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PubMed1978

The visual evoked potential in children after kwashiorkor.

An index of the long-term effects of kwashiorkor on the electrocortical development of the child was obtained by recording the visual evoked potential (VEP) of 4 groups of children aged 6--12 years. The malnourished group, consisting of 30 Black children hospitalized for treatment of kwashiorkor during the first 27 months of life, was age-matched with 3 control groups. Some evidence of right hemisphere VEP deficit was found in the kwashiorkor group.

Child↗
PubMedDate not supplied

Apparent hypocalcaemia in Nigerian children with kwashiorkor.

Thirty children with kwashiorkor had a mean +/- SEM plasma calcium (Ca) of 7.15 +/- 0.10mg/100ml; total proteins (TP) of 4.60 +/- 0.17g/100ml and albumin (A) of 1.89 +/- 0.11g/100ml. These values are significantly lower (p < 0.001) than the corresponding values of 9.07 +/- 0.10; 7.30 +/- 0.11 and 3.85 +/- 0.07 observed in thirty other age-matched normal controls. No significant differences exist in the plasma alkaline phosphatase (AP) levels in both groups. Correction of calcium for hypoalbuminaemia in the kwashiorkor group revealed that the observed hypocalcaemia in kwashiorkor is merely apparent.

Calcium↗
PubMed1998

Intravenous amino acids, cholestasis and kwashiorkor.

Kwashiorkor dermatosis has not been reported in children on parenteral nutrition (PN). We report a case of kwashiorkor developing in a partially PN dependent patient with cholestasis, when amino acids were removed from the PN solution in an effort to control the cholestasis. Although the kwashiorkor dermatosis improved within 24 hours after the addition of amino acids (1 g/kg) to the PN solution, the cholestasis worsened.

Amino Acids↗
PubMed1975

Kwashiorkor in Cleveland.

Kwashiorkor is uncommon in the United States. Two cases of kwashiorkor were encountered in Cleveland in a short period of time. Both infants had edema, growth failure, irritability, skin and hair changes, and anemia. In each case a major abnormality of feeding had been neither recognized nor corrected during contact with medical personnel. The children did not have milk allergy and both were fed in the hospital without major difficulty, all symptoms resolving with adequate calorie, protein, vitamin, and iron intake. The importance of complete feeding histories is emphasized since such gross protein-calorie malnutrition and its sequelae are preventable.

Breast Feeding↗
PubMed1994

Aflatoxin, kwashiorkor, and morbidity.

Children suffering from kwashiorkor could be grouped as those in whom aflatoxin was detectable in both serum and urine, and those in whom this mycotoxin was undetectable. Examination of the clinical records of the aflatoxin-positive and -negative children (58% and 42% of the sample, respectively) showed several other differences between the two groups. Compared with the aflatoxin-negative group, the children scored as aflatoxin-positive showed a significantly lower haemoglobin level (P = 0.02), a longer duration of oedema (P = 0.057), an increased number of infections (P = 0.037), and a longer duration of hospital stay (P = 0.008). The present findings suggest that the consumption of a staple food such as maize that is contaminated with the fungus Aspergillus flavus exposes susceptible kwashiorkor children to the metabolic hazards of aflatoxins, resulting in a greater risk of frequent infections.

Aflatoxins↗
PubMed1978

High erythrocyte membrane (Na+ + K+)-ATPase in kwashiorkor, in vivo reversal by diuretic.

Specific activity (mumol Pi released/h/mg membrane protein) of ouabain-sensitive (Na+ + K+)-ATPase has been shown to be higher in erythrocytes from children suffering from kwashiorkor, compared to that in normal children. Twenty four hours after treatment of these children with a diuretic, there was reduction in their body weights due to loss of oedema fluid. Ouabain sensitive (Na+ + K+)-ATPase of the erythrocyte membrane was inhibited by about 40% and this was associated with gain of 1.8 mequivalents Na+ per litre of erythrocytes. The results suggest that high ouabain-sensitive (Na+ + K+)-ATPase could be one of the mechanisms operative in erythrocytes to prevent accumulation of Na+ in kwashiorkor.

Adenosine Triphosphatases↗
PubMed2005

Rice nightmare: Kwashiorkor in 2 Philadelphia-area infants fed Rice Dream beverage.

A 14-month-old girl and a 7-month-old boy each presented with a diffuse dermatitis, whole body edema, and hypoalbuminemia. The diets of both infants consisted almost entirely of Rice Dream, a rice-based, protein-poor beverage. Both infants were diagnosed with kwashiorkor, which resolved with protein supplementation. Clues from the physical examination, a diet history, appropriate laboratory examinations, and an index of suspicion are crucial in promptly diagnosing and treating infants with kwashiorkor. Manufacturers of rice beverages should appropriately warn parents about the dangers of using their products as infant nourishment.

Dermatitis↗
PubMed1975

Free catecholamine excretion in the urine in normal infants and in those with marasmus or kwashiorkor.

Free catecholamine (epinephrine + norepinephrine) excretions of normal male infants 2.1-3.2, 4.5-10.6, and 12.5-18.5 months of age, respectively, and of infants and children with marasmus or marasmic kwashiorkor were measured on three consecutive days after admission and after partial rehabilitation. In normal infants, particularly the older ones, the first day's excretion was higher than that of the next two days, probably in response to the stress of the procedures. There was an increase with age, but on a surface area basis, the differences were not significant, the three age groups excreting 15.1 plus or minus 10.2, 23.8 plus or minus 20.9, and 24.7 plus or minus 14.3 mug/m-2/day, respectively. Excretions of marasmic infants on admission were not significantly different from those of the control children. Higher mean values were due to elevated excretions of infants with severe infection. After partial rehabilitation, excretions were similar to those of control subjects. In children with marasmic kwashiorkor excretions were no different from those of control infants, except in severely infected children. Admission values revealed more day-to-day variation than recovery values or than those of normal and marasmic infants, in whom subject to subject variation was more marked.

Adaptation, Physiological↗
PubMed1977

Kwashiorkor not associated with poverty.

Four infants are described with kwashiorkor that was unassociated with poverty or infection as predisposing factors of their disease. The condition followed various dietary regimens deficient in protein of five weeks to seven months in duration. Features of this "sugar-bady" form of kwashiorkor included a low level of physician awareness of malnutrition as a diagnostic consideration, growth retardation, edema, muscle wasting, mental changes, and mild lymphocytosis. Initially, recovery was associated with rapid loss of weight and anemia and subsequently with weight gain and return to good health.

Arizona↗
PubMed1986

Timing and magnitude of adolescent growth in height and weight in Cape coloured children after kwashiorkor.

One hundred sixteen patients who had had kwashiorkor between the ages of 5 months and 4 4/12 years and 89 controls were the subjects of a 15-year follow-up study of their growth and development. We report the findings of a longitudinal analysis of 53 (30 females) of the ex-patients and 30 (15 females) of the controls, selected because at the end of 15 years of study they conformed to the criteria of adult secondary sexual characteristics, height velocity less than 2 cm/yr, and completeness of data. Nonlinear curve-fitting techniques were applied to the height and weight data for these subjects using the Preece-Baines model 1 growth function to determine the timing and magnitude of adolescent growth spurts and the associated biologic changes. Both ex-patients and controls grew below the 25th percentile of British longitudinal standards, but the male ex-patients were heavier, and perhaps taller, than the controls for most of their childhood and adolescence. Velocity curves indicated that the ex-patients had higher pre-adolescent peak increments than the controls and a generally longer growth spurt of reduced magnitude. Two possible explanations are discussed: Garrow and Pike's theory that children with kwashiorkor have a genetic potential for greater physical growth, and a socioeconomic crisis occurring within a family affects the youngest child, who subsequently requires a longer time to recover than do siblings within an improving socioeconomic situation.

Black People↗
PubMed1998

Severe hypophosphatemia in children with kwashiorkor is associated with increased mortality.

Severe hypophosphatemia, serum phosphate concentration <0.32 mmol/L (<1.0 mg/dL), occurred in 8 of 68 (12%) of children with kwashiorkor within 48 hours of admission; 5 of 8 (63%) of these children died, compared with 13 of 60 (22%) children without severe hypophosphatemia (P <.02). Dermatosis and dehydration were significantly correlated with severe hypophosphatemia, but these clinical signs could not reliably predict fatal cases. Severe hypophosphatemia seems to be common and life-threatening in children with kwashiorkor in Malawi.

Child, Preschool↗
PubMed1998

The clinical manifestation of the kwashiorkor syndrome is related to increased lipid peroxidation.

Along with the onset of severe kwashiorkor symptoms, a 20-month-old child showed biochemical signs of markedly increased lipid peroxidation, with a decrease of plasma antioxidants and decreased proportions of polyunsaturated fatty acids in plasma and red cell phospholipids. Additionally, plasma concentrations of the lipid peroxidation products malondialdehyde and hexanal, as well as the urinary excretion of leukotriene E4, were found to be increased. All biochemical alterations normalized along with subsequent clinical improvement. These findings suggest that the extent of lipid peroxidation is strongly related to the severity of the kwashiorkor syndrome.

Aldehydes↗
PubMed1986

Brainstem auditory evoked potentials in severely malnourished children with kwashiorkor.

Brainstem auditory evoked potentials (BAEPs) were recorded in a group of 22 children hospitalized for the treatment of severe malnutrition (kwashiorkor). Recordings were repeated after three weeks of treatment. The control group consisted of age- and sex-matched healthy infants. Abnormal BAEP interpeak-latencies (IPLs) were found in 32% of the kwashiorkor group in the initial recording and in 40% of this group in the follow-up recording. Abnormalities were evenly distributed between the I-III, III-V and I-V IPLs and in the majority of cases were unilateral. The influence of increasing stimulus rate was investigated. The findings may reflect defects in myelination of auditory brainstem pathways, however, BAEP abnormalities were not related to several indices of growth retardation or to serum albumin and hemoglobin levels.

Auditory Pathways↗
PubMed1997

Aflatoxins in the lungs of children with kwashiorkor and children with miscellaneous diseases in Nigeria.

Autopsy lung specimens from 20 children with kwashiorkor and 20 with other miscellaneous diseases, at the Obafemi Awolowo Teaching Hospital complex, Ile-Ife, Nigeria, were analyzed for the presence of aflatoxin using high-performance liquid chromatography. Aflatoxins were detected in 18 children who died from kwashiorkor but only in 13 of those who died from miscellaneous diseases. Of the 10 children, 5 in each group, who died with pneumonia, all had detectable levels of aflatoxins in their lungs. The two children with congestive cardiac failure, one secondary to pneumonia and the other secondary to tuberculous pericarditis, had more than two detectable aflatoxins in their lungs. These findings demonstrate that Nigerian children are exposed to aflatoxins and that high levels can accumulate in lung tissue.

Adolescent↗
PubMed1982

Secretory IgA in nasal secretions of children with acute gastroenteritis and kwashiorkor.

Secretory immunoglobulin A (IgA) was quantitated using the Mancini technique in the nasal washings of children with acute gastroenteritis and in children with kwashiorkor but without gut symptoms. The total immunoglobulin was expressed as a percentage of total protein in nasal secretion measured by biuret method. The IgA level was slightly lower in the kwashiorkor group than in the control group, and there was no statistical difference between IgA level in the acute gastroenteritis and the control group. An explanation for these observations is offered.

Acute Disease↗
PubMed1986

A kwashiorkor-like syndrome in a Caucasian with enteropathy.

A Caucasian child with congenital heart disease (CHD) presented at the age of 19 months with a kwashiorkor-like syndrome. Jejunal biopsy showed sub-total villus atrophy. The clinical picture of repeated infection causing growth faltering followed by oedema, hair and skin changes, resembled the response to infection of many nutritionally stressed children in the tropical world. The exact aetiology of kwashiorkor and the diagnostic specificity of its clinical features remain in doubt, as does precise definition. This case highlights the problems of diagnosing a condition which is essentially the end point of a combination of nutritional and environmental stresses.

Celiac Disease↗
PubMed1990

Prothrombin time as an index of mortality in kwashiorkor.

Prothrombin time, serum albumin, aminotransferases and liver size were evaluated in 40 consecutive cases of kwashiorkor. Eleven (27.5%) of the 40 patients died. Eight out of the 11 patients who died had a prolonged prothrombin time of more than 3 s above the control compared to only 4 out of the 29 who survived (p = 0.005). Mean serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) albumin, globulin and liver size were abnormal but similar in both groups. These results may indicate a predictive mortality value of prothrombin time in kwashiorkor.

Bacterial Infections↗
PubMed1992

Increase in total serum triglyceride and phospholipid in kwashiorkor.

Fasting serum lipids in children presenting with protein-energy malnutrition were studied in comparison with those of sex- and age-matched well nourished controls. There was no difference in serum total cholesterol between malnourished and well nourished children. However, serum triglyceride and phospholipid concentrations were significantly higher in children with kwashiorkor or marasmic kwashiorkor than in well nourished controls. It appears that serum concentrations of triglycerides and phospholipids increase with increasing severity of malnutrition, and that fasting serum triglyceride and phospholipid concentrations above 3 mmol/l are jointly predictive of a poor prognosis in malnourished children.

Case-Control Studies↗