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PubMed1995

Glucocorticoids mediate macrophage dysfunction in protein calorie malnutrition.

BACKGROUND: In hospitalized patients protein calorie malnutrition substantially increases the incidence of infection and death. Protein calorie malnutrition results in significant macrophage dysfunction. Whether a primary nutrient deficit or elevated glucocorticoids levels mediate this dysfunction is unclear. The aim of this study was to evaluate the neuroendocrine response to protein calorie malnutrition and its effects on macrophage function. METHODS: By use of a murine model of protein calorie malnutrition, mice were randomized to (1) a standard 24% casein diet (control), (2) protein-free diet (PFD), (3) PFD in adrenalectomized mice, (4) PFD plus the glucocorticoid receptor antagonist RU486 (10 mg/kg), or (5) a standard 24% casein diet plus a 50 mg corticosterone pellet implanted subcutaneously for 7 days. Mice were killed after 7 days, and body weight and serum albumin and corticosterone levels were measured. Peritoneal macrophages were obtained, and stimulated superoxide and interleukin-6 productions were measured. RESULTS: Protein calorie malnutrition significantly impaired macrophage function and elevated serum glucocorticoid levels. Blocking the stress corticosterone response with adrenalectomy or using RU486 to block corticosterone receptors prevented the impairment of macrophage function without restoring nutritional indexes (body weight and serum albumin level). Administration of glucocorticoids via a subcutaneous pellet reproduced macrophage impairment without leading to nutritional deficits. CONCLUSIONS: The neuroendocrine systemic response to protein calorie malnutrition with elevated serum corticosterone levels is a major determinant of macrophage dysfunction in protein calorie malnutrition.

Animal Nutritional Physiological Phenomena↗
PubMed1999

Prevalence and correlates of malnutrition among children in rural minority areas of China.

BACKGROUND: Child growth retardation and malnutrition remain a matter of uttermost public concern in economically disadvantaged areas of China. The present study aimed to estimate the prevalence of protein-energy malnutrition with various anthropometric indices and examine its correlates in a large sample of poor rural minority children. METHODS: A total of 2019 children under 7 years of age belonging to the Hani, Yi, Hui, Miao ethnic minority groups and the Han major group were drawn from four poor rural minority counties in the Yunnan Province of China. Well-trained investigators completed child physical measurements and maternal interviews. Protein-energy malnutrition was defined as being underweight (weight for age), wasting (weight for height) and stunting (height for age) on the basis of reference data from the National Center of Health Statistics (NCHS)/World Health Organization (WHO). RESULTS: The respective prevalence of moderate and severe protein-energy malnutrition was 15.8 and 3.1% for underweight children, 31.8 and 19.2% for stunting and 0.9 and 0.5% for wasting. Stunting was most common in children aged 2 years. Boys were more likely to suffer from malnutrition. Logistic regression analyses showed that lower family income, lower parental height, belonging to the Miao, Yi and Hani ethnic groups compared with Han and poorer maternal child-rearing behavior significantly increased the risk for stunting of children. CONCLUSIONS: Protein-energy malnutrition is relatively high in the rural minority children of China. Chronic socioeconomic underdevelopment and genetic effects, rather than a severe or immediate lack of food, may lead to protein-energy malnutrition.

Child↗
PubMed2006

Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD.

BACKGROUND: Serum albumin (S-Alb), C-reactive protein (CRP), and interleukin 6 (IL-6) predict malnutrition, atherosclerotic cardiovascular disease (CVD), and mortality in patients with end-stage renal disease (ESRD). Fetuin A, an inhibitor of vascular calcification, also is associated strongly with clinical outcome in patients with ESRD. In this study, multivariate analyses were performed to assess these 4 biomarkers as predictors of malnutrition, CVD, and mortality in patients with ESRD. METHODS: One hundred seventy-six patients with ESRD (54 +/- 12 years) underwent measurements of S-Alb, high-sensitivity CRP (hs-CRP), plasma IL-6, and fetuin A close to the start of dialysis therapy and were followed up for a median of 26 months (range, 1 to 66 months). Nutritional status was evaluated by means of subjective global assessment. CVD was defined based on medical history. Associations between biomarker levels and malnutrition, CVD, and mortality were evaluated by means of receiver operating characteristic curve, logistic regression analysis, and Cox proportional hazards model. RESULTS: All 4 biomarkers predicted malnutrition, CVD, and mortality. Multivariate analysis, according to receiver operating characteristic analysis, showed that malnutrition was predicted best by hs-CRP and IL-6 levels; CVD, by IL-6 level; and mortality, by albumin and IL-6 levels. When using the cutoff levels derived from receiver operating characteristics, logistic regression analysis showed that only hs-CRP level (odds ratio [OR], 3.6) was associated with malnutrition, and only IL-6 level (OR, 3.7) was associated with CVD. Levels of S-Alb, IL-6, and fetuin A, but not hs-CRP, were associated with increased relative risk for mortality as assessed by Cox in a model adjusting for age, sex, and diabetes mellitus. CONCLUSION: Multivariate analyses show that in patients with ESRD, malnutrition is predicted best by hs-CRP and IL-6 levels; CVD, by IL-6 level; and mortality, by S-Alb, IL-6, and fetuin A levels, but not by hs-CRP level. This comparative analysis indicates that of these biomarkers, IL-6 level may be the most reliable predictor of CVD and mortality in patients with ESRD.

Adult↗
PubMed1986

The effect of nutritional support on T-lymphocyte subpopulations in protein calorie malnutrition.

T-lymphocyte subpopulations were measured in the two major types of adult malnutrition, adult marasmus and kwashiorkor-like hypoalbuminemic malnutrition. The population of T-cells (T3) and the percentage of both helper (T4) and suppressor (T8) T-cells were significantly (P less than .05) decreased in patients with kwashiorkor-like hypoalbuminemic malnutrition, but did not differ from control values in patients with adult marasmus. The ratio of helper T-cell (T4), to suppressor T-cells (T8) (range 1.2-1.6) did not vary from control values in either type of malnutrition. One week of nutritional support was not associated with a significant increase in any of the T lymphocyte subpopulations in either type of malnutrition. These T-cell subpopulation changes are consistent with the greater depression of cellular immune function seen in patients with metabolic stresses associated with kwashiorkor-like hypoalbuminemic malnutrition. With the increasing frequency in which abnormalities of T-cell subpopulations are being reported in various diseases, the coexistence of kwashiorkor-like hypoalbuminemic malnutrition should be noted for its potentially confounding effect.

Adult↗
PubMed2006

Malnutrition, eating difficulties and feeding dependence in a stroke rehabilitation centre.

PURPOSE: To analyse prevalence of malnutrition, eating difficulties and feeding dependence in stroke rehabilitation patients because little is known about these prevalence's. Stroke patients have an increased risk for developing eating difficulties, feeding dependence and malnutrition because of their neurological deficits. METHODS: Malnutrition is defined by having unintentional weight loss or a low BMI. Structured observations of eating difficulties and feeding dependence were performed at a regular meal. RESULTS: During the study period of 18 months 69 patients of the 114 admitted stroke patients were included in our study. On admittance malnutrition was present in 35% of the patients and decreased to 3% after 4 weeks of rehabilitation. In total 43% of the patients had one or more eating difficulties and 16% was dependent in feeding. Aberrant eating speed was significantly associated with the presence of malnutrition at admission. CONCLUSIONS: The prevalence of malnutrition in stroke rehabilitation patients is high and decreases significantly during four weeks of rehabilitation. Research is needed into constructs of malnutrition, eating difficulties and feeding dependence.

Activities of Daily Living↗
PubMed1995

The prognostic significance of protein-energy malnutrition in geriatric patients.

Although it has been shown that protein-energy malnutrition is a predictor of adverse outcome in geriatric patients, it is unclear whether this is due to underlying disease or disability, or whether malnutrition is an independent outcome predictor. To clarify the predictive role of malnutrition, we analysed the 4.5-year mortality and living location follow-ups of 219 geriatric patients admitted to a geriatric assessment unit. Prevalence of anthropometric and serological malnutrition indicators were between 13.7% and 39.8% at hospital admission. In bivariate models, prealbumin, subnormal arm muscle area, and subnormal body weight were predictors of mortality and survival at home. On the other hand, albumin, transferrin, and triceps skin-fold thickness did not predict these outcomes. In multivariate models the hazard ratio (HR) of 4.5-year mortality remained significant with an HR of 1.8 (95% CI 1.3-2.6) for subnormal arm muscle area, and 1.6 (95% CI 1.0-2.6) for subnormal body weight. Prealbumin was the strongest serological outcome predictor (multivariate mortality HR 1.9, 95% CI, 1.3-2.8). In these models, subnormal cognitive function, impaired physical function, and creatinine clearance < 30 ml/min were also associated with increased mortality. Malnutrition did not predict hospital discharge location, but among patients discharged home, those with initial malnutrition had a decreased length of survival at home. Our findings indicate that certain protein-energy malnutrition indicators are independent risk factors predicting decreased length of overall survival and survival at home in geriatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1995

Relationship of protein calorie malnutrition to alcoholic liver disease: a reexamination of data from two Veterans Administration Cooperative Studies.

The relationship of protein calorie malnutrition (PCM) to alcoholic liver disease was studied in 666 patients enrolled in two Veterans Administration Cooperative Studies. Some findings of malnutrition could be detected early in 62% of the comparison patients (43 subjects who were alcoholic, but had not yet developed clinical or laboratory evidence of liver injury). In those who had progressed to the stage of liver injury sufficient to manifest clinical jaundice (536 patients), some findings of malnutrition were present in every patient (100%). The degree of malnutrition correlated closely with the development of all the serious complications of the liver disease (ascites, encephalopathy, and hepatorenal syndrome), as well as the overall mortality. The degree of malnutrition was also important in predicting response to some forms of treatment. When prednisolone, a catabolic adrenal steroid, was used, efficacy was independent of the level of malnutrition. However, a relationship was observed with the severity of the liver injury [quantified by the level of jaundice and coagulopathy, i.e., Maddrey's discriminant function (DF(Maddrey)]. For prednisolone, the response was seen only when the DF was 81-100 reducing mortality 45% When oxandrolone, an androgenic anabolic steroid treatment was given, efficacy was observed only in those with moderate malnutrition (PCM score 60-79% of normal) and maximized with adequate caloric intake reducing mortality 86%. To simplify the method of calculating the PCM score for predicting response to anabolic therapy, a multiple logistic regression model was developed from the parameters used to assess nutritional status: DF(PCM) = 0.098 (peripheral blood lymphocytes) + 0.078 (creatinine height index).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

The impact of malnutrition on kidney function.

Malnutrition is the most common cause of mortality in the world. It affects underdeveloped as well as industrialized societies, in the latter demonstrating a prevalence in hospitalized patients of between 30 and 50%. Although the prevalence has decreased in recent studies, the problem is still significant among a selected group of patients. The clinical manifestations of malnutrition may be evident on physical examination but alterations in renal function may not show up at the initial exam. Clinical and experimental models of protein-calorie malnutrition have confirmed significant alterations in renal hemodynamics, renal concentration capacity, and renal acid excretion. Children and adults with malnutrition have been shown to have a decreased glomerular filtration rate and renal plasma flow (RPF), as well as a lowered capacity to concentrate the urine and excrete an acid load. Moreover, clinical and experimental models of protein-calorie malnutrition have unravelled the roles of the renin-angiotensin system, renal prostaglandins, and urea production in the renal function changes associated with malnutrition. We have reviewed the most pertinent and recent studies from our and other laboratories which have improved our understanding of renal functional alterations in malnutrition.

Acid-Base Imbalance↗
PubMed2003

Prevalence of malnutrition in hospitalized medical patients: impact of underlying disease.

BACKGROUND/AIMS: Malnutrition is common among hospitalized patients. We investigated whether certain diseases predispose more frequently for malnutrition than others. METHODS: Nutritional state was assessed by clinical scores, anthropometry and bioimpedance analysis in 502 consecutively admitted patients in the departments of internal medicine in two hospitals in Berlin (n = 300, university hospital; n = 202, district hospital). The prevalence of malnutrition was compared in patient groups with a different diagnosis. RESULTS: Malnutrition was present in 24.2% of all patients. A clear association between diagnoses and malnutrition was found: the prevalence of malnutrition was significantly higher in malignant than in non-malignant diseases (50.9 vs. 21.0%, p < 0.0001). High prevalence rates >30% were observed in subgroups of patients with inflammatory bowel diseases, chronic heart failure and benign lung diseases. Patients with gastrointestinal diseases, however, were not more frequently malnourished than other medical patients (28.8 vs. 22.0%). Malnourished patients were significantly older (70.0 +/- 13.6 vs. 58.3 +/- 15.6 years, p < 0.0001) and had a 40% longer hospital stay (13.1 +/- 8.1 vs. 9.3 +/- 6.8 days, p < 0.0001) than well-nourished patients. CONCLUSIONS: Patients with malignancies, inflammatory bowel disease, chronic heart failure and benign lung diseases need special attention due to the high prevalence of malnutrition.

Age Factors↗
PubMedDate not supplied

Serum interleukin-6 levels correlate with malnutrition and survival in patients with advanced non-small cell lung cancer.

AIM: To investigate the level of interleukin-6 in advanced non-small cell lung cancer and to analyze the relationship with malnutrition and survival. METHODS AND STUDY DESIGN: Seventy-one newly diagnosed advanced non-small cell lung cancer patients were enrolled in this prospective study. Malnutrition was defined by using subjective global assessment. Performance status was assessed by the Karnofsky scale. Serum levels of albumin, transferrin, C-reactive protein, lymphocytes/mm3, lactate dehydrogenase and growth hormone were determined before treatment. The patients were followed, and the factors affecting survival were analyzed. RESULTS: The mean follow-up after diagnosis was 180 days. IL-6 levels increased in 48 (68%) of 71 patients. According to the subjective global assessment, 28 (39%) patients were well nourished and 43 (61%) were malnourished. Of the 43 malnourished patients, 29 (41%) were moderately malnourished or suspected of being malnourished and 14 (20%) were severely malnourished. The IL-6 level was related to impaired performance status (P = 0.0001), severe malnutrition (P = 0.004), increased C-reactive protein (P = 0.013), higher growth hormone (P = 0.025) and transferrin (P = 0.03) levels. On univariate analysis, impaired performance status, moderate and severe malnutrition, decreased serum albumin and transferrin, a raised IL-6 and lactate dehydrogenase levels were the significant prognostic factors for survival. Multivariate analysis indicated that a raised IL-6, severe malnutrition and a low serum level of albumin were independent prognostic factors for survival in patients with advanced non-small cell lung cancer. CONCLUSIONS: IL-6 secretion may play a role in the pathophysiology of malnutrition in advanced lung cancer. Results show a relation between elevated IL-6 serum levels and malnutrition, poor performance status, acute phase response and shorter survival in patients affected by advanced non-small cell lung cancer.

Aged↗
PubMed2005

Malnutrition and health in developing countries.

Malnutrition, with its 2 constituents of protein-energy malnutrition and micronutrient deficiencies, continues to be a major health burden in developing countries. It is globally the most important risk factor for illness and death, with hundreds of millions of pregnant women and young children particularly affected. Apart from marasmus and kwashiorkor (the 2 forms of protein- energy malnutrition), deficiencies in iron, iodine, vitamin A and zinc are the main manifestations of malnutrition in developing countries. In these communities, a high prevalence of poor diet and infectious disease regularly unites into a vicious circle. Although treatment protocols for severe malnutrition have in recent years become more efficient, most patients (especially in rural areas) have little or no access to formal health services and are never seen in such settings. Interventions to prevent protein- energy malnutrition range from promoting breast-feeding to food supplementation schemes, whereas micronutrient deficiencies would best be addressed through food-based strategies such as dietary diversification through home gardens and small livestock. The fortification of salt with iodine has been a global success story, but other micronutrient supplementation schemes have yet to reach vulnerable populations sufficiently. To be effective, all such interventions require accompanying nutrition-education campaigns and health interventions. To achieve the hunger- and malnutrition-related Millennium Development Goals, we need to address poverty, which is clearly associated with the insecure supply of food and nutrition.

Cost of Illness↗
PubMed1999

Dendritic spine pathology in infants with severe protein-calorie malnutrition.

BACKGROUND: Experimental undernutrition in animals, during the critical brain development period, produces retardation of brain growth as well as a number of different morphologic and functional abnormalities in neurons, mainly in the dendritic synaptic apparatus. These alterations are the cause of the poor neurointegrative development that occurs in experimental malnutrition. Severe malnutrition during early postnatal life in humans is known to produce similar neurointegrative disorders as well as mental retardation, but there are very few studies describing the morphology of the dendritic apparatus in infants suffering from this condition. OBJECTIVE: To study the dendritic spine density and morphology in dendrites from cortical neurons in infants dying from severe malnutrition. METHODOLOGY: Brain sections from the somestesic, motor, and occipital cortical areas of 13 infants who died of severe malnutrition and 7 eutrophic infants who died of other causes were studied by means of the rapid Golgi method. Apical dendritic spines from neurons of the fifth cortical layer were studied and counted in all sections. RESULTS: Apical dendrites were significantly shorter in malnourished infants than in the control group (581.54 +/- 54.32 microm in severe malnutrition vs 846.3 microm in normal infants). The number of dendritic spines per dendrite was also significantly diminished (185.3 +/- 36.1 in malnourished vs 374.3 +/- 41.6 in eutrophic infants). There were marked morphologic abnormalities in the dendritic spines of infants dying of severe malnutrition that were classified as dysplastic. CONCLUSIONS: Short apical dendrites, fewer spines, and dendritic spine abnormalities occur in severe infant malnutrition. These anatomic anomalies might be related to the neuropsychological deficits that occur in these children.

Case-Control Studies↗
PubMed2000

Socio-economic risk factors for severe protein energy malnutrition among children in Mulago Hospital, Kampala.

BACKGROUND: Despite Uganda's recent economic success, malnutrition is still an important public health problem and little information is available on socio-economic risk factors for severe protein energy malnutrition. OBJECTIVE: To determine socio-economic risk factors for severe protein energy malnutrition among children aged 0-60 months. DESIGN: A case control study. SETTING: Mulago Referral and Teaching Hospital, Kampala, Uganda. PATIENTS: Sixty six severely malnourished children (age 0-60 months) were matched, for age and sex, with 66 well nourished controls, and socio-economic, demographic, health facility utilisation and feeding practices were compared between the two groups. RESULTS: Severe protein energy malnutrition was associated with young age of the caretaker (p = 0.005), living in a mud walled house (OR 2.44, CI 1.13-5.32), lack of breast feeding (OR 3.22, CI 1.31-8.02), failure to complete immunisation (OR 3.68, CI 1.53-9.011), no land ownership (OR 4.62, CI 2.09-10.3), and no ownership of livestock (OR 13.65, CI 3.60-60.84), by the caretaker. The level of formal education of the caretaker was not associated with severe malnutrition. CONCLUSION: There seems to be a strong association between severe malnutrition and some indicators of poverty, lack of breastfeeding, and failure to complete immunisation. Programmes aimed at poverty alleviation, promotion of breastfeeding and immunisation, will go a long way in preventing malnutrition.

Case-Control Studies↗
PubMed1998

X-ray diagnosable pneumonia in children with severe malnutrition at Kenyatta National Hospital.

OBJECTIVES: To estimate the prevalence of radiologically evident pneumonia among children with severe malnutrition and to evaluate the diagnostic utility of commonly used clinical indicators of pneumonia among children with severe malnutrition. METHODS: All children with severe malnutrition and admitted at the then Paediatric Observation Ward without congestive cardiac failure, severe anaemia, or severe dehydration, were clinically evaluated and a posteroanterior chest X-ray taken for each child. Pneumonia was diagnosed on the basis of radiological changes consistent with pneumonia as reported by an experienced radiologist. The performance of the various clinical parameters as diagnostic tests for pneumonia were also evaluated. SETTING: Kenyatta National Hospital, a tertiary level teaching institution for the University of Nairobi. RESULTS: One hundred and seven children comprising 68 males and 39 females were recruited into the study. Of these children, 38 had kwashiorkor, 40 had marasmus, while 29 had marasmic kwashiorkor. Radiological evidence of pneumonia was found in 58% of children with kwashiorkor, 75% with marasmic kwashiorkor, and 82% with marasmus. All the commonly used clinical parameters performed poorly as diagnostic tests for pneumonia among children with severe malnutrition. CONCLUSION: Prevalence of pneumonia was very high among children with severe malnutrition. Available clinical parameters, singly or in combination, are poor diagnostic tools for pneumonia in children with severe malnutrition. It is advisable to treat children with severe malnutrition as if they had pneumonia, even in the absence of suggestive clinical signs.

Age Distribution↗
PubMedDate not supplied

Effect of protein malnutrition on the weight and serum albumin of albino rats.

BACKGROUND: Protein Malnutrition is one of the major mortality factors in the children of Pakistan. Not only do the children suffer from infections (because of low resistance secondary to malnutrition), but they also lose weight significantly. The two spectra of the diseases are Kwashiorkor and Marasmus. We conducted this study on laboratory animals to assess the weight change and correlated it with the extent of malnutrition by studying and estimating the serum albumin levels as well. METHODS: 40 male albino rats of 2 weeks age were used for the experiment. They were divided into Control and Experimental groups containing equal number of animals. The experimental group was subjected to protein malnutrition for 3 to 6 weeks. They were killed with the paired control animals. The parameters of the two groups were compared for statistical analysis. RESULTS: The results showed significant change in the weights of the experimental animals right from the first week of malnutrition while the change in serum albumin level became significant after prolonged malnutrition. CONCLUSION: Protein malnutrition is reflected from the decrease in the serum albumin levels of the animals and their weights are also decreased significantly.

Animals↗
PubMed1992

[Malnutrition in dilated cardiomyopathy. Correlation with echocardiographic indices of left ventricular function].

PURPOSE: To evaluate the incidence of severe protein-calorie malnutrition in patients with dilated cardiomyopathy (DC), and its correlation with left ventricular contractility. METHODS: Group A--51 patients with DC in decompensated congestive heart failure class III or IV, 36 men, aged 51.9 +/- 15.6 years. Group B--25 patients admitted for elective myocardial revascularization with normal LV contractility, 20 men, aged 57.2 +/- 10.5 years. Tricipital skinfold thickness (TS) and mid-arm muscle circumference (MAMC) were obtained in all patients. Severe protein-calorie malnutrition was defined when both measurements were below the fifth populational percentile (Frisancho tables). In Group Am the echocardiographic left ventricular (LV) diastolic diameter (DD), ejection fraction (EF) and systolic volume (SV) were obtained. Those LV parameters were compared between DC patients with and without severe malnutrition. Correlation analysis were performed between TS, MAMC and LV DD, EF, and SV, in the patients of Group A. RESULTS: Severe malnutrition occurred in 7/51 (13.7%) of Group A, and none in Group B. TS values were of 8.90 +/- 4.47 cm in Gr. A and 23.48 +/- 8.52 in B (p < 0.001). MAMC measured 22.25 +/- 3.13 cm in Gr. A and 23.58 +/- 8.52 in B (p = 0.03), LVEF was of 36.29 +/- 9.43% in severe malnutrition patients and of 37.84 +/- 9.78 in the other patients of Group A (p = 0.70). Conversely, LVDD was of 70.90 +/- 11.3 mm vs. 70.75 +/- 8.54 mm (p = 0.98), and LVSV was of 113.0 +/- 52.7 ml vs. 137.6 +/- 56.8 (p = 0.45), when compared severe malnutrition with the rest of patients of Group A. No correlation was found between TS and MAMC and LV, EF, DD and SV in Group A. CONCLUSION: Severe malnutrition was frequent in patients with DC and heart failure. TS measurements, reflecting caloric reserves, were more affected. Echocardiographic parameters of LV function did not correlate with nutritional status.

Adolescent↗
PubMed1989

Intraperitoneal endotoxin but not protein malnutrition shifts d-tubocurarine dose-response curves in mouse gastrocnemius muscle.

Burn injury-induced changes at the neuromuscular junction include muscle weakness and altered response to neuromuscular blocking drugs. Protein malnutrition and sepsis can concomitantly occur with burn trauma. The role of pure malnutrition or sepsis, in the absence of burn injury, in inducing neuromuscular changes was studied in the mouse gastrocnemius muscle. Additionally, cAMP levels in muscle were evaluated to reflect metabolic activity. Sepsis was studied using doses of endotoxin at one-fourth or one-third the dose evoking 50% lethality. Diets of 5% protein and 5% protein + 35% fiber achieved protein and protein/calorie malnutrition, respectively. In each model neuromuscular function was evaluated by maximal tension developed. Pharmacologic responses were measured through effective dose to paralyze active tension by either 50 or 95%. Protein and protein/calorie malnutrition leading to an approximate 8% body weight loss caused a depression of maximal tension developed; this depression in tension was associated with a 10-fold increase in cAMP levels. Effective doses of d-tubocurarine for twitch inhibition during malnutrition were not significantly different from controls. Sepsis at 2 weeks caused an approximate 8% body weight loss, a significant decrease in maximal tension and at least a 3- to 5-fold shift to the right in dose-response curves to d-tubocurarine. In contrast to malnutrition, cAMP levels were significantly decreased (P less than .001) in sepsis to 1/400 of controls. The altered neuromuscular function and pharmacology observed in sepsis are similar to changes observed in burn injury. Protein malnutrition common to these two states may be important in functional but not pharmacological changes at the neuromuscular junction.

Animals↗
PubMed1993

Prolonged breast-feeding: no association with increased risk of clinical malnutrition in young children in Burkina Faso.

Reported are our findings from a case-control study of the association between prolonged breast-feeding and clinical malnutrition in an urban setting in West Africa. The cases were children aged 12-36 months who had been hospitalized with a diagnosis of clinical malnutrition. Children of a similar age who lived in neighbouring courtyards were recruited as controls. For 152 case-control pairs in which both children were receiving solid foods, non-breast-feeding was associated with an increased risk of clinical malnutrition (crude odds ratio = 2.37; 95% confidence interval = 1.24, 4.55). This association remained statistically significant after controlling for various potentially confounding variables (P = 0.03). Our findings suggest that either prolonged breast-feeding may offer substantial protection against clinical malnutrition in the study population or malnutrition leads mothers to stop breast-feeding. These results are inconsistent with those of a number of workers who have reported that prolonged breast-feeding is associated with an increased risk of malnutrition. This inconsistency might have arisen because of differences in the definition of malnutrition used or because of variations in the quantity and quality of weaning foods available in different settings. We found no evidence to support the hypothesis that prolonged breast-feeding may be detrimental to children.

Breast Feeding↗