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PubMed1970

Immunity, transferrin, and survival in kwashiorkor.

In a study of 40 children with kwashiorkor, serum albumin, transferrin, and immunoglobulin levels were measured. Treatment included chloroquine, pyrimethamine, multivitamins, folic acid, iron compounds, and a high-protein diet. After two weeks the mean serum transferrin values in the children who survived and those who died were 1.30 mg./ml. and 0.33 mg./ml., respectively. Many of the children died immediately after treatment started, and it is suggested that in children with severe kwashiorkor and low serum transferrin levels any increase in free-circulating iron may result in overwhelming infection and death. Thus the appropriate time for instituting iron therapy in such patients should be reconsidered.

Child, Preschool↗
PubMed1971

Impaired cellular immunity in kwashiorkor with improvement after therapy.

Children with kwashiorkor showed a high incidence of deranged cellular immunity as evidenced by impairment of delayed cutaneous hypersensitivity reactions to candida and diphtheria toxoid antigens and of lymphocyte transformation after phytohaemagglutinin stimulation. This may contribute to their susceptibility to infection. A correlation was shown between the degree of impairment of tests of cellular immunity and the severity of the kwashiorkor. Once recovery was initiated the skin tests gave the expected positive results and the lymphocyte transformation index improved. Protein deprivation may result in impaired deoxyribonucleic acid (DNA) synthesis and in atrophy of both the thymus and the lymphoid tissue.

Antigens↗
PubMed2003

The effects of aflatoxin B1 on the development of kwashiorkor in mice.

Seventy Swiss albino mice (6-week-old male) were selected for the investigation into aflatoxin B1's role in the cause of kwashiorkor. The mice were divided randomly into four groups. They were grouped within each group by being fed either low or normal protein level diets supplemented with very small amounts of aflatoxin B1 (0.5 microg/day). The control groups were fed aflatoxin B1-free diets containing either normal or low protein levels. All groups were monitored for 7 weeks. The increase in body weight was found to be low in groups I and II, given diets contaminated with aflatoxin B1. Although groups II and IV, which were given low dietary protein, showed remarkable decreases in serum total protein and albumin levels (group II: total protein 4.1 +/- 0.1 g/dL, albumin 2.6 +/- 0.8 g/dL and group IV: total protein 4.6 +/- 1.3 g/dL, albumin 2.8 +/- 0.82 g/dL) when compared with the groups fed a normal dietary protein level (group I: total protein 5.9 +/- 1.3g/dL, albumin 3.4 +/- 0.7g/dL and group III: total protein 5.4 +/- 1.6g/dL, albumin 3.5 +/- 1.2g/dL; P < 0.05). The statistical difference between these two groups was found not to be significant (P > 0.05). However, decreases in total protein and albumin levels were a little more prominent in group II. In addition, histopatological changes of the liver was remarkable in the group fed a low protein diet and aflatoxin B1 when compared with the group fed only a low protein diet and no aflatoxin B1. More significantly, however, was the increase in liver weight in both groups fed a low protein diet (groups II and IV). Our conclusion is that aflatoxin B1 could not have contributed to the development of kwashiorkor.

Aflatoxin B1↗
PubMed1976

Metabolic and hormonal responses to a protein-glucose meal in normal infants and in marasmus and marasmic kwashiorkor.

Blood sugar and plasma free fatty acids (FFA), immunoreactive insulin (IRI), and growth hormone (GH) responses to a protein-glucose meal were determined in normal infants and those with marasmus and marasmic kwashiorkor. Among the normal subjects, fasting blood sugar (BS), peak BS and IRI, and the IRI/BS ratio tended to decrease as age increased. Peak IRI was at least 13muU/ml above fasting in 21 of 24 infants. Fasting GH levels were high 38.5 +/- 13.6 (SD) and 26.3 +/- 14.0 ng/ml, in the two youngest groups (under 1 year) and were comparable with those of the late newborn period. They were slightly lower, 20.8 +/- 22.1, in those 12.5-18.5 months of age. Suppressions of FFA and subsequent rebounds were in close temporal relation to BS and IRI peaks and lows, but not the GH levels. GH was promptly suppressed by the meal, and in most infants secondary elevations were seen. Untreated marasmic infants had normal or low BS, correspondingly normal or low IRI, markedly elevated FFA (1,821 +/- 588 muEq/liter), and GH levels comparable with those of the control subjects. There was some delay in BS elevation and disappearance and poor insulin release after the meal, with only two of nine having elevations of at least 13 muU /ml The BS elevations and IRI responses, however, were adequate to block FFA release. GH levels were poorly suppressed by the meal but some infants had further elevations, possibly in response to protein. After partial rehabilitation, fasting BS and FFA and BS elevations after the meal were normal. A slight improvement in insulin release was apparent. Fasting GH levels and responses to the meal were normal. Fasting, minimally treated children with marasmic kwashiorkor (MK) had normal or low BS, normal or low IRI, normal FFA, and probably normal GH levels. There was considerable delay in BS elevation, moderately delayed glucose disappearance, and very poor or unmeasurable insulin release after the test meal; FFA and GH were poorly suppressed. After partial rehabilitation, fasting BS was normal, FFA levels were (630 +/- 163 muEq/l), IRI was still low, BS elevations and disappearance improved. IRI responses modestly improved, and GH responses were normal.

Age Factors↗
PubMed1977

The binding of chloroquine to normal and Kwashiorkor serum.

The binding of chloroquine to kwashiorkor and normal serum was investigated. The results show that more drug is bound in kwashiorkor serum, and that this occurs predominantly at the gamma globulin fraction. Therapeutically, in malnutrition there is no significant abnormality of protein binding with respect to chloroquine.

Alpha-Globulins↗
PubMed1976

Fat embolism in kwashiorkor.

Fat embolism from the grossly fatty liver of an infant with kwashiorkor is described. Globules of fat were seen at necropsy in the hepatic veins, in the right atrium and ventricle of the heart and in the pulmonary artery. Sections of the lung showed fat emboli in numerous branches of the pulmonary artery. Examination of lung sections taken at necropsy from 40 patients who had severe kwashiorkor failed to show similar fat embolism.

Embolism, Fat↗
PubMed2001

Selenium status, kwashiorkor and congestive heart failure.

UNLABELLED: Selenium deficiency is associated with congestive heart failure (CHF) in geographic areas where dietary selenium intake is low and in individuals receiving total parenteral nutrition. Among 66 children with kwashiorkor (including marasmic-kwashiorkor), those who developed CHF had lower serum selenium concentrations than those who did not (32.9 +/- 8.3 vs 41.1 +/- 11.9 microg/L, mean +/- SD, p = 0.03). This association was independent of serum albumin and selenium status was not associated with severity of symptoms, anthropometric indices or HIV infection. CONCLUSION: This association raises the possibility that selenium may contribute to CHF in washiorkor.

Child↗
PubMed2001

[Kwashiorkor after an exclusion diet for eczema].

BACKGROUND: Nutritional disorders observed in children with eczema may be aggravated by inappropriate diet, sometimes with dramatic effects. CASE REPORT: A child aged 3 years 7 months presented a state of severe malnutrition with edema (kwashiorkor). The child had chronic eczema and had been given a highly restrictive diet based on a principle of exclusion without medical advise. Cure was achieved without sequelae with a normal diet. DISCUSSION: This case illustrates the fragility of nutritional status in children with chronic widespread skin disease due to the risk of cutaneous loss of protein. Kwashiorkor is an exceptional observation in developed countries and, in this context, might be on the rise due to the popularity of exclusion diets for presumed allergic disease.

Child, Preschool↗
PubMed1975

Chemically defined diet in the treatment of kwashiorkor.

The authors report on the treatment of children with kwashiorkor, using Vivonex or Casilan. With Vivonex, all patients were bottle-fed as early as the 2nd or 3rd day, whereas Casilan had to be administered by stomach tube for about a week. Children fed Casilan vomited much more frequently than patients receiving Vivonex. When Casilan was given, the albumin level rose after 8 days, whereas with Vivonex, this did not occur unitl 15 days. On the other hand, only the Vivonex fed children showed an increase of hemoglobin in the first 3 weeks of treatment. With Vivonex, the patients reached their minimum weight much faster and at a lower albumin level than with Casilan. In both groups, the frequency of diarrhea was similar; the relatively high glucose concentration of Vivonex and the disturbance of resorption, even of monosaccharides, which is frequently observed in severe cases of kwashiorkor may be responsible for the diarrhea of the children receiving Vivonex.

Blood Glucose↗
PubMed1992

The exocrine pancreas in kwashiorkor and marasmus. Light and electron microscopy.

Histological sections of pancreas and liver from 65 cases of children dying from childhood malnutrition were reviewed. The extent of pancreatic atrophy and fibrosis was compared with fatty change in the liver. Pancreatic atrophy was common, and often associated with severe fatty change in the liver, but also occurred in marasmic children with scanty liver fat. Pancreatic fibrosis, when present, was only of mild degree. Among 16 patients with marasmus, fibrosis was only seen in one pancreas. Fibrosis was recorded in 8/25 cases of kwashiorkor, and in 7/24 cases diagnosed as marasmic-kwashiorkor. Electron microscopy of the pancreas was performed in seven cases, using tissue collected at immediate autopsy. Atrophy and variable amounts of degranulation of acinar cells were seen. There was often disorganization of the endoplasmic reticulum with intracisternal sequestration. Mitochondrial swelling was consistent with terminal anoxia. Centro-acinar cells were prominent. Some acini were dilated and contained fibrillar material. These findings support the pioneer paper by Blackburn and Vinijchaikul (1969) and underline the importance of pancreatic atrophy in the pathology of protein-energy malnutrition.

Child, Preschool↗
PubMedDate not supplied

Tropical calcific pancreatitis presenting as kwashiorkor.

Tropical clacific pancreatitis can be accompanied by varying degrees of malnutrition but full-blown kwashiorkor is an extremely rare presentation. We report the case of a 10-year-old male who presented with clinical features of severe kwashiorkor. He had extensive pancreatic clacification and exocrine pancreatic deficiency. The child was treated with pancreatic enzyme replacement, and enteral nutrition supplemented with vitamins and micronutrients. Following therapy, he started gaining weight, the skin changes partly disappeared and his hair resumed its normal black colour.

Calcinosis↗
PubMed1991

[Nutritional regulation of serum osteocalcin: study in kwashiorkor].

The serum levels of osteocalcin (bone gla protein) in two groups of Senegalese children, healthy controls and severely malnourished (kwashiorkor) children during nutritional rehabilitation, were measured. The serum osteocalcin of all kwashiorkor children was dramatically decreased on admission to hospital, but increased fourfold during rehabilitation. Serum osteocalcin was low in the control group. In both groups these low levels seemed to be independent of those of 1,25-dihydroxyvitamine D3 which were in the normal range. The results suggest that serum osteocalcin levels might be related to protein-energy status.

Appetite Regulation↗
PubMed1978

Septicaemia in kwashiorkor.

In blood and stool cultures from 90 Black children with kwashiorkor, the commonest organisms isolated were Gram-negative aerobic rods. The mortality rate was highest in the group who developed septicaemia. In patients with negative blood cultures, the outcome was much more favourable, although the majority of them showed evidence of respiratory and/or bowel infections. It is felt that routine antibiotic therapy is advisable in the management of kwashiorkor.

Bacteria↗
PubMed1978

Successful use of a soya-maize mixture in the treatment of kwashiorkor.

Forty-eight children aged 5 years or less admitted consecutively with a clinical diagnosis of kwashiorkor were randomly allocated to two groups. One group was treated with milk while the other group was fed soya-maize porridge; both groups received the same supportive treatment. The recovery rate in both groups was comparable. Protein intake and the rate of rise in serum albumin and transferrin concentrations were greater in the milk-fed group. The incidence of diarrhoea was significantly less in the children fed soya-maize. Soya-maize porridge is recommended as an effective and inexpensive treatment for kwashiorkor.

Animals↗
PubMed1987

Increased frequency of induced sister chromatid exchanges in kwashiorkor.

The study included 16 infants with advanced manifestations of kwashiorkor and 16 unrelated age-matched normals as controls. Whole blood samples, at room temperature, were exposed to gamma-rays in increasing dosages. Lymphocytes were cultured; phytohaemagglutinin and bromodeoxyuridine (10 microM) were added, at initiation of culture, and harvesting was performed after 64 to 68 h. Slides were coded and sister chromatid exchanges (SCE) counted. In controls, no significant increase in the frequency of SCE was found. For kwashiorkor infants the SCE frequencies showed significant increase as irradiation dosages rose. It is concluded that the changes observed are probably due to alteration in: the cell cycle length; activities of enzymes responsible for DNA repair; DNA growing points; and protection of cells from chromosome breakage.

Child, Preschool↗
PubMed1977

Malnutrition and malabsorption. Effect of nutritional rehabilitation on gastrointestinal function in kwashiorkor and marasmus--a longitudinal study.

The effects of long-term feeding of an adequate diet on the progressive changes in the biochemical parameters including gastrointestinal functions in children suffering from marasmus and kwashiorkor are presented. In both groups fasting bloos sugar, blood urea nitrogen, hemoglobin, serum total proteins and albumin at admission were significantly lower than in matched controls. These parameters improved after proper dietary therapy over a period of two years. The improvement in the biochemical parameters correlated with clinical and anthropological measurement. On admission, the gastrointestinal function as assessed by various tests was poor in both the groups. This returned to normal or near normal after nutritional rehabilitation. The return was much quicker for glucose and fat absorption than for lactose and d-xylose absorption. The rate of improvement in marasmus was slower than that in kwashiorkor.

Blood Glucose↗
PubMedDate not supplied

[Salivary amylase in kwashiorkor. III. Investigative study of salivary concentration and secretion in 4 patients presenting complications during nutritional recovery].

In four kwashiorkor children with ages between 20 and 36 months, the salivary volume (ml), the amylase concentration (U/ml) and secretion (U/Kg/5 min.) was studied, since the first day in the hospital until the discharge. These children had same diseases during the nutritional recuperation. The control group had eighteen children of the same age and eutrophic. The salivary secretion during 5 minutes was taken by special technic and in the same moment in each day. In one patient with serious kwashiorkor the level of the salivary secretion was slow while the nutritional state was bad. The levels of the salivary amylase secretion and concentration was slow while the disease was present making difficult the nutritional recuperation in each patient.

Amylases↗
PubMed1977

The binding of phenobarbitone and phenytoin to kwashiorkor serum.

The binding of phenytoin and phenobarbitone to the serum of kwashiorkor patients and normal serum has been investigated. There was no alteration in the binding of phenytoin. However, there was a decrease in the binding of phenobarbitone to kwashiorkor serum, and this was particularly striking in the presence of added phenytoin. It was confirmed that phenytoin was almost exclusively albumin-bound, while phenobarbitone was bound to albumin, alpha 1-and alpha 2-globulin in almost equal proportions.

Alpha-Globulins↗