WHO guideline on the dairy protein content in ready-to-use therapeutic foods for treatment of uncomplicated severe acute malnutrition

This WHO guideline is an update of the specific recommendation in the technical annex of the 2007 Joint Statement by the World Health Organization (WHO), the World Food Programme (WFP), the United Nations System Standing Committee on Nutrition (UNSSCN) and the United Nations Children's Fund (UNICEF) on community-based management of severe acute malnutrition, which states that at least 50% of the proteins in ready-to-use therapeutic foods (RUTF) should come from dairy products. When this Joint Statement was released, the only RUTF formulation available contained dairy as the primary source of protein. Recently, alternative RUTF formulations with different sources of protein have been tested in several trials. The aim of these alternative RUTF formulations is to reduce the production cost of RUTF by partially or fully replacing dairy protein with cheaper and/or locally available options. Reducing the cost of RUTF would increase access to treatment for children with severe acute malnutrition. This guideline provides global, evidence informed recommendations focusing on whether reduced dairy or non-dairy RUTF should be used for treating uncomplicated severe acute malnutrition.

Comparison of cricket diet with peanut-based and milk-based diets in the recovery from protein malnutrition in mice and the impact on growth, metabolism and immune function.

Some evidence suggests that edible insects could be used to treat malnutrition following protein deficiency. However, additional studies are needed to better assess the potential of edible insects as a therapeutic food supplement and their long-term impact on recovery from malnutrition. The goals of this study were to investigate the effectiveness of a cricket-based diet in recovery from protein-malnutrition in early life, and to compare cricket protein to more traditional sources used for food fortification and supplementation. Protein-malnutrition was induced by administration of an isocaloric hypoprotein diet (5% protein calories) in young male mice for two weeks during puberty, followed by a six-week recovery period using a cricket-, peanut- or milk-based diet. We examined the impact of protein-malnutrition and subsequent recovery on body weight, growth and select biomarkers of inflammation and metabolism. Protein-malnutrition resulted in growth retardation, downregulation of inflammatory markers in spleen tissue, decreased levels of serum triglycerides, and elevated serum levels of leptin and adiponectin. The cricket-based diet performed equally well as the peanut- and milk-based diets in body weight recovery, but there were differences in immune and metabolic markers among the different recovery diets. Results suggest edible crickets may provide an alternative nutrient-dense protein source with relatively low environmental demands for combating the effects of early-life malnutrition compared to more traditional supplementation and fortification sources. Additional investigations are needed to examine the short and long term impacts of different recovery diets on metabolism and immune function.

Supplementation of Ocean-Based Advance Protein Powder (APP) for Restoration of Body Growth, Bone Development and Immune Functions in Protein Malnourished Mice: Implications for Preventing Child Malnutrition.

Child malnutrition is a global public health challenge. A protein malnutrition (PM) model in young mice was established in this study. The efficacy of an ocean-based protein (APP) extracted from by-catch fish as compared to casein and soy on restoring body weight, bone growth, and immunity of PM mice was evaluated. Results show that supplementation of APP increases body weight, lean muscle mass, bone area, mineral content and density. APP supplementation increases spleen, thymus weight, and interlukin-6 production. In conclusion, APP is an alternative source of protein to effectively restore body weight, bone growth and immune function of PM mice.

[The Influence of Protein on the Prevention of Fragility Fractures Among Senior Adults]. / Der Einfluss von Protein auf die Prävention von Fragilitätsfrakturen bei älteren Erwachsenen.

The Influence of Protein on the Prevention of Fragility Fractures Among Senior Adults Abstract. The aim of this review article is to discuss protein intake in senior adults at risk for fragility fractures as a modifiable factor for fracture prevention. Proteins are building blocks of the bone matrix and the muscles. This dual function fits in with the concept of prevention of fragility fractures in senior adults aimed at reducing both bone loss and falls. In older adults, a protein-rich diet could be another simple and effective way to promote bone and muscle health, in addition to the established recommendations for adequate vitamin D and calcium intake.

A Novel Concept of Amino Acid Supplementation to Improve the Growth of Young Malnourished Male Rats.

BACKGROUNDS/AIMS: This study was aimed at understanding the relationship between plasma amino acids and protein malnutrition and at determining whether amino acid supplementation associated with malnutrition and growth improves linear growth in growing rats. METHODS: Body length and plasma amino acids were measured in young male rats that were fed the following diet for 3 weeks, mimicking a low and imbalanced protein diets based on maize, a major staple consumed in developing countries: a 70% calorically restricted cornmeal-based diet (C), C + micronutrients (CM), CM + casein (CMC), CM + soy protein (CMS) or CMS + 0.3% lysine. RESULTS: A correlation analysis of linear growth and plasma amino acids indicated that lysine, tryptophan, branched-chain amino acids, methionine, and phenylalanine significantly correlated with body length. Supplementation with these 5 amino acids (AA1) significantly improved the body length in rats compared to CMC treatment whereas, nitrogen-balanced amino acid supplemented controls (AA2) did not (CM +1.2 ± 0.2, CMC +2.7 ± 0.3, CMS +2.1 ± 0.3, AA1 +2.8 ± 0.2, and AA2 +2.5 ± 0.3 cm). CONCLUSION: With securing proper amino acid balance, supplementing growth-related amino acids is more effective in improving linear growth in malnourished growing male rats. Analysis of the correlation between plasma amino acids and growth represents a powerful tool to determine candidate amino acids for supplementation to prevent malnutrition. This technology is adaptable to children in developing countries.

Stereology shows that damaged liver recovers after protein refeeding.

OBJECTIVE: The aim of the present study was to investigate the putative effects of a low-protein diet on the three-dimensional structure of hepatocytes and determine whether this scenario could be reversed by restoring the adequate levels of protein to the diet. METHODS: Using design-based stereology, the total number and volume of hepatocytes were estimated in the liver of mice in healthy and altered (by protein malnutrition) conditions and after protein renutrition. RESULTS: This study demonstrated a 65% decrease in the liver volume (3302 mm3 for the control for undernourished versus 1141 mm3 for the undernourished group) accompanied by a 46% reduction in the hepatocyte volume (8223 µm3 for the control for undernourished versus 4475 µm3 for the undernourished group) and a 90% increase in the total number of binucleate hepatocytes (1 549 393 for the control for undernourished versus 2 941 353 for the undernourished group). Reinstating a normoproteinic diet (12% casein) proved to be effective in restoring the size of hepatocytes, leading to an 85% increase in the total number of uninucleate hepatocytes (15 988 560 for the undernourished versus 29 600 520 for the renourished group), and partially reversed the liver atrophy. CONCLUSIONS: Awareness of these data will add to a better morphologic understanding of malnutrition-induced hepatopathies and will help clinicians improve the diagnosis and treatment of this condition in humans and in veterinary practice.

Leucine restores murine hepatic triglyceride accumulation induced by a low-protein diet by suppressing autophagy and excessive endoplasmic reticulum stress.

Although it is known that a low-protein diet induces hepatic triglyceride (TG) accumulation in both rodents and humans, little is known about the underlying mechanism. In the present study, we modeled hepatic TG accumulation by inducing dietary protein deficiency in mice and aimed to determine whether certain amino acids could prevent low-protein diet-induced TG accumulation in the mouse liver. Mice fed a diet consisting of 3 % casein (3C diet) for 7 days showed hepatic TG accumulation with up-regulation of TG synthesis for the Acc gene and down-regulation of TG-rich lipoprotein secretion from hepatocytes for Mttp genes. Supplementing the 3 % casein diet with essential amino acids, branched-chain amino acids, or the single amino acid leucine rescued hepatic TG accumulation. In the livers of mice fed the 3 % casein diet, we observed a decrease in the levels of the autophagy substrate p62, an increase in the expression levels of the autophagy marker LC3-II, and an increase in the splicing of the endoplasmic reticulum (ER) stress-dependent Xbp1 gene. Leucine supplementation to the 3 % casein diet did not affect genes related to lipid metabolism, but inhibited the decrease in p62, the increase in LC3-II, and the increase in Xbp1 splicing levels in the liver. Our results suggest that ER stress responses and activated autophagy play critical roles in low-protein diet-induced hepatic TG accumulation in mice, and that leucine suppresses these two major protein degradation systems. This study contributes to understanding the mechanisms of hepatic disorders of lipid metabolism.

[Development of a high content protein beverage from Chilean mesquite, lupine and quinoa for the diet of pre-schoolers]. / Desarrollo de una bebida de alto contenido proteico a partir de algarrobo, lupino y quinoa para la dieta de preescolares.

This research was aimed at developing a high content protein beverage from the mixture of liquid extracts of a pseudocereal, quinoa (Chenopodium quinoa Willd) and two legumes: mesquite (Prosopis chilensis (Mol.) Stunz) and lupine (Lupinus albus L.), native from the Andean highlands of the Chilean northern macro-zone, flavored with raspberry pulp, to help in the feeding of children between 2 and 5 years of lower socioeconomic status with nutritional deficiencies. The formulation was defined by linear programming, its composition was determined by proximate analysis and physical, microbiological and sensory acceptance tests were performed. After 90 days of storage time, the beverage got a protein content of 1.36%, being tryptophan the limiting amino acid; for its part, the chromaticity coordinates of CIEL*a*b* color space showed no statistical significant differences (p < 0.05) maintaining the "dark pink" tonality, the viscosity and the sensory evaluation were acceptable for drinking.

Metabolic responses to acute physical exercise in young rats recovered from fetal protein malnutrition with a fructose-rich diet.

BACKGROUND: Malnutrition in utero can "program" the fetal tissues, making them more vulnerable to metabolic disturbances. Also there is association between excessive consumption of fructose and the development of metabolic syndrome. However, there is little information regarding the acute effect of physical exercise on subjects recovered from malnutrition and/or fed with a fructose-rich diet. The objective of this study was to evaluate the metabolic aspects and the response to acute physical exercise in rats recovered from fetal protein malnutrition with a fructose-rich diet. METHODS: Pregnant Wistar rats were fed with a balanced (B) diet or a low-protein (L) diet. After birth and until 60 days of age, the offspring were distributed into four groups according to the diet received: B: B diet during the whole experiment; balanced/fructose (BF): B diet until birth and fructose-rich (F) diet afterwards; low protein/balanced (LB): L diet until birth and B diet afterwards; low protein/fructose (LF): L diet until birth and F diet afterwards. RESULTS: The excess fructose intake reduced the body weight gain, especially in the BF group. Furthermore, the serum total cholesterol and the LDL cholesterol were elevated in this group. In the LF group, the serum total cholesterol and the muscle glycogen increased. Acute physical exercise increased the serum concentrations of glucose, triglycerides, HDL cholesterol and liver lipids and reduced the concentrations of muscle glycogen in all groups. CONCLUSION: An excess fructose intake induced some signs of metabolic syndrome. However, protein malnutrition appeared to protect against the short term effects of fructose. In other hand, most responses to acute physical exercise were not influenced by early malnutrition and/or by the fructose overload.

Taurine supplementation restored the changes in pancreatic islet mitochondria in the fetal protein-malnourished rat.

Intra-uterine growth retardation has been linked to the development of type 2 diabetes in later life. Mitochondrial changes have been suggested as a link between fetal malnutrition and adult insulin resistance. Taurine has been implicated in this process. We investigated whether protein malnutrition in early life alters mitochondria of the pancreatic islets in adulthood, and whether taurine supplementation restores these changes. Male offspring of rats fed a control diet, a low-protein diet or a low-protein diet supplemented with taurine during pregnancy and lactation were weaned onto the control diet. In each group, at 20 weeks of age, intravenous glucose tolerance tests, euglycaemic-hyperinsulinaemic clamp studies, morphometric analysis of the pancreatic islets and ultra-structural analysis of the mitochondria of the ß-cells were performed. The expressions of cytochrome c oxidase (COX) I and mitochondrial respiratory chain complex II were also measured. Fetal protein-malnourished rats showed decreased pancreatic islet mass and reduced insulin-secretory responses to a glucose load. These rats also showed reduced mitochondrial DNA-encoded COX I gene expression in the islets. Electron microscopic examination showed abnormal mitochondrial shapes in the ß-cells of fetal protein-malnourished rats. Taurine supplementation to the low-protein diet restored all these changes. Our findings indicate that a maternal protein-restriction diet causes long-lasting mitochondrial changes that may contribute to the development of type 2 diabetes later in life. The lack of taurine may be a key causative factor for these dysfunctional mitochondrial changes.

Avaliação de métodos para identificar desnutrição energético-protéica de pacientes em hemodiálise / Assessment of methods to identify protein-energy wasting in patients on hemodialysis

INTRODUÇÃO: O método capaz de melhor identificar desnutrição energético-protéica (DEP) em pacientes em hemodiálise (HD) ainda se mantém em debate. Logo, avaliamos o estado nutricional de pacientes em HD por diferentes métodos e verificamos qual deles identificava o maior número de pacientes com DEP. MÉTODOS: Quinze pacientes em HD (52,7 ± 10 anos; 33,3 por cento Masculino). O estado nutricional foi avaliado por medidas antropométricas, pela avaliação subjetiva global (ASG), por albumina plasmática e pelo consumo alimentar (recordatório de 24 horas). A gordura corporal foi avaliada por antropometria. O critério de diagnóstico de DEP preconizado pela International Society of Renal Nutrition and Metabolism (ISRNM) foi empregado. RESULTADOS: Observou-se que o índice de massa corporal esteve dentro da normalidade (24,2 ± 4,4 kg/m²). Ao avaliar a condição nutricional pela adequação da circunferência muscular do braço CMB) e da prega cutânea de tríceps (PCT) notou-se que a adequação da CMB esteve dentro dos parâmetros de normalidade (102,6 ± 13 por cento), ao passo que a adequação da PCT esteve abaixo da normalidade (Feminino: 75,3 ± 40,4 por cento; Masculino: 73,5 ± 20,6 por cento). Contudo, o percentual de gordura corporal esteve elevado (Feminino: 34,5 ± 7,3 por cento; Masculino: 23,6 ± 4,2 por cento). Com relação à ASG, a maioria dos pacientes (n = 12) apresentou algum grau de desnutrição e este constituiu o método que identificou o maior número de pacientes com DEP. Ao empregar os critérios da ISRNM, notou-se que apenas dois pacientes apresentaram DEP. CONCLUSÃO: Todos os pacientes avaliados encontravam-se com DEP por algum dos métodos utilizados. A ASG foi o método que, isoladamente, conseguiu detectar o maior número de pacientes com DEP.

INTRODUCTION: The method capable of best identifying protein-energy wasting (PEW) in hemodialysis (HD) patients is controversial. Thus, we assessed the nutritional status of HD patients by use of different methods and verified which one identified the highest number of patients with PEW. METHODS: The study assessed the nutritional status of 15 HD patients (age: 52.7 ± 10.1 years; males: 33.3 percent) by use of anthropometric measurements, subjective global assessment (SGA), serum albumin, and dietary intake (24-hour food recall). Body fat was assessed by use of anthropometry. The International Society of Renal Nutrition and Metabolism (ISRNM) criteria were used to diagnose PEW. RESULTS: The body mass index (24.2 ± 4.4 kg/m²) and the percentage of standard value for mid-arm muscle circumference were within the normal limits (102.6 ± 13 percent). Nevertheless, the percentage of standard value for triceps skinfold was below the normal limits (females, 75.3 ± 40.4 percent; and males, 73.5 ± 20.6 percent), although a high body fat percentage was observed (females, 34.5 ± 7.3 percent; males, 23.6 ± 4.2 percent). When assessing the nutritional status by use of SGA, most patients (80 percent, n = 12) were malnourished, and SGA was the method that identified the highest number of patients with PEW. By using the ISRNM criteria, PEW was diagnosed in only two patients. CONCLUSION: All patients were diagnosed with PEW by use of one of the methods studied. The SGA was the method that, in isolation, could detect the greatest number of patients with PEW.

Catch-up and targeted growth following variable duration protein restriction: effects on bone and body mass.

Protein malnutrition leads to growth retardation that can be reversed through catch-up growth, once normative nutrition is restored. Because growth is a dynamic process, catch-up capacity is likely influenced by the maturity of the animal and/or the duration of the insult, in addition to the type of insult experienced. We compared length of malnutrition, sexual dimorphism, body mass, and skeletal growth. Eighty Rattus norvegicus were divided into 10 treatment groups (five diets; male and female) and followed for more than 1 year. At weaning, animals were placed on either a control or low-protein isocaloric diet. Three experimental groups were switched to the control diet at 40, 60, or 90 days. Beginning with 21 days of age, animals were weighed daily and radiographed throughout the study. To determine the presence of catch-up growth, growth rates (GRs) were calculated (linear regression) for 20-day time spans before and after diet changes and compared among treatment groups. Targeted growth was measured as final size or as the coefficient of variation with age. These results show that 1) protein-restricted animals experience catch-up growth with dietary rehabilitation; 2) for females, catch-up GRs are proportional to GRs in control animals at the same age as the timing of dietary rehabilitation but not for males; and 3) targeted growth was observed in some, but not all, aspects of anatomy. The length of the tibia and humerus was indistinguishable from controls, regardless of length of malnutrition or gender, whereas the ulna and male body mass exceeded control sizes. Although most measures decreased in variation with ontogeny, the tibia failed to do so. These results support a complex biological regulation of catch-up and targeted growth. The implications for selection are that flexible and responsive developmental trajectories may have an advantage over those programed into a single size.

Influence of the timing of switching a protein-free to a protein-containing diet on the wound healing process in a rat all-layer skin defect.

We prepared full thickness skin defects in rats fed on a protein-free diet as a hypoproteinaemia model, then switched the animals to a diet containing a normal protein level 1, 6 or 12 days after wounding (inflammatory, granulation and rearrangement phases of the wound healing process) to examine whether improvement in the low-protein state promotes subsequent wound healing. The interval until wound healing in rats fed on a normal protein diet was significantly shorter, whereas that in rats continuously fed on a protein-free diet was significantly longer than those of other groups. Early correction tended to accelerate wound healing. Although wound contraction in groups receiving a protein-corrected or protein-free diet remained similar until 15 days after wounding, thereafter the duration of the rearrangement phase was significantly longer in the protein-free group than in the other groups. The collagen level per unit of granulation tissue area during wound healing was significantly lower in the protein-free group than in the other groups. These findings indicate that protein correction at any time after wounding accelerates wound healing, although early correction is more effective, and reduces the duration of the rearrangement phase more than those of the inflammatory and granulation phases because of the deposit of collagen.

Optimal nutrition and its potential effect on survival in critically ill patients.

Optimal nutrition serves to maintain normal organ function and to preserve body energy stores to guarantee survival during times of shortage of food. Especially total body protein content is an important determinant of survival. However, recommendations about nutrition refer mostly to total energy intake with either no emphasis on total protein content or protein intake only considered as a fixed percentage of caloric intake. This paper focuses on the role of total body protein mass or lean body mass (= mass of organs and muscle) (LBM) on survival of healthy humans and critically ill patients. Recommendations on the amount of protein per kg bodyweight are made based on the scarce evidence available in humans.

A low-protein diet supplemented with ketoacids plays a more protective role against oxidative stress of rat kidney tissue with 5/6 nephrectomy than a low-protein diet alone.

Dietary protein restriction is one major therapy in chronic kidney disease (CKD), and ketoacids have been evaluated in CKD patients during restricted-protein diets. The objective of the present study was to compare the efficacy of a low-protein diet supplemented with ketoacids (LPD+KA) and a low-protein diet alone (LPD) in halting the development of renal lesions in CKD. 5/6 Nephrectomy Sprague-Dawley rats were randomly divided into three groups, and fed with either 22 % protein (normal-protein diet; NPD), 6 % protein (LPD) or 5 % protein plus 1 % ketoacids (LPD+KA) for 24 weeks. Sham-operated rats were used as controls. Each 5/6 nephrectomy group included fifteen rats and the control group included twelve rats. Proteinuria, decreased renal function, glomerular sclerosis and tubulointerstitial fibrosis were found in the remnant kidneys of the NPD group. Protein restriction ameliorated these changes, and the effect was more obvious in the LPD+KA group after 5/6 nephrectomy. Lower body weight and serum albumin levels were found in the LPD group, indicating protein malnutrition. Lipid and protein oxidative products were significantly increased in the LPD group compared with the LPD+KA group. These findings indicate that a LPD supplemented with ketoacids is more effective than a LPD alone in protecting the function of remnant kidneys from progressive injury, which may be mediated by ketoacids ameliorating protein malnutrition and oxidative stress injury in remnant kidney tissue.

Efetividade da multimistura como suplemento de dietas deficientes em vitaminas e/ou minerais na recuperação ponderal de ratos submetidos à desnutrição pós-natal / The effectiveness of the multi-mixture as supplement to mineral and/or vitamin deficient diets, promoting weight gain in rats submitted to post-natal under-nourishment

OBJETIVO: Avaliar a efetividade da "multimistura", usada como suplemento de dietas deficientes em vitaminas, deficientes em minerais, ou deficientes em vitaminas e minerais, na recuperacão ponderal de ratos desnutridos. MÉTODOS: Após o desmame, 56 ratos Wistar, submetidos à desnutricão pós-natal, foram aleatoriamente distribuídos em 7 grupos diferenciados segundo o tipo de dieta oferecida: controle, dietas deficientes em vitaminas, deficientes em minerais, deficientes em vitaminas e minerais e os grupos cujas dietas deficientes eram suplementadas com a "multimistura" (dietas deficientes em vitaminas + "multimistura", deficientes em minerais + "multimistura" e deficientes em vitaminas e minerais + "multimistura"). A "multimistura" (pó de casca de ovo, pó de folha de mandioca e farelo de trigo, na proporção de 1:1.8) foi adicionada ao nível de 4 por cento. O ganho ponderal e os Coeficientes de Eficiência Protéica ou alimentar foram usados como indicadores da efetividade da "multimistura" como suplemento de vitaminas e/ou minerais. RESULTADOS: Após 28 dias, todos os grupos apresentaram valores de ganho ponderal, coeficientes de eficiência protéica, e coeficientes de eficiência alimentar, inferiores aos do grupo controle (p<0,05), exceto aquele que recebeu dietas deficientes em vitaminas + "multimistura". O grupo que recebeu dieta deficiente em minerais apresentou os piores resultados. A suplementação dessa dieta com a "multimistura" determinou a obtenção de valores significantemente superiores, mas aquém daqueles observados no grupo controle. CONCLUSÃO: Esses resultados sugerem que a suplementação de dietas pouco nutritivas com a "multimistura", fornece as necessidades de vitaminas de ratos desnutridos e supre apenas parte das necessidades de minerais desses animais.

Cytogenetic studies in bone marrow cells from Wistar rats in protein malnutrition.

The effect of severe protein deficiency at weaning has been studied in bone marrow, which is a primary lymphoid organ. Our experimental model of secondary immunodeficiency in Wistar rats has shown: (1) a decreased number of viable bone marrow cells (P <.0001); (2) diminished percentage of mitosis (P <.01); and (3) severe alteration in the percentage of chromosome pairs 3, 11, and 12 bearing nucleolar organizer regions (NORs) (P <.05). This last finding indicates a poor ribosomal gene activity. These alterations were reverted after the oral administration of a 20% casein diet during 5 to 9 days. However, there were no karyotype variations between the experimental groups. We conclude from these results that severe protein deficiency at weaning alters several aspects of bone marrow cell proliferation and ribosomal gene activity as determined by the number of silver stained nucleolus organizer regions.

Déficit de vitamina A y su relación con la sepsis urinaria durante el embarazo / Vitamin A deficiency and its relation with urinary sepsis in pregnancy

Uno de los problemas nutricionales más graves e importantes que afecta a la humanidad es la deficiencia de vitamina A. Este trabajo se desarrolló con el objetivo de establecer si hay relación entre el estado de deficiencia de vitamina A y la sepsis urinaria durante el embarazo. Se realizó un estudio ambispectivo con el diseño de casos y controles y bajo la hipótesis de que uno de los factores etiológicos en la sepsis urinaria de la gestante es el déficit de vitamina A. Se estudiaron 40 embarazadas ingresadas en el Hospital Ginecoobstétrico "Mártires de Girón" de Cienfuegos, 20 de ellas con el diagnóstico de sepsis urinaria, y un grupo control. Se estudió la edad, antecedentes patológicos personales, anemia, e ingestión de vitaminas. A todas se les realizó el test de impresión conjuntival para diagnosticar el déficit de vitamina A. Los datos fueron procesados mediante el sistema computadorizado SPSS y se utilizó el estadígrafo Chi cuadrado como prueba de inferencia estadística. Se encontró una elevada asociación entre sepsis urinaria y déficit de vitamina A. La enfermedad estudiada predominó entre las embarazadas más jóvenes, con un elevado número de antecedentes patológicos personales y anemia. Fue contradictorio el hecho de que se encontrara déficit de vitamina A, a pesar de tener una alta ingestión de vitaminas(AU)

One of the most serious and important nutritional problems affecting mankind is Vitamin A deficiency. This paper is aimed at setting whether there is a relation between Vitamin A deficiency and urinary sepsis in pregnancy. An ambispective study using a design of cases and controls was carried out under the hypothesis that one of the etiological factors in the urinary sepsis of pregnant woman is Vitamin A deficiency. Forty pregnant women admitted to "Martires de Girón" Gynecobstetric Hospital in Cienfuegos were studied and 20 of them was diagnosed with urinary sepsis, and a control group. Age, personal pathological history, anemia and vitamin intake were analyzed. All the pregnant women were made a conjunctival impression test to diagnose vitamin A deficiency. Data were processed by a SPSS computer system and Chi square was used as an statistical inference test. A close association between urinary sepsis and vitamin A deficiency was found. The studied disease was predominant in younger pregnant women with high number of personal pathological antecedents and anemia. The fact that Vitamin A deficiency was found in spite of a high vitamin intake was contradictory(AU)

Effect of nutritional rehabilitation of undernourished rats on serum insulin-like growth factor (IGF)-I and IGF-binding proteins.

The aim of the present work was to study the effect of nutritional rehabilitation with different concentration of dietary protein (6, 18 or 50%) of previously undernourished rats on serum Insulin-like growth factor-I (IGF-I) and Insulin-like growth factor binding proteins levels (IGFBPs). Undernutrition was induced by feeding rats with 0.5% casein diet for 5 weeks. Over this period, growth, serum total proteins, IGF-I levels and IGFBP-3/IGFBP-2 ratio were significantly decreased compared to the group fed ad libitum 18% casein diet. Nutritional rehabilitation for 21 days with 6% casein diet did not change any of these parameters. Nutritional rehabilitation with 18 or 50% casein diet for one day did not initiate the restoration of serum IGF-I levels and IGFBP-3/IGFBP-2 ratio. However, after 10 days with 18 or 50% casein diets, there was an increase of 12 fold in IGF-I levels and 7 fold in the IGFBP-3/IGFBP-2 ratio. Finally, rehabilitation for 21 days with 18 or 50% casein diet produced an increase of 21 and 26 fold in IGF-I levels, and 6.1 and 14.5 fold in the IGFBP-3/IGFBP-2 ratio respectively. These results suggest that nutritional rehabilitation with 18% casein and above were more effective than 6% casein diets to reestablish body weight. Serum IGF-I and IGFBP-3 concentrations were sensitive indicators of the evolution of the nutritional status of the rats depending of the protein concentration in the diet in previously undernourished rats.