The effect of aromatic amino acid supplementation on a1- antirypsin synthesis in oedematous malnutrition

OBJECTIVES: We have previously demonstrated that infected children with oedematous protein energy malnutrition have an impaired acute phase response to infection. We hypothesize that this impaired response is due to a relative shortage of aromatic amino acids. We therefore sought to determine whether supplementation of the diet of infected oedematous malnourished children with aromatic amino acids (70 mg/kg/d phenylalanine, 80 mg/kg/d N-acetyltyrosine, 30 mg/kg/d tryptophan) would increase the rate of synthesis of acute phase proteins compared with an isonitrogenous diet supplemented with alanine. METHODS: In oedematous malnourished children, a primed continuous infusion of 3H2-leucine was used to determine the in vivo synthesis rates of a1-antirypsin (a1-at), an acute phase protein, when they were infected (Study 1) and after clearing of infection (Study 2). RESULTS: There was effect of aromatic amino acid supplementation on the rate of synthesis or concentration of a1-at. CONCLUSION: Supplementation of the diet of oedematous malnourished children with aromatic amino acids did not enhance the immune response as determined by the in vivo synthesis of a1-at. (AU)

Energy and protein accessibility at the household level in Jamaica: results from a national survey - abstract

Patterns of food consumption in Jamaica are of interest not only because of the increase in the food prices relative to the national minimum wage but also because the increased mortality rates from cardiovascular diseases in Jamaica may be related to dietary intakes. Data on household food expenditure were collected in the Jamaica Survey of Living Conditions and these were used to determine household energy and protein accessibility. The survey comprised a national representative sample of 3,861 households. The mean per capita daily energy and protein accessibility levels were 2,170 calories and 64 gm, respectively. This can be compared to reference requirements of 2,250 calories and 43 gm protein. The sample was divided into quintiles of total consumption with the top comprising the richest 20 per cent of the sample and the bottom quintile the poorest 20 per cent. The mean accessibility levels from the poorest quintiles were 909 calories and 24 gm protein while those of richest were 3,356 calories and 102 gm protein. The deficit in energy and protein in the poorest individuals may not be as dramatic as these figures indicate. The total energy and protein accessibility levels do not include meals consumed outside of the home, whether these were bought or received as gifts or as wages. This source of nutrients may be important to this group. In addition, the poorest households have more children which will decrease their per capita nutrient received. However, the indication is that the poorest individuals may be having intakes below those required. This would not only result in poor development of children but also may affect productivity levels in adults and hence national development (AU)

Relationships among dietary quality, children's appetites, growth stunting and efficiency of growth in poor populations

Monotonous diets prevail among the poor in developing countries. In Jamaica, small children do not eat a variety of foods and the foods they do eat has a low energy density and is low in protein. Further, infants receive sweetened maize meal porridge and infant formula in a bottle. Older children eat a thicker porridge and rarely eat meats. Yet these children are content with small infrequent feedings. They often have infections which further diminishes their appetite resulting in weight loss. Their weight often does not catch up between infections. Gaseous intestinal distention, foul feces, and anorexia (indicative of small bowel anaerobic overgrowth) are common symptoms of undernutrition. Further anorexia is also a symptom of zinc, potassium, and phosphorous deficiencies. 17 percent of children <5 years old in Jamaica weighed <80 percent of the NCHS standard for age. Among 11-17 year old boys, the height of low income boys in Jamaica was much shorter (by 9 cm) than that of middle income Jamaican boys and the NCHS standards. This shows that earlier, chronic, environmental stress results in stunting. Further childhood undernutrition can also impair mental development. Food supplements do not always result in weight or height gain, however. Yet essential minerals and vitamins are not included in food supplements, but are included in animal feed. Lean tissues and adipose tissue synthesis are needed for normal growth each of which requires different diets. An optimal balance of amino acids and essential elements known as type II nutrients (potassium, magnesium, calcium, phosphorus, and zinc) are needed for lean tissue synthesis while adipose tissue synthesis needs energy for storage. Jamaican children who quickly improve after malnutrition become fat indicating that muscle synthesis lags behind adipose tissue synthesis. In conclusion, to prevent growth failure, nutritionists should concentrate on nutrient balance and nutrient intake in the diets and supplements of children.(AU)

Adaptation to a marginal intake of energy in young children

Six male children, aged 8-28 months, were studied for three consecutive periods of 1 week each. They were given diets that provided 1.7g protein/kg per d and supplements of minerals and vitamins, with a metabolizable energy intake during the 1st, 2nd and 3rd week of 419, 293 and 335 kJ (100, 70 and 80 kcal)/kg per d, diets 1, 2 and 3 respectively. All the food offered was consumed. Each child was weighed at the same time each day on an electronic balance. On the 6th and 7th day of each study period urine and stool were collected for 24h to assess nitrogen balance. Using linear regression analysis it was shown that all children gained weight on diet 1, 2.3(SD 1.3)g/kg per d, and five of six children gained weight on diet 3, the mean for the whole group being 2.7(SD 2.3)g/kg per d, not significantly different. On diet 2 all children lost weight, -5.4(SD 1.3)g/kg per d, highly significantly different from each of the other dietary periods. Using asymptotic regression analysis it could be shown that the rate of weight loss during the first part of the week on diet 2, -11g/kg per d, was greater than at the end of the week, -2g/kg per d, with a tendency towards a steady weight by day 7. Apparent N retention (mg/kg per d) was positive at the end of each of the three dietary periods: diet 1, 112(SD 25); diet 2, 54(SD 34); diet 3, 82(SD20). In five of the six children there was a marked reduction in stool frequency on diet 2 compared with diet 1, that was maintained to the period on diet 3. The findings suggest that during the period on diet 2 there was a saving of energy of the order of 105 kJ(25 kcal)/kg per d, which lasted through into the period on diet 3

Relationship between hepatic glutathione and fatty liver in weanling rats on a low protein diet

Weanling rats were fed on one of four diets: laboratory chow, PLC; 23 percent casein protein, CC; 8 percent casein protein, LP; 8 percent casein protein with supplemental cysteine to the level found in CC diet, LPC. Liver and blood glutathione (GSH), total liver fat and hepatic triglyceride were measured at 6, 12 and 20 days. On the PLC diet the increase in body weight, liver weight and liver GSH were significantly greater than on the CC diet (p<0.01). After 20 days on the LP diet rats showed a significant increase in liver triglyceride and total fat. The addition of cysteine to the low protein diet was associated with a significant increase in body weight and liver GSH and prevented liver triglyceride and total fat from increasing. GSH levels in extrahepatic tissues were not affected to the same extent as in the liver. There was a significant negative linear correlation between hepatic GSH and both liver triglyceride and liver total fat. A low dietary cysteine can cause fatty infiltration of the liver and this may be mediated through a fall in liver GSH (AU)

Erythrocyte clutathione reductase activity and riboflavin status in severely malnourished children - abstract

Erythrocyte glutathione reductase (EGR), cofactor is riboflavin (vit B2), functions together with glucose 6-phosphate dehydrogenase to maintain cellular levels of glutathione and thus the integrity of the erythrocyte. The compromised antioxidant status of severely malnourished children along with increased exposure to metabolic stress led us to postulate that EGR activity might be increased in malnutrition as a compensatory response to oxidative stress. We therefore measured EGR activity in 49 severly malnourished children on admission and again in 35 of these children at discharge. Erythocyte glutathione-reductase-activation-coefficient (ERGAC), an index of riboflavin status, was also assessed. Twenty-two healthy children served as controls (C). The malnourished group had significantly higher EGR activity (8.34 ñ 0.31 U/g Hb; mean ñ SEM) than the control group (6.63 ñ 0.23 U/g Hb). On admission, children with marasmus (M) had significantly higher EGR activities (8.95 ñ .046 U/g Hb) than children with marasmic kwashiorkor (MK: 8.08 ñ 0.67 U/g Hb) or kwashiorkor (K: 7.66 ñ 0.53 U/g Hb). At discharge, high levels of EGR were maintained in all groups. However, the kwashiorkor group showed a significant increase up to (10.37 + 0.41 U/g Hb). An EGRAC > 1.30 indicates riboflavin deficiency. Forty per cent of the controls as well as 50 percent of the malnourished children were deficient in riboflavin supplementation of the malnourished groups, the EGRAC fell to normal levels. We concluded (1) that EGR activity is increased in severly malnourished children; this may be as a result of increased metabolic stress, and (2) the riboflavine status of malnourished children improved significantly during their recovery (AU)

Calcific pancreatic diabetes mellitus

A case report of a young man developing calcific pancreatic diabetes mellitus secondary to alcoholic pancreatitis has been presented. His clinical course demonstrates phasic insulin dependence (AU)

Hepatic function in rats with dietary-induced fatty liver, as measured by the uptake of indocyanine green

The hepatic uptake of indocyanine green (ICG) has been measured in rats receiving a 50 g protein/kg diet for 6, 12 or 20 d or a choline-deficient diet for 2 or 6 d. There was no effect on ICG uptake on the choline-deficient diet, although all the rats developed an intense fatty infiltration of the liver by 6 d. The rats on the 50 g protein/kg diet showed impaired uptake of ICG at 6, 12 and 20 d, which appeared to be related to the extent of fatty infiltration. It is concluded that ICG uptake is predominantly a function of the periportal zone of the liver lobule, and therefore likely to be sensitive to insults that exert their predominant effect in this zone. (AU)

Comparison of the chemical and biochemical composition of thirteen muscles of the rat after dietary protein restriction

The objective of this study was to determine whether the chemical and biochemical changes induced by muscle wasting caused by dietary protein restriction are different in various skeletal muscles. Rats were fasted for 3 d and then fed on a 10 g protein/kg diet for 21d. Thirteen muscles from the trunk, forelimb, and hind-limb regions were analysed for muscle weight, and the content of water, fat, cellular and extracellular protein, DNA and RNA. Results were compared to values for an `initial' control group killed at the start of the experiment. Weight loss was greatest in trunk muscles and least in the distal forelimb muscles. Water content decreased in most muscles, but increased in three forelimb muscles. A significant loss of lipid was found in the gastroenemius, while the biceps brachii gained lipid. Changes in lipid content of the muscles did not form a distinctive pattern. All muscles except the distal forelimb muscles lost a significant amount of cellular protein, while all muscles except the diaphragm gained extracellular protein. DNA content was unchanged in all muscles. The value for cellular protein: DNA was significantly reduced in the rectus abdominis and the diaphragm. A significant loss of RNA was found in all muscles; the percentage change was greatest in trunk muscle and least in the distal forelimb muscles. The values for RNA: protein and RNA: DNA were significantly lower in all muscles except two distal forelimb muscles. With the exception of the water and lipid content of the muscles, the directions of the changes in the experimental animals were the same for all muscles. The results suggested, however, that the magnitude of changes in certain chemical and biochemical indices of composition may depend to some extent on the anatomical location of the muscle: trunk muscles tended to show the greatest percentage change, while the distal forelimbs changed the least.(AU)