared with 83 +/- 89 mg/L). HIV infection and body composition did not explain the differences between marasmus and kwashiorkor. The accelerated rate of protein turnover in children with marasmus and acute infection requires further investigation.

Acute Disease↗
PubMed1989

Pharmacokinetics of quinine in African children suffering from kwashiorkor.

The pharmacokinetics of quinine were studied in seven normal African children and in six African children suffering from kwashiorkor, after an oral dose of 10 mg kg-1 of quinine hydrochloride. The two groups were similar in age but the children with kwashiorkor weighed significantly less than the control children (P less than 0.001). The children with kwashiorkor further differed from the control children in having significantly lower packed cell volume (P less than 0.001), total plasma protein and plasma albumin (P less than 0.001), and higher serum SGOT (P less than 0.05). The apparent absorption half-life was significantly longer in kwashiorkor than in controls (P less than 0.05). Similarly, the Cmax was significantly lower (P less than 0.01) in kwashiorkor than in controls. Quinine was eliminated more slowly in children with kwashiorkor, the elimination half-life being significantly longer (P less than 0.001) and the oral clearance significantly less (P less than 0.001) than in controls. It is concluded that kwashiorkor significantly affects the pharmacokinetics of quinine, and that the effect may be due to the pathological changes in the intestine and liver in this condition.

Child, Preschool↗
PubMed1999

Serum free carnitine levels in children with kwashiorkor.

OBJECTIVE: To determine the serum free carnitine concentration in normally nourished children and in children with kwashiorkor and to relate the carnitine concentration to the ability to oxidise exogenous long chain fatty acids in the body. STUDY DESIGN: A cross-sectional comparative study of two age-matched groups. SUBJECTS: Forty seven children with kwashiorkor and 47 age-matched normally nourished children. MAIN OUTCOME MEASURES: Fasting blood samples were enzymatically analysed for free carnitine levels. 13C labelled hiolein was administered orally and the recovery of 13C from the breath air was monitored after administration of the feed. The cumulative per cent dose (CUMPD) recovery of 13C 16 hours after the ingestion of labelled hiolein was determined. RESULTS: Normal children had significantly higher free carnitine concentrations (mean = 60.7 mumol/l; 95% confidence interval of the mean = 42.7-77.8) than the kwashiorkor children (mean = 16.5 mumol/l; 95% confidence interval of the mean = 11.3-19.8)(p < 0.001). There was no correlation between serum free carnitine concentration and serum albumin in kwashiorkor subjects, but there was a significant correlation between serum free carnitine concentration and the degree of weight loss as indicated by the weight: weight for age and sex ratio. The greater the weight loss, the lower the serum carnitine concentration amongst the kwashiorkor children (r = 0.46; p < 0.01). There was a linear relationship between serum free carnitine and hiolein oxidation (r = 0.89; p < 0.001). CONCLUSION: There is carnitine deficiency in kwashiorkor, and that the impaired lipid oxidation in kwashiorkor is related to this deficiency.

Breath Tests↗
PubMed1990

Fatty acid composition of erythrocyte membrane lipid obtained from children suffering from kwashiorkor and marasmus.

The fatty acid composition of erythrocyte membrane (EM) lipids obtained from normal, kwashiorkor, and marasmic children was analyzed by gas chromatography. The proportion of palmitic acid (16:0) was lower and of oleic acid (18:1) higher in the kwashiorkor group than in the control group. The marasmic group showed lower proportions of eicosatrienoic acid (20:3) and arachidonic acid (20:4) and a higher proportion of oleic acid (18:1) than the control group. A significant difference was found between the marasmic and kwashiorkor groups with respect to arachidonic acid (20:4), which showed a lower proportion in the former group than the latter. The ratio of arachidonic acid to linoleic acid (20:4/18:2) was markedly lower in the marasmic group than the control group, suggesting a possible impairment in the conversion of linoleic acid to arachidonic acid in marasmic children. The ratio of unsaturated fatty acids to saturated fatty acids was markedly elevated in the kwashiorkor group over that of control group, indicating increased fluidity of EM in kwashiorkor. It is suggested that the altered membrane fatty acid composition reflects deranged lipid metabolism and affects the physical and physiological properties of EM and could contribute to changes in the activities of several red blood cell membrane-bound enzymes reported earlier in kwashiorkor children.

Child, Preschool↗
PubMed1982

Aflatoxins in the livers of children with kwashiorkor.

Autopsy liver specimens from Nigeria and South Africa obtained from three kwashiorkors, three marasmic-kwashiorkors and one marasmic child were analysed for the presence of aflatoxins using both high performance liquid chromatography and thin layer chromatography. Significant levels of aflatoxin B1 were found in the livers of the three kwashiorkor children. Aflatoxicol was detected in the liver of one marasmic-kwashiorkor and a small quantity of aflatoxin M1 in the liver of another. No aflatoxins were found in the livers of the third marasmic-kwashiorkor or the marasmic child. These findings extend recent clinical observations that indicate an association between aflatoxins and kwashiorkor.

Aflatoxin B1↗
PubMed1987

Famine in Ethiopia 1983-1985: kwashiorkor and marasmus in four regions.

Parts of southern Ethiopia were form 1983 to 1985 affected by drought and famine. This study describes the prevalence of marasmus and kwashiorkor in four drought-affected regions: Bale, Sidamo, Gamu Gofa and southern Shoa. An analysis of 37,511 children in the 1-5 year age group representing 212 communities has been performed. The study demonstrates that both marasmus and kwashiorkor are facets of drought. The epidemiologies of kwashiorkor and marasmus differ: marasmus is the most common form of acute malnutrition in all areas, while kwashiorkor is found in a limited number of communities only. These latter communities have a subsistence farming economy, most often in ensete-growing areas. In the lowland semi-arid regions, which have an agro-pastoralist economy, kwashiorkor is virtually absent. These epidemiological findings are discussed in relation to different theories of the aetiology and pathogenesis of kwashiorkor.

Body Height↗
PubMed1992

Aflatoxins and kwashiorkor in Durban, South Africa.

The present investigation has indicated that maize seeds stored under various simulated seasonal conditions show a spectrum of fungi that appear as a succession. The aflatoxin-producing fungus, Aspergillus flavus, is favoured by storage conditions of high temperature and humidity (summer and autumn seasons). This coincides with the more frequent admission of children suffering from kwashiorkor at King Edward VIII Hospital in Durban. Aflatoxin analysis was undertaken on 74 children diagnosed at King Edward VIII Hospital in Durban as cases of kwashiorkor, marasmus or underweight (Wellcome classification). The control group consisted of 35 age-matched patients with no symptoms of protein energy malnutrition. Aflatoxins were detected in serum and/or urine from all groups, including the controls. The serum/urine ratio was significantly higher in the kwashiorkor group than in the other groups. The control group, however, had a higher proportion of urine aflatoxins than the kwashiorkor group. These findings were interpreted in terms of impaired liver function in kwashiorkor. Aflatoxins may have a rôle in the pathogenesis of kwashiorkor, although the present findings do not indicate that they are a causal factor.

Aflatoxins↗
PubMed2006

The quality of the diet in Malawian children with kwashiorkor and marasmus.

Nutritionists have suggested that kwashiorkor is related to low dietary protein and/or antioxidant intake. This study explored the hypothesis that among Malawian children with severe malnutrition, those with kwashiorkor consume a diet with less micronutrient- and antioxidant-rich foods, such as fish, eggs, tomatoes and orange fruits (mango, pumpkin and papaya), than those with marasmus. A case-control method with a food frequency questionnaire was used to assess the habitual diet. Children with severe childhood malnutrition presenting to the central hospital in Blantyre, Malawi during a 3-month period in 2001 were eligible to participate. The food frequency questionnaire collected data about foods consumed by siblings <60 months of age in the home. It was assumed that the habitual diet of all siblings 1-5 years old in the same home was similar. Dietary diversity was assessed using a validated method, with scores that ranged from 0 to 7. Regression modelling was used to control for demographic and disease covariates. A total of 145 children with kwashiorkor and 46 with marasmus were enrolled. Children with kwashiorkor consumed less egg and tomato than those with marasmus: 17 (15) vs. 24 (31) servings per month for egg, mean (SD), P < 0.01 and 27 (17) vs. 32 (19) servings per month for tomato, P < 0.05. Children with kwashiorkor had a similar dietary diversity score as those with marasmus, 5.06 (0.99) vs. 5.02 (1.10), mean (SD). Further research is needed to determine what role consumption of egg and tomato may play in the development of kwashiorkor.

Case-Control Studies↗
PubMed1997

Intestinal permeability in kwashiorkor.

UNLABELLED: Intestinal permeability can be assessed non-invasively using the lactulose-rhamnose (L-R) test, which is a reliable measure of small intestinal integrity. AIMS: To determine risk factors for abnormal intestinal permeability in kwashiorkor, and to measure changes in L-R ratios with inpatient rehabilitation. DESIGN: A case-control study of 149 kwashiorkor cases and 45 hospital controls. The L-R test was adapted to study kwashiorkor in Malawi, with testing at weekly intervals during nutritional rehabilitation. Urine sugars were measured by thin layer chromatography in London. RESULTS: The initial geometric mean L-R ratios (x100) (with 95% confidence interval) in kwashiorkor were 17.3 (15.0 to 19.8) compared with 7.0 (5.6 to 8.7) for controls. Normal ratios are < 5, so the high ratios in controls indicate tropical enteropathy syndrome. Abnormal permeability in kwashiorkor was associated with death, oliguria, sepsis, diarrhoea, wasting and young age. Diarrhoea and death were associated with both decreased L-rhamnose absorption (diminished absorptive surface area) and increased lactulose permeation (impaired barrier function) whereas nutritional wasting affected only L-rhamnose absorption. Despite, clinical recovery, mean L-R ratios improved little on treatment, with mean weekly ratios of 16.3 (14.0 to 19.0), 13.3 (11.1 to 15.9) and 14.4 (11.0 to 18.8). CONCLUSION: Abnormal intestinal permeability in kwashiorkor correlates with disease severity, and improves only slowly with nutritional rehabilitation.

Case-Control Studies↗
PubMed1979

Deficiency in kwashiorkor serum of factors required for optimal lymphocyte transformation in vitro.

Blastogenic responses of normal human peripheral blood lymphocytes cultured in media supplemented with serum from children with kwashiorkor were, on average, 47.7% of those observed when the same cells were cultured in the presence of normal AB serum. Incorporation of radioactive uridine was also diminished in the presence of normal AB serum. Incorporation of radioactive uridine was also diminished in the presence of kwashiorkor serum indicating that lectin-induced RNA synthesis was also affected. The kwashiorkor serum effect was not due to a cytotoxic action nor could it be attributed to the presence of saccharides or other inhibitors of the inducing lectins. Mixing experiments showed that kwashiorkor serum was not inhibitory, but that it lacked factors present in normal serum that are required for optimal lymphocyte blastogenesis. The deficiency of these factors could largely be rectified by supplementing kwashiorkor serum with an ultrafiltrate of normal serum containing components with molecular weights of less than 500 Daltons. We conclude that nutritional deprivation of severity sufficient to cause kwashiorkor leads to a deficiency of low molecular weight lymphocyte growth factors. This lack may contribute to the immunodeficiency associated with the disease.

Cell Survival↗
PubMed1995

Altered 3,5,3'-triiodothyronine thyroxine ratio in experimentally induced kwashiorkor and obesity in rats.

The plasma triiodothyronine (T3) and thyroxine (T4) ratios have been evaluated in kwashiorkor and diet-induced obese weaned rats. The concentrations of T3 and T4 were determined in plasma by radio-immunoassay. A significant decrease in T3 level in the order kwashiorkor < obese < control was observed. However T4 concentration was more elevated (P < 0.01) in the obese than the normal controls, while more significantly depressed (P < 0.001) in the kwashiorkor than in control animals. The T3/T4 ratio decreased in the order obese < kwashiorkor < control. It was concluded from these studies that kwashiorkor and diet-induced obesity not only interfere with the absolute concentration of the thyroid hormones but also alter the T3/T4 ratio. The altered T3 and T4 ratio perhaps contributes to the maintenance of the isoenergetic state rather than to the promotion of negative or positive energy balance in kwashiorkor and obese subjects respectively.

Animals↗
PubMed1995

Successful surgical treatment of secondary Kwashiorkor after total gastrectomy: report of a case.

We report herein the case of a 56-year-old woman who developed secondary Kwashiorkor 9 years after undergoing a total gastrectomy for early gastric cancer. Until she began developing the symptoms of Kwashiorkor, including general fatigue, edema of the face and extremities, anemia, alopecia, and weight loss, she had been leading a normal life post-gastrectomy. Her symptoms were alleviated by total parenteral nutrition (TPN) therapy, but reappeared soon after TPN therapy was discontinued. Therefore, she required several subsequent courses of TPN. In an attempt to permanently resolve the ongoing Kwashiorkor symptoms, reconstructive surgery involving transposition of the jejunum from the previous Graham method to the interposition method was performed 10 years after the initial gastrectomy. After the second operation, her malnutrition was completely alleviated, and she has been in good health for the 8 years since. To our knowledge, there has been no other report of the symptoms of secondary Kwashiorkor after total gastrectomy being alleviated by altering the procedure of reconstruction of the intestinal tract. Thus, we recommend surgical treatment to alter the digestive continuity to a more physiological pathway for selected patients with secondary Kwashiorkor syndrome.

Anastomosis, Surgical↗
PubMed1986

Exocrine pancreatic function of children from the Ivory Coast compared to French children. Effect of kwashiorkor.

One hundred nineteen children, either French or from the Ivory Coast, aged 1-8 years, were submitted to pancreatic function testing by duodenal aspiration. Trypsin, chymotrypsin, lipase, phospholipase, amylase, volume, bicarbonate, chloride, and calcium were estimated before and after an intravenous injection of 1 CU secretin + 3 CHR units pancreozymin per kilogram of body weight. Sixty-two patients were normal European children, and 11 were normal African children. Twenty-five African children presented with kwashiorkor and 10 African children had presented with kwashiorkor but had recovered at the time of the test. Three cases of recurrent kwashiorkor are also included. In the normal group of African children, phospholipase concentration, volume, and bicarbonate were significantly decreased but chymotrypsin and trypsin concentrations were not, when compared to the normal European population. In kwashiorkor patients, lipase, amylase, phospholipase, and chymotrypsin concentration were significantly decreased compared to normal Africans. Trypsin, volume, and bicarbonate were not affected. These modifications disappeared after refeeding. In cases of recurrent kwashiorkor, all enzymes, including trypsin, were decreased. Calcium was never modified. These modifications were very different from those observed in chronic alcoholic and hypercalcemic pancreatitis. In a two-year study, chronic calcifying pancreatitis (CCP) was diagnosed in 14 patients (13 males), hospitalized in Abidjan. The mean age at onset of the disease was 41 years (SD 12.71), which is very similar to European cases. The most frequent cause was alcoholism, as in Occidental countries. The nutrition of the population was low in protein, calories being provided mostly by manioc, but no apparent symptoms of malnutrition were observed in the parents of our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Two pathways to kwashiorkor?

Comparisons, based on anthropometric and biochemical measurements, have been made between Gambian and Ugandan children with kwashiorkor, and Gambian children with marasmus. Cases of kwashiorkor and marasmus in The Gambia were very similar both anthropometrically and in their plasma hormone and amino-acid patterns, but quite different in these respects from kwashiorkor in Uganda. Additional data from a prospective longitudinal study recently completed in The Gambia indicated that, when it occurred, hypoalbuminaemia appeared acutely, in contrast to the gradual development observed in Uganda. These findings suggest that kwashiorkor in The Gambia and in Uganda have distinct aetiologies and possible reasons for the difference in pathophysiologies are discussed. In particular the association of hypoalbuminaemia with diarrhoeal disease in The Gambia indicates that plasma protein loss from the gastro-intestinal tract could be a factor precipitating kwashiorkor in children who would otherwise be regarded as cases of marasmus.

Amino Acids↗