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PubMed1983

Effect of levamisole on E rosette inhibition by serum of malnourished children.

E rosette forming lymphocyte levels were measured in 5 normal children (in the presence or absence of levamisole) after in vitro gamma globulin (AGG) or sera containing E rosette inhibitory substance obtained from kwashiorkor children. The experiments were repeated using lymphocytes from 5 kwashiorkor children who showed detectable levels of serum E rosette inhibitory substance. There was a diminution in the E rosette formation of normal lymphocytes treated with AGG or with serum of kwashiorkor children having E rosette inhibitory substance. Addition of levamisole in vitro significantly increased the levels of E rosettes. Similarly low levels of E rosettes were demonstrated when lymphocytes of kwashiorkor children were incubated with autologous sera. Treatment with levamisole in vitro also improved the levels of E rosettes.

Child, Preschool↗

PubMedDate not supplied

Serum cholesterol esterifying activity in kwasiorkor.

Serum lipid levels were determined in 30 children with kwashiorkor and in 30 healthy children of comparable age. The serum concentrations of unesterified and esterified cholesterol, albumin and the cholesterol esterifying activity (CEA) were also measured in children with kwashiorkor before treatment and after recovery. All serum lipid fractions were significantly lower in kwashiorkor than in the normal children. After treatment and recovery, serum lipid levels were comparable to those observed in normal children. There was also a significant increase in serum cholesterol esterifying activity (CEA) following recovery from kwashiorkor.

Child↗

PubMed1984

Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis.

Three hundred sixty-three alcoholic patients with alcoholic hepatitis were studied in six Veterans Administration medical centers. By history, alcohol consumption was 227.9 g per day, with a mean duration of 23.8 years. Cirrhosis accompanied the alcoholic hepatitis in 58.7 percent of the patients who underwent biopsy or autopsy. Complete nutritional assessment was performed in 284 patients, and observed nutritional changes were classified into those associated with marasmus or those characterizing kwashiorkor. A smaller comparison group of 21 alcoholic patients matched for age and alcohol consumption but without clinically evident liver disease was also studied in an identical manner. None of the patients with liver disease was completely free from malnutrition, whereas 62 percent of the alcoholic patients without liver disease showed abnormalities. In patients with alcoholic hepatitis, some findings associated with marasmus were seen in 86 percent, and some features of kwashiorkor were observed in 100 percent. When present together, the complete picture of kwashiorkor and marasmus correlated closely with the clinical severity of the liver disease (p less than 0.005). The nearly constant association of either complete or partial kwashiorkor or marasmus suggests that the separation of these two entities is artificial in alcoholic patients with liver disease. Although, experimentally, malnutrition may not be essential for the development of alcoholic hepatitis, clinically, it appears to precede the development of the liver injury, which suggests an interaction. Recognition is important so that appropriate nutritional therapy can be provided.

Adult↗

PubMed2002

Outpatient care for severely malnourished children in emergency relief programmes: a retrospective cohort study.

BACKGROUND: In emergency nutritional relief programmes, therapeutic feeding centres are the accepted intervention for the treatment of severely malnourished people. These centres often cannot treat all the people requiring care. Consequently, coverage of therapeutic feeding centre programmes can be low, reducing their effectiveness. We aimed to assess the effectiveness of outpatient treatment for severe malnutrition in an emergency relief programme. METHODS: We did a retrospective cohort study in an outpatient therapeutic feeding programme in Ethiopia from September, 2000, to January, 2001. We assessed clinical records for 170 children aged 6-120 months. The children had either marasmus, kwashiorkor, or marasmic kwashiorkor. Outcomes were mortality, default from programme, discharge from programme, rate of weight gain, and length of stay in programme. FINDINGS: 144 (85%) patients recovered, seven (4%) died, 11 (6%) were transferred, and eight (5%) defaulted. Median time to discharge was 42 days (IQR 28-56), days to death 14 (7-26), and days to default 14 (7-28). Median rate of weight gain was 3.16 g kg(-1) x day(-1) (1.86-5.60). In patients who recovered, median rates of weight gain were 4.80 g kg(-1) day(-1) (2.95-8.07) for marasmic patients, 4.03 g x kg(-1) x day(-1) (2.68-4.29) for marasmic kwashiorkor patients, and 2.70 g x kg(-1) x day(-1) (0.00-4.76) for kwashiorkor patients. INTERPRETATION: Outpatient treatment exceeded internationally accepted minimum standards for recovery, default, and mortality rates. Time spent in the programme and rates of weight gain did not meet these standards. Outpatient care could provide a complementary treatment strategy to therapeutic feeding centres. Further research should compare the effectiveness of outpatient and centre-based treatment of severe malnutrition in emergency nutritional interventions.

Ambulatory Care↗

PubMed1982

High-density-lipoprotein-cholesterol in protein-energy malnutrition.

1. Plasma total cholesterol, high-density-lipoprotein (HDL)-cholesterol total protein, albumin and globulin levels were estimated in blood samples from thirty children with kwashiorkor, thirty-five with marasmus, twenty-eight with marasmic-kwashiorkor and twenty-seven control children. 2. HDL-cholesterol was estimated after the very-low-density and low-density lipoproteins were precipitated from the plasma with heparin and manganese chloride. 3. The distribution of HDL-cholesterol in the control and in the children with PEM was skewed and the range of values was wide. The values were independent of age and sex. 4. After logarithmic transformation of the HDL-cholesterol and HDL-cholesterol:total cholesterol values, the geometric mean values for the three groups of children with PEM were significantly decreased when compared with values for the control children. 5. The decrease in the mean HDL-cholesterol value for the children with kwashiorkor was more than for children with marasmus and marasmic-kwashiorkor.

Blood Proteins↗

PubMed1995

The computed axial tomography of the brain in protein energy malnutrition.

Forty consecutive new cases of protein energy malnutrition were evaluated clinically and biochemically; in addition, the brain morphology was assessed by computed tomography within 24 hours of admission. Cerebral shrinkage was shown in six of 14 (42.9%) cases of marasmus, ten of 14 (71.4%) cases of kwashiorkor, and 11 of 12 (91.7%) cases of marasmic-kwashiorkor. Ventricular dilatation was demonstrated in 57.1% of marasmus cases, 71.4% of kwashiorkor cases and 91.7% of patients suffering from marasmic-kwashiorkor. However, none of the subjects studied showed any changes in the brain stem or cerebellum. Only ten returned 2 months after nutritional rehabilitation for repeat tomograms. None of these repeat tomograms showed any residual morphological changes. The study demonstrated that the brain is affected in all types of malnutrition, albeit in different proportions, but these changes are completely reversible.

Brain↗

PubMed2005

Nutritional and clinical status of children admitted to the malnutrition ward, Maputo central hospital: a comparison of data from 2001 and 1983.

Malnutrition is the fourth commonest reason for hospital admission to the paediatric department of the Central Hospital, Maputo and has the second highest death rate (20 per cent). A study from 1995 into mortality at this paediatric department, suggested an increase in severe malnutrition. Recent studies have shown that the global burden of undernutrition in the world is declining; however, data for Eastern Africa shows a deterioration. The current study was aimed at describing and comparing the patients on the malnutrition ward, in 2001 and 1983. The study gathered indices of nutritional status and secondary diagnoses from the notes of all children (aged between 6 months and 5 years) discharged from the malnutrition ward for a period of l year (January-December 2001), and from data (collected in January-December 1983) for the malnutrition ward. Data was entered and analysed using Epi-Info 6 and SPSS statistics package. The ethics committee of the hospital approved the study. Data was collected for 558 children in 2001 and 833 in 1983. There was no gender difference, average age was 21.7 months in 2001 and 23.8 months in 1983 and the average hospital stay was 13.1 and 14.3 days, respectively. In 2001, 33 per cent had kwashiorkor, 26 per cent marasmus, and 28 per cent marasmic kwashiorkor. Three hundred and twenty children (82 per cent) were <2 Z-scores below the median weight-for-age and 252 children (65 per cent) were <3 Z-scores. Forty per cent had malaria, 65 per cent anaemia, 53 per cent bronchopneumonia, 14 per cent TB, 36 per cent diarrhoea, and 12 per cent HIV/AIDS. In 1983, 49 per cent had kwashiorkor, 17 per cent marasmus, and 11 per cent had marasmic kwashiorkor. A total of 494 children (81 per cent) were <2 Z-scores below the median weight-for-age and 335 children (55 per cent) were <3 Z-scores. Eighteen per cent had malaria, 37 per cent anaemia, 28 per cent bronchopneumonia, 6 per cent TB, 8 per cent diarrhoea, and 4.4 per cent measles/post-measles. A comparison between the clinical status of 1983 with that of 2001 shows little difference in age, gender or length of stay. There were fewer admissions in 2001, although a higher percentage of severely underweight children and the 2001 group had more secondary infections, especially malaria, bronchopneumonia and anaemia. Clinical malnutrition at a referral hospital level, in spite of the remarkable Mozambican economic growth, shows signs of following the depressing pattern for much of Eastern Africa. A prospective study including HIV tests and anthropometric data for this and the city's other hospitals is warranted. Discussion needs to be prompted on a local level about malnutrition and the use of guidelines.

Body Weight↗

PubMed2003

Diagnostic potential of serum vitamin E tocopherol and cholesterol levels in children with protein energy malnutrition in western Kenya.

OBJECTIVE: To determine the levels and diagnostic potential of vitamin E (alpha-tocopherol) in protein energy malnutrition (PEM) in western Kenya. DESIGN: Passive Hospital based study conducted on inpatients and outpatients. SETTING: Webuye sub-District and Moi Teaching and referral Hospitals, Western Kenya. SUBJECTS AND METHODS: Serum levels for vitamin E and cholesterol concentrations in children < 5 years of age (n=56) admitted to Webuye District Hospital, Bungoma, Western Kenya and some (n=3) admitted to Moi teaching and referral Hospital, Eldoret Kenya suffering from Kwashiorkor, Marasmus or PEM and malaria plus there controls, for a period of one year (January-December, 2001) were examined. High Performance Liquid Chromatography (HPLC) and Spectrophotometry were used for the analysis. RESULTS: The serum vitamin E levels were higher in Kwashiorkor (0.078 mg/ml, SD 0.034) than marasmus (0.075 mg/ml; SD 0.069) and controls (0.057 mg/ml; SD 0.022). The mean serum cholesterol levels were higher in marasmus (204.6 mg/dl; SD 104.8) than Kwashiorkor (186.0 mg/dl; SD 119.3) and controls (154.3; SD 33.3). There was a significant correlation in vitamin E concentrations between Kwashiorkor and controls only at P<0.01 as compared to Marasmus and Marasmic/Kwashiorkor. Vitamin E levels did not show significant correlation to cholesterol in malnourished children from Webuye, Bungoma in western Kenya at P<0.01. CONCLUSION: Vitamin E could be a useful diagnostic tool for PEM in this area.

Case-Control Studies↗

PubMed1990

The absence of adapted sodium and potassium transport in erythrocytes of cerebral palsied children with secondary malnutrition.

Previous studies of erythrocyte ion (potassium and sodium) transport during marasmus and kwashiorkor have indicated increased passive permeation to both ions in both syndromes, and increased Na,K pump activity in kwashiorkor and reduced activity in marasmus. Children with severe cerebral palsy (CP) frequently suffer secondary protein energy malnutrition (PEM). Unlike marasmus and kwashiorkor, this PEM is uncomplicated by micronutrient deficiency, parasitism and infections. Because of deformities classification of PEM cannot be performed in these children by stature-based anthropometry, therefore we used triceps skinfold thicknesses less than the fifth percentile and absence of weight gain in the previous year as criteria for malnutrition. K influx data from well- and malnourished CP children, and from well-nourished controls reveal that ouabain-sensitive K influx is highest in malnourished CP, followed by well-nourished CP (P = 0.02), and lowest in controls (P less than 0.001, vs. malnourished). Determinations of ouabain-sensitive Na efflux, though less precise and therefore more variable, were consistent with this finding of no decrease of Na,K pump activity occurring during the development of this malnutrition. There were no statistically significant differences in ouabain-insensitive fluxes of either Na or K. Ion transport in undernourished CP children thus resembles that found in kwashiorkor rather than in marasmus; but oedema is rarely seen in this form of secondary PEM.

Adolescent↗

PubMed1968

Organ weights and water content of rats fed protein-deficient diets.

To provide the basic information needed for studies of drug toxicity in rats suffering from protein deficiency, weanling male albino rats were fed for 28 days on either laboratory chow or a synthetic diet containing 27% or 8% of casein. The low-protein diet produced a kwashiorkoric cachexia characterized by stunting, alopecia, tail dermatitis, apathy, augmented calorie intake per kg body-weight and a 20% death rate. Autopsies at weekly intervals disclosed that the synthetic normal-protein diet produced a slight loss of total body-weight, due to loss of weight in the adrenal glands and gastrointestinal tissues, and a more-or-less generalized dehydration of body organs. The body-weight of the kwashiorkoric rats was half that of the control groups, due especially to loss of weight in caecum, kidneys, liver, muscle, skin, spleen, salivary glands and thymus gland; loss of weight was less marked in other organs, particularly the stomach, heart and testes and, especially, the brain. There was further dehydration of adrenals and brain but the liver and gastrointestinal tissues tended to be hydrated. The kwashiorkoric diet had not entirely suppressed growth-stimulated relative increase in weight of muscle, skin and testes. The histology of organs was essentially normal in the survivors. Absence of oedema in organs distinguished the kwashiorkoric rats from rats with total calorie depletion.

Animal Nutritional Physiological Phenomena↗

PubMed1994

Correlation of some biochemical parameters with clinical features of protein energy malnutrition.

The authors report on a study correlating the laboratory findings of children with protein energy malnutrition (PEM) with their clinical presentations. Forty-nine cases of marasmus, 17 of kwashiorkor and 28 of marasmic-kwashiorkor, as well as 20 controls, were studied and monitored in hospital. Fasting plasma samples obtained on days 2, 14 and 21 were analyzed for total proteins, albumin, triglycerides and cholesterol. Blood glucose and haemoglobin were also determined. The total plasma proteins and albumin were significantly lower in all the malnourished cases compared to the controls, with marked hypoproteinaemia among those cases with kwashiorkor. Plasma triglycerides were significantly lower in the malnourished group, when compared to controls. With dietary treatment, plasma triglycerides rose significantly accompanied with regression in liver size. Four out of the 17 children with kwashiorkor, had died; they had the lowest serum albumin concentrations of all the cases studied. The mean haemoglobin concentration of those who died was also significantly lower than that of the survivors.

Blood Glucose↗

PubMed1998

A study of some changes of cell-mediated immunity in protein energy malnutrition.

This work was done to assess both monocytic and lymphocytic functions and to identify their role in the altered immunocompetence in protein energy malnutrition (PEM). This was accomplished through the evaluation of the phagocytic function and the in vitro production of interleukin 1 and interleukin 2 (IL-1 and IL-2) from cultured mononuclear cells. Forty patients with PEM within the age of (5-20 months) and twenty normal healthy subjects of matched age and sex were studied. They were subjected to complete blood picture, total serum protein, serum albumin, C3, C4, monocyte phagocytic function and in vitro production of both IL-1 and Il-2 from cultured mononuclear cells. Patients were graded on the basis of their clinical findings into three groups: Marasmic, marasmic kwashiorkor and Kwashiorkor. The study revealed that monocyte phagocytosis, complement components, in vitro production of IL-1 and IL-2 were significantly lower in the patients group when compared to normal control group, this increase was most obvious in the marasmic Kwashiorkor and Kwashiorkor groups. In addition, mononuclear cells from the infected patients produced less IL-1, Il-2 although the total leucocytic count was significantly increased than in the non-infected patients, indicating a functional rather than numerical cellular impairment. It was concluded that both monocytic and lymphocytic functions were impaired in PEM. This functional impairment may be involved in the failure of development of specific immune response and predisposed to increased susceptibility to infection in these patients.

Female↗

PubMed1993

Decreased chloramphenicol clearance in malnourished Ethiopian children.

The disposition of chloramphenicol and chloramphenicol monosuccinate has been studied in thirty-four Ethiopian children of varying nutritional status. After a single intravenous dose corresponding to chloramphenicol 25 mg per kg bodyweight, the plasma clearance of chloramphenicol monosuccinate was decreased only in severely malnourished children with kwashiorkor. Seventeen % of the dose (range 0-51%) was recovered in urine as intact prodrug, indicating incomplete and variable bioavailability of chloramphenicol. Compared to underweight children, on average marasmic and kwashiorkor subjects exhibited a 2- and 3-fold increase, respectively, in the AUC of chloramphenicol. Elevated AUCs could be traced to reduced hepatic clearance of the drug. The unbound fraction both of chloramphenicol and its prodrug were slightly elevated in serum from kwashiorkor subjects. The possibility of using a single point measurement of plasma chloramphenicol as a guide to individualized dosage are discussed.

Biological Availability↗

PubMed1988

Pharmacokinetics of streptomycin in Ethiopian children with tuberculosis and of different nutritional status.

Fifty-six malnourished Ethiopian children with tuberculosis classified in four nutritional groups (normal, underweight, marasmus and kwashiorkor), were given streptomycin 20 or 30 mg.kg-1 i.m. The plasma concentration-time data revealed an increased apparent volume of distribution in children with kwashiorkor compared to normals. The total plasma clearance was low and did not differ between the nutritional groups. Thus, the half-life was prolonged only in kwashiorkor. The results could be explained by decreased protein binding in plasma and decreased renal clearance by glomerular filtration.

Child↗

PubMed1983

Chloramphenicol pharmacokinetics in Ethiopian children of differing nutritional status.

The pharmacokinetics of i.v. chloramphenicol succinate and oral chloramphenicol palmitate were studied in Ethiopian children with different nutritional states. In children with kwashiorkor the plasma clearance of chloramphenicol was significantly lower than in children of normal weight (4.16 ml/min/kg versus 7.53 ml/min/kg). In consequence the mean half-life was prolonged (3.76 h versus 2.85 h) and this led to somewhat higher plasma levels in the kwashiorkor children. The influence of the pathophysiological changes offset one another so that plasma concentrations within the therapeutic range were obtained in children with kwashiorkor given recommended standard i.v. doses. The absorption of chloramphenicol after oral administration in severely malnourished children was erratic, which suggests that this route should be avoided in such patients.

Administration, Oral↗

PubMed1981

Urinary free amino acids pattern in protein-energy malnourished Sudanese children.

The urinary free amino acid pattern in a morning urine sample of Sudanese children suffering from Kwashiorkor and marasmus were determined before and during the course of treatment up to the 2nd week. The urinary amino acid/total urinary N (3.62) was found to be almost constant for Kwashiorkor patients, while the mean for marasmic patients was found to be 27. The concentration of leucine, valine, phenylalanine, methylhistidine, lysine, hydroxylysine and beta-amino-isobutyric acid was elevated in marasmic children, while the concentration of most of these amino acids was at a lower level in Kwashiorkor patients. The significance of these differences was discussed in relation to the biochemical detection of these deficiencies in field nutrition surveys.

Amino Acids↗

PubMed1980

The metabolic fate of [14C] benzoic acid in protein-energy deficient rats.

The metabolic fate of [14C] benzoic acid administered i.p. to marasmic-kwashiorkor rats has been investigated. Rats fed a normal diet with benzoic acid administered i.p. at 200 mg/kg, excreted the benzoic acid mainly as hippuric acid (99% of 24 h excretion), while marasmic-kwashiorkor rats excreted 62--85% as hippuric acid and 14--37% as the glucuronide conjugate. 2 weeks after repletion metabolism of benzoic acid by the marasmic-kwashiorkor rats on the stock diet had returned to normal; most of the benzoate was excreted as hippuric acid.

Animals↗

PubMed2004

The evaluation of serum leptin level and other hormonal parameters in children with severe malnutrition.

OBJECTIVES: Protein-energy malnutrition (PEM) is a clinical problem caused by inadequate intake of one or more nutritional elements, and remains as one of the most important health problems in developing countries. The aim of this study is to determine the relationship among leptin concentrations, body weight and concentrations of some serum hormones, e.g., basal GH, IGF-1, basal cortisol and IGF-BP3, in severe malnourished children, and to determine the effects of leptin in malnourished children. DESIGN AND METHODS: The study group consisted of 36 children diagnosed with PEM. Thirty healthy children were enrolled as the control group. After an overnight fast and before initiation of feedings, fasting venous blood samples were obtained from a forearm vein with needle technique for routine tests, and leptin, IGF-1, IGF-BP3, basal GH and cortisol levels were measured. Tests were carried out in the laboratories of the Department of Biochemistry by commercial kits. RESULTS: Serum leptin levels of infants with marasmus and kwashiorkor were significantly lower than that of the controls (2.09 +/- 0.93 and 2.27 +/- 1.01, 6.82 +/- 2.28 ng/ml, respectively, P < 0.001). However, there was no significant difference between serum leptin levels in children with marasmus and those with kwashiorkor (P > 0.05). Serum IGF-1 and IGF-BP3 levels were significantly lower in malnourished children (P < 0.001, both). Also, basal GH and cortisol levels were significantly higher in malnourished children (P < 0.001, both). There was a positive correlation among serum leptin levels and IGF-1 and IGF-BP3 levels and also a negative correlation among serum leptin levels and basal GH and cortisol levels in children diagnosed with marasmus or kwashiorkor and the control group. CONCLUSIONS: The decrease of energy intake and adipose tissue and serum IGF-1 levels in children with PEM may result in decrease of leptin secretion. Decrease in serum leptin levels may initiate food intake by increasing appetite and stimulating the secretion of cortisol and GH that might increase energy expenditure through an autocrine mechanism. Moreover, serum leptin level may be an important signal to reflect the metabolism of children with PEM.

Anthropometry↗