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PubMed1980

A prospective 15-year follow-up study of kwashiorkor patients. Part I. Physical growth and development.

A series of 221 infants admitted to hospital with kwashiorkor between 1958 and 1960 has been followed up for 15 years. Seventy-two (32%) died of malnutrition either at the time of first admission or shortly thereafter. The subsequent physical growth and development of the survivors remaining in Cape Town has been compared with that of 89 of their siblings who had never had kwashiorkor, but grew up in the same environment. No differences were noted between the two groups, but considered together they demonstrated a pattern of retarded growth and delayed development. This suggests an adaptive mechanism suited to survival in poor socio-economic circumstances. The years of poor growth in childhood and early adult life are not associated with an undue mortality, and malnutrition exacts its toll of morbidity and mortality in the early years of life. It is to this age group that intervention with short-term solutions (food subsidization and supplementation) should be applied with the expectation of demonstrable benefit. The long-term solution depends on advancing socio-economic conditions, bringing better nutrition and enlightened health practices; this will eventually lead to improved standards of growth and development.

Aging↗
PubMed1993

A case of kwashiorkor.

Kwashiorkor is part of the spectrum of protein-energy malnutrition. The condition results from a lack of nutritional protein coupled with carbohydrate excess. Protein malnutrition is much more common in the Third World; however, it is also the most common form of nutritional deficiency among hospitalized patients in the United States. Cutaneous clues to the diagnosis of protein deficiency include the "flag sign," hypochromotrichia, alopecia, "crazy pavement" dermatosis, pallor, and glossitis. Systemic manifestations include peripheral edema, liver disease, neurologic changes, diarrhea, weight loss, and hypoalbuminemia. We report here a case of profound kwashiorkor in a nonhospitalized patient who presented with multiple cutaneous and systemic findings indicative of protein malnutrition.

Adult↗
PubMed1976

Defective leucocyte inhibitory factor (LIF) production by lymphocytes in children with kwashiorkor.

Production of the lymphokine leucocyte inhibitory factor (LIF) by phytohaemagglutinin (PHA)-stimulated lymphocytes was assessed in 25 children with kwashiorkor. Although the lymphocytes of 12 of these patients produced adequate amounts of LIF, the rest of the group failed to produce lymphokine after PHA activation. There was no correlation between the ability to produce LIF and the age, severity of malnutrition or any other clinical parameters assessed in these patients. This finding confirms the presence of defective cell-mediated immunity observed in a substantial proportion of kwashiorkor children.

Humans↗
PubMed1953

Treatment and prevention of kwashiorkor.

Recent research carried out on kwashiorkor in Kampala, Uganda, is discussed. The first essential in both the treatment and the prevention of this disease being a diet rich in protein (preferably animal protein, to ensure an adequate intake of vitamin B(12) and a satisfactory mixture of amino-acids), methods of incorporating sufficient protein into children's diets were investigated.For the treatment of severe cases, two high-protein diets-one based on animal protein, the other on plant protein-gave good results. In the first, the protein was obtained from dried skimmed milk and a calcium caseinate preparation known as Casilan; in the second, it was supplied by soya. Some vitamin B(12), which is lacking in the soya itself, was added to the second diet in order to ensure satisfactory weight gains.With regard to prevention, the author points out that although it is theoretically simple there are serious practical difficulties. The best sources of protein-milk, meat, and fish-are unfortunately, at present, too expensive for general consumption in Uganda. Therefore, the best possible use of plant protein must be made for the time being. In this connexion, the author recommends investigating the value of sunflower, which grows more easily in Uganda than soya. He feels that soya, sunflower, and maize could probably be combined to provide a mixture of amino-acids which-though not as perfect as that found in animal proteins-would be very satisfactory.

Animals↗
PubMed1981

Iatrogenic kwashiorkor in infants.

Four children experienced kwashiorkor six weeks to six months following the introduction of a low-protein, high-fat, nondairy creamer into their diets. In all cases, the milk substitute eventually became their sole nutritional source and resulted in hypoproteinemia, edema, and hepatic abnormalities. All patients had been given the milk substitute in an attempt to control suspected milk protein sensitivity. Only one of the four patients was subsequently shown to have cow's milk sensitivity. All had complete resolution of symptoms within six weeks following institution of a nutritionally adequate diet.

Edema↗
PubMed1990

Comparative action of calpain on erythrocyte Ca2(+)-pumping ATPase in sickle cell anaemia, essential hypertension and kwashiorkor.

Calpain, a calcium-dependent, neutral cysteine-protease was purified from the erythrocyte cytosol of subjects having essential hypertension (HTN), sickle cell anaemia, (SCA), or kwashiorkor (KWA). Identical electrophoretic mobility on SDS-polyacrylamide gradient gel, sensitivity to micromolar amounts of Ca2+, absolute requirement for a reducing environment and a high susceptibility to inhibition by leupeptin and thiol-group modifying reagents confirm that calpain preparations from these erythrocytes are equivalent to calpain I. Whereas the extent of calpain activation of erythrocyte membrane Ca2(+)-pumping ATPase of normal subjects was almost equal to that due to calmodulin, calpain activation of the HTN and SCA pump was greater than activation by calmodulin. Like in normal membranes, exogenous calmodulin protected the Ca2(+)-pumping ATPase of these erythrocytes against calpainization; the degree of protection by calmodulin is least in SCA and HTN. Electrophoretic separation of erythrocyte membranes and the purified Ca2(+)-pumping ATPase of HTN, SCA and KWA subjects does not indicate the presence of fragments resulting from the proteolytic action of calpain.

Anemia, Sickle Cell↗
PubMed1975

Serial measurements of vitamin B-12 and vitamin B-12-binding capacity in marasmic kwashiorkor.

Vitamin B-12 and total vitamin B-12-binding capacity (TBBC) have been determined by a radio-saturation assay in the blood of a large group of patients suffering from marasmic kwashiorkor on admission, and during their whole re-feeding. The results have been compared with values obtained in control children of the same ethnic group and with normal children living in Belgium. Vitamin B-12 levels are high on admission and only normalize during the second month of re-feeding. TBBC is normal on admission but significantly increases during re-feeding.

Black People↗
PubMed1987

Detergent induced lysis of erythrocytes in kwashiorkor.

The effect of the non-ionic detergent Nonidet P40 on lysis of erythrocytes in children suffering from kwashiorkor was studied. The concentration of the detergent causing 50% haemolysis was significantly reduced in these patients. Detergent haemolysis was more sensitive than osmotic fragility (which was reduced). The abnormality was only slight in marasmic children.

Anemia↗
PubMed1990

Effacement of glomerular foot processes in kwashiorkor.

In a study of the pathogenesis of the oedema of kwashiorkor the ultrastructure of the kidneys from 6 children was examined shortly after they died from oedematous malnutrition. There was a generalised effacement of the glomerular epithelial cells onto the basement membrane. The filtration slits that remained were narrowed. The picture was similar to that seen in minimal-change nephrotic syndrome--but none of the children had albuminuria. The degree of effacement was statistically related to treatment with gentamicin. The findings suggest that there is a defect in the anionic charge of the glomerular basement membrane in oedematous malnutrition, that the membrane charge is more easily neutralised by cations such as gentamicin, and that, because proteinuria is not a feature of oedematous malnutrition, the proteinuria in other conditions associated with glomerular epithelial cell effacement (eg, minimal-change nephrotic syndrome) is due to something more complex than simple loss of charge.

Basement Membrane↗
PubMed1975

Adrenal function in normal infants and in marasmus and kwashiorkor. Cortisol secretion, diurnal variation of plasma cortisol, and urinary excretion of 17-hydroxycorticoids, free corticoids, and cortisol.

Normal infants exhibited circadian rhythmicity of plasma F concentration. Infants from 2.1 to 3.2 months of age had CSR significantly higher than those of older infants. THF/THE urinary excretion ratios increased with age. The 17OHCS excretion was higher in the younger infants. Urinary excretions of free corticoids and cortisol were similar in all age groups. In marasmus, plasma F concentrations in the morning and evening were significantly elevated. Normal diurnal variation returned following therapy. CSR and 17OHCS excretions were not different from age controls, but were significantly lower than size controls, THF/THE ratios, urinary excretion of free corticoids and cortisol were normal. In marasmic kwashiorkor, plasma F concentrations were significantly elevated in the morning and evening. There was a suggestive decrease with therapy. CSR was low before and after treatment. THF/THE ratios, urinary 17OHCS excretion, and urinary free corticoids and cortisol were not significantly different from infants matched for size or patients with marasmus.

17-Hydroxycorticosteroids↗
PubMed1975

ECG as a prognostic instrument in Kwashiorkor.

Serial ECG studies were carried out on 32 cases of severe kwashiorkor and two cases of marasmus. Single readings were also carried out on 10 controls. In those cases which had a bad prognosis, particularly those that died, there was a marked shift of the axis of the mean QRS vector of the limb leads to the right. Those that did not deteriorate showed no such shift, and those that deteriorated but eventually recovered, showed a shift to the left in the recovery phase. No such shift was noted in the two cases of marasmus. I suggest that this shift in mean QRS vector could be a useful and accurate prognostic guide.

Electrocardiography↗
PubMedDate not supplied

Secondary sexual development of 'Cape Coloured' girls following kwashiorkor.

This report describes the secondary sexual development of 45 'Cape Coloured' female ex-kwashiorkor patients and 43 female controls. All patients were originally seen between five months and four years four months of age, treated and then followed up for 15 years after discharge. Age at menarche was available on 42 ex-patients and 33 controls, and age at peak height velocity (PHV) was available for 30 ex-patients and 15 controls. Maximum likelihood estimates of the mean age at entry to each pubertal stage were made, age at menarche was obtained directly from the subject records and age at PHV was obtained by fitting a non-linear growth function to the data for each subject. All subjects passed through the sequence of pubertal events in the normal order, i.e., no reversals were observed. Ex-patients were generally delayed in relation to controls but there were no significant differences for ages at entry to any of the pubertal stages. The subjects were combined for comparison to equivalent data on British girls. The South African girls were significantly delayed in the development of pubic hair and menarche but showed no significant differences for age at entry or duration of breast development and PHV. It is suggested that lack of delay in breast development may have selective advantages to females living in situations of chronic malnutrition.

Female↗
PubMedDate not supplied

Secondary sexual development of Cape coloured boys following kwashiorkor.

This report describes the secondary sexual development of 78 Cape Coloured male ex-kwashiorkor patients and 53 male controls. All patients were originally seen between 5 months and 4 years 4 months of age, treated and then followed up for 15 years after discharge. Age at peak height velocity (PHV) was available for 23 ex-patients and 15 controls. Maximum likelihood estimates of the mean age at entry to each pubertal stage were made and age at PHV was obtained by fitting a non-linear growth function to the data for each subject with appropriate serial height records. No significant differences were observed between ex-patients and controls for either the sequence of pubertal events or for the age of entry to each stage. When compared to a sample of normal British boys the Cape Coloured sample exhibited significant delay for ages at entry to all pubertal stages with differences ranging from 0.84 years for PH2 to 1.94 years for PH5. It is suggested that adrenal androgens play a major role in delaying secondary sexual development during chronic malnutrition and that the anterior pituitary's response to such conditions is to selectively delay pubertal status.

Adolescent↗
PubMed1958

Kwashiorkor type of fatty liver in primates.

Fatty livers resembling those seen in the early stages of kwashiorkor have been produced in primates. Monkeys were fed, for about 1 year, purified diets free from choline and betaine and low in methionine. Supplementation with choline slightly improved food consumption and gain in weight. Choline prevented the appearance of any stainable lipide in the liver of the control animals. The extent to which the slightly greater intake of protein, including methionine, in the choline-supplemented animals contributed to the prevention of the periportal accumulation of fat in the liver is being determined.

Animals↗
PubMed1991

Plasma lecithin-cholesterol acyltransferase activity and plasma lipoprotein composition and concentrations in kwashiorkor.

Plasma lecithin-cholesterol acyltransferase (LCAT) activity, lipoprotein composition, and lipoprotein concentrations were measured in 21 children with kwashiorkor before (day 1), during (day 10), and after treatment (day 30). Day 1 LCAT activity (78.2 mumol.L-1.h-1) was decreased with respect to day 10 (139.2 mumol.L-1.h-1, P less than 0.001) and day 30 (108.0 mumol.L-1.h-1, P = 0.08). Plasma total cholesterol (TC), cholesterol ester (CE), and lipoprotein CEs (VLDL, IDL, LDL, and HDL) were reduced relative to days 10 and 30 (P less than 0.001). Before treatment HDL composition was abnormal. On days 1, 10, and 30, the respective mean HDL-apolipoprotein A-I (apo A-I) concentrations were 23.33, 39.66, and 36.08 mumol/L. LDL-apo B concentrations were 0.40, 0.68, and 0.56 mumol/L (P less than 0.01, days 10 and 30 vs day 1). LDL particles on day 1 were decreased in number, depleted of CE, and laden with triacylglycerol and surface lipids. LCAT activity on day 1 correlated with LDL-CE linoleate (P less than 0.05, r = 0.48). Reduced plasma LCAT activity is an important factor related to abnormalities in lipoprotein composition and concentrations.

Apolipoproteins B↗
PubMed1991

Nondairy-creamer-induced kwashiorkor: 5-year follow-up.

Failure to thrive may not be a result of organ disease, physical abuse, or intentional neglect. We describe an infant who developed kwashiorkor with a high-fat, low-protein, nondairy coffee creamer diet. The elimination diet was administered on the advice of a family friend for a facial rash. The child presented at 10 months of age with decreased weight for height, rash, hepatomegaly, edema, hypoproteinemia, hypoalbuminemia, anemia, hypoglycemia, and evidence of hepatic sequestration of lipids. A rapid recovery of biochemical abnormalities was evident on reinstitution of a full diet. An intellectual assessment at age 5 years showed normal results.

Female↗
PubMed1984

Kwashiorkor in Baltimore.

Advanced cases of malnutrition are rare in the United States. Since it is rarely suspected, a correct diagnosis of malnutrition, even in extreme form, may easily be missed. We present a recent case of the kwashiorkor form of the syndrome of protein-energy malnutrition to emphasize its diagnostic features and to enhance early recognition and initiation of proper therapy. The misunderstanding of a physician's recommendations by a teen-aged mother may have initiated this illness.

Adolescent↗