Prenatal factors contribute to the emergence of kwashiorkor or marasmus in severe undernutrition: evidence for the predictive adaptation model.

BACKGROUND: Severe acute malnutrition in childhood manifests as oedematous (kwashiorkor, marasmic kwashiorkor) and non-oedematous (marasmus) syndromes with very different prognoses. Kwashiorkor differs from marasmus in the patterns of protein, amino acid and lipid metabolism when patients are acutely ill as well as after rehabilitation to ideal weight for height. Metabolic patterns among marasmic patients define them as metabolically thrifty, while kwashiorkor patients function as metabolically profligate. Such differences might underlie syndromic presentation and prognosis. However, no fundamental explanation exists for these differences in metabolism, nor clinical pictures, given similar exposures to undernutrition. We hypothesized that different developmental trajectories underlie these clinical-metabolic phenotypes: if so this would be strong evidence in support of predictive adaptation model of developmental plasticity. METHODOLOGY/PRINCIPAL FINDINGS: We reviewed the records of all children admitted with severe acute malnutrition to the Tropical Metabolism Research Unit Ward of the University Hospital of the West Indies, Kingston, Jamaica during 1962-1992. We used Wellcome criteria to establish the diagnoses of kwashiorkor (n = 391), marasmus (n = 383), and marasmic-kwashiorkor (n = 375). We recorded participants' birth weights, as determined from maternal recall at the time of admission. Those who developed kwashiorkor had 333 g (95% confidence interval 217 to 449, p<0.001) higher mean birthweight than those who developed marasmus. CONCLUSIONS/SIGNIFICANCE: These data are consistent with a model suggesting that plastic mechanisms operative in utero induce potential marasmics to develop with a metabolic physiology more able to adapt to postnatal undernutrition than those of higher birthweight. Given the different mortality risks of these different syndromes, this observation is supportive of the predictive adaptive response hypothesis and is the first empirical demonstration of the advantageous effects of such a response in humans. The study has implications for understanding pathways to obesity and its cardio-metabolic co-morbidities in poor countries and for famine intervention programs.

Biometric and food consumption parameters of rats subjected to hypoproteic and hipercaloric diet / râmetros biométricos e de consumo alimentar de ratos submetidos à dieta hipoprotéica e hipercalórica / Parámetros biométricos y de consumo alimentar de ratones sometidos a la dieta hipoproteíca e hipercalórica

A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Para estudos experimentais, o rato tem sido o principal modelo para avaliar as conseqüências de ingestão de dietas com diferentes teores protéicos, contudo ainda não estão claros os níveis de severidade dessas dietas para essa espécie. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Para tanto, utilizaram-se 30 ratos Wistar (90 dias de idade), os quais foram divididos em dois grupos: controle (GC) e experimental (GC). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos, durante 12 semanas. No final do experimento, avaliaram-se o peso, o crescimento, a massa gorda e massa magra dos animais. Os animais do GE não ganharam peso, tiveram retardo no crescimento, formaram menos massa gorda e menos massa muscular.(AU)

The protein lack causing Kwashiorkor is the most prevalent kind of malnutrition, because the food sources of proteins are usually more expensive. For experimental investigations, the rat has provided the primary model to evaluate the consequences of the ingestion of diets with different protein levels; however, the degrees of severity of these diets for these species are still not clear. In this sense, we aimed at evaluating the severity of a 4%-hypoproteic diet on young rats. We used 30 Wistar rats (90 days old), which were divided in two groups: control (CG) and experimental (EG). CG rats were fed with normoprotein chow, while EG rats were fed with a chow having 4% protein, for 12 weeks. At the end of the experiment, we evaluated the weight, growth, and fat and lean masses of the animals. The rats from EG did not gain weight, they had growth retardation, and built less fat and muscle masses.(AU)

La falta de proteínas, causando Kwashiorkor, es el tipo de mala nutrición más predominante, pues fuentes de alimentos protéicos, generalmente, son más costosos. Para estudios experimentales, el ratón ha sido el principal modelo para evaluarse las consecuencias de ingestión de dietas con distintos teores protéicos, aún así todavía no están claros los niveles de severidad de esas dietas para esa especie. En ese sentido, proponemos evaluar la severidad de una dieta hipoprotéica al 4% para ratones jóvenes. Para tanto, utilizamos 30 ratones Wistar (90 días de edad), los caules fueron divididos en dos grupos: control (GC) y experimental (GE). El GC recibió dieta normoprotéica, mientras que el GE recibió dieta con el 4% de teor de proteínas, ambos durante 12 semanas. Al fi nal del experimento, evaluamos el peso, el crecimiento, la masa gorda y masa delgada de los animales. Los animales del GE no ganaron peso, tuvieron retraso en el crecimiento, formaron menos masa gorda y menos masa muscular(AU)

Hematologic and biochemical parameters of rats subjected to hypoproteic and hipercaloric diet

A má-nutrição é um problema de saúde pública que ainda assola crianças e adultos no mundo inteiro, principalmente em países em desenvolvimento. A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Uma dieta hipoprotéica causa alterações metabólicas num animal em intensidades diretamente proporcionais ao nível de depleção de proteínas, bem como o tempo em que o indivíduo permanece sob o estado de subnutrição. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Utilizam-se 30 ratos Wistar (90 dias de idade), divididos em grupo controle (15) e experimental (15). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos durante 12 semanas. No final do experimento, sangue foi coletado para realização de hemograma e dosagem de atividade de fosfatase alcalina, alanina aminotrasferase, além da concentração de proteínas totais e frações, colesterol total, triglicerídeos, uréia, ácido úrico, T3, T4 e aminoácidos plasmáticos. Os animais do GE demonstraram menor atividade defosfatase alcalina no sangue, anemia microcítica normocrômica, hipoproteinemia, hipoglobulinemia, reduação na concentração plasmática de triglicerídeos, aumento da concentração plasmática de T3 e T4 e diminuição da concentração plasmática dos seguintes aminoácidos: metionina, fenilalanina, valina, leucina e isoleucina.(AU)

Malnutrition is a public health issue which still affects children and adults all over the world, especially in developing countries. Protein defi ciency causing Kwashiorkor is the most prevalent type of malnutrition, because protein-rich foods are generally expensive. A hypoproteic diet causes metabolic alterations in an animal which are directly proportional to the degree of protein depletion, as well as to the duration of the malnutrition. In this sense, we proposed to evaluate the severity of a 4%-hypoproteic diet in young rats. We used 30 Wistar rats (90 days of age), divided in control (CG, n=15) and experimental (EG, n=15) groups. CG was fed with a normoprotein chow, while EG was fed with a diet having 4% protein, for 12 weeks. At the end of the experiment, blood was collected for determination of the hemogram, activities of alkaline phosphatase and alanine aminotransferase, and concentration of total and fractional proteins, total cholesterol, triglycerides, urea, uric acid, T3, T4 and plasma aminoacids. The animals from EG had lower activity of the alkaline phosphatase enzyme in blood, normochromic microcytic anemia, hypoproteinemia, hypoglobulinemia, decreased plasma triglyceride concentration, increased plasma concentrations of T3 and T4, and decreased plasma concentrations of the following aminoacids: methionine, phenylalanine, valine, leucine and isoleucine.(AU)

La mala nutrición es un problema de salud pública que todavía aniquila niños y adultos en el mundo entero, principalmente en países en desarrollo. La falta de proteínas, causando Kwashiorkor, es el tipo de mala nutrición más común, pues fuentes de alimentos proteicos, generalmente, son más caras. Una dieta poco proteica causa alteraciones metabólicas en un animal en intensidades directamente proporcionales al nivel de depleción de proteínas, así como el tiempo en que el individuo queda bajo el estado de baja nutrición. En ese sentido, proponemos evaluar la severidad de una dieta de bajo contenido proteico al 4% para ratones jóvenes. Utilizamos 30 ratones Wistar (90 días de edad), divididos en grupo control (15) y experimental (15). El GC recibió dieta normoproteica, mientras el GE recibió dieta con el 4% de cantidad de proteínas, ambos durante 12 semanas. Al fi nal del experimento, sangre fue recolectado para realización del examen de la sangre y cantidad de actividad de fosfatase alcalina, alanina aminotrasferase, además de la concentración de proteínas totales y fracciones, colesterol total, triglicerídeos, urea, ácido úrico, T3, T4 y aminoácidos plasmáticos. Los animales del GE demostraron menor actividad de fosfatase alcalina en la sangre, anemia microcítica normocrómica, hipoproteinemía, hipoglobulinemia, reducción en la concentración plasmática de triglicerídeos, aumento de la plasmática de T3 y T4 y disminución de la concentración plasmática de los siguientes aminoácidos: metionina, fenilalanina, valina, leucina y isoleucina.(AU)

Biometric and food consumption parameters of rats subjected to hypoproteic and hipercaloric diet / Parâmetros biométricos e de consumo alimentar de ratos submetidos à dieta hipoprotéica e hipercalórica / Parámetros biométricos y de consumo alimentar de ratones sometidos a la dieta hipoprotéica e hipercalórica

A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Para estudos experimentais, o rato tem sido o principal modelo para avaliar as conseqüências de ingestão de dietas com diferentes teores protéicos, contudo ainda não estão claros os níveis de severidade dessas dietas para essa espécie. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Para tanto, utilizaram-se 30 ratos Wistar (90 dias de idade), os quais foram divididos em dois grupos: controle (GC) e experimental (GC). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos, durante 12 semanas. No final do experimento, avaliaram-se o peso, o crescimento, a massa gorda e massa magra dos animais. Os animais do GE não ganharam peso, tiveram retardo no crescimento, formaram menos massa gorda e menos massa muscular.

ABSTRACT: The protein lack causing Kwashiorkor is the most prevalent kind of malnutrition, because the food sources of proteins are usually more expensive. For experimental investigations, the rat has provided the primary model to evaluate the consequences of the ingestion of diets with different protein levels; however, the degrees of severity of these diets for thesespecies are still not clear. In this sense, we aimed at evaluating the severity of a 4%-hypoproteic diet on young rats. We used30 Wistar rats (90 days old), which were divided in two groups: control (CG) and experimental (EG). CG rats were fed with normoprotein chow, while EG rats were fed with a chow having 4% protein, for 12 weeks. At the end of the experiment, we evaluated the weight, growth, and fat and lean masses of the animals. The rats from EG did not gain weight, they had growth retardation, and built less fat and muscle masses.

RESUMO: A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Para estudos experimentais, o rato tem sido o principal modelo para avaliar as conseqüências de ingestão de dietas com diferentes teores protéicos, contudo ainda não estão claros os níveis de severidade dessas dietas para essa espécie. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Para tanto, utilizaram-se 30 ratos Wistar (90 dias de idade), os quais foram divididos em dois grupos: controle (GC) e experimental (GC). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos, durante 12 semanas. No fi nal do experimento, avaliaram-se o peso, o crescimento, a massa gorda e massa magra dos animais. Os animais do GE não ganharam peso, tiveram retardo no crescimento, formaram menos massa gorda e menos massa muscular.

Hematologic and biochemical parameters of rats subjected to hypoproteic and hipercaloric diet / Parâmetros hematológicos e bioquímicos de ratos submetidos à dieta hipoprotéica e hipercalórica / Parámetros hematológicos y bioquímicos de ratones sometidos a la dieta hipoprotéica e hipercalórica

A má-nutrição é um problema de saúde pública que ainda assola crianças e adultos no mundo inteiro, principalmente em países em desenvolvimento. A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Uma dieta hipoprotéica causa alterações metabólicas num animal em intensidades diretamente proporcionais ao nível de depleção de proteínas, bem como o tempo em que o indivíduo permanece sob o estado de subnutrição. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Utilizam-se 30 ratos Wistar (90 dias de idade), divididos em grupo controle (15) e experimental (15). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos durante 12 semanas. No final do experimento, sangue foi coletado para realização de hemograma e dosagem de atividade de fosfatase alcalina, alanina aminotrasferase, além da concentração de proteínas totais e frações, colesterol total, triglicerídeos, uréia, ácido úrico, T3, T4 e aminoácidos plasmáticos. Os animais do GE demonstraram menor atividade defosfatase alcalina no sangue, anemia microcítica normocrômica, hipoproteinemia, hipoglobulinemia, reduação na concentração plasmática de triglicerídeos, aumento da concentração plasmática de T3 e T4 e diminuição da concentração plasmática dos seguintes aminoácidos: metionina, fenilalanina, valina, leucina e isoleucina.

ABSTRACT: Malnutrition is a public health issue which still affects children and adults all over the world, especially in developing countries. Protein defi ciency causing Kwashiorkor is the most prevalent type of malnutrition, because protein-rich foods are generally expensive. A hypoproteic diet causes metabolic alterations in an animal which are directly proportional to the degree of protein depletion, as well as to the duration of the malnutrition. In this sense, we proposed to evaluate the severity of a 4%-hypoproteic diet in young rats. We used 30 Wistar rats (90 days of age), divided in control (CG, n=15) and experimental (EG, n=15) groups. CG was fed with a normoprotein chow, while EG was fed with a diet having 4% protein, for 12 weeks. At the end of the experiment, blood was collected for determination of the hemogram, activities of alkaline phosphatase and alanine aminotransferase, and concentration of total and fractional proteins, total cholesterol, triglycerides,urea, uric acid, T3, T4 and plasma aminoacids. The animals from EG had lower activity of the alkaline phosphatase enzyme in blood, normochromic microcytic anemia, hypoproteinemia, hypoglobulinemia, decreased plasma triglyceride concentration, increased plasma concentrations of T3 and T4, and decreased plasma concentrations of the following aminoacids: methionine, phenylalanine, valine, leucine and isoleucine

RESUMEN: La mala nutrición es un problema de salud pública que todavía aniquila niños y adultos en el mundo entero, principalmente en países en desarrollo. La falta de proteínas, causando Kwashiorkor, es el tipo de mala nutrición más común, pues fuentes de alimentos proteicos, generalmente, son más caras. Una dieta poco proteica causa alteraciones metabólicas en un animal en intensidades directamente proporcionales al nivel de depleción de proteínas, así como el tiempo en que el individuo queda bajo el estado de baja nutrición. En ese sentido, proponemos evaluar la severidad de una dieta de bajo contenido proteico al 4% para ratones jóvenes. Utilizamos 30 ratones Wistar (90 días de edad), divididos en grupo control (15) y experimental (15). El GC recibió dieta normoproteica, mientras el GE recibió dieta con el 4% de cantidad de proteínas, ambos durante 12 semanas. Al fi nal del experimento, sangre fue recolectado para realización del examen de la sangre y cantidad de actividad de fosfatase alcalina, alanina aminotrasferase, además de la concentración de proteínas totales y fracciones, colesterol total, triglicerídeos, urea, ácido úrico, T3, T4 y aminoácidos plasmáticos. Los animales del GE demostraron menor actividad de fosfatase alcalina en la sangre, anemia microcítica normocrómica, hipoproteinemía, hipoglobulinemia, reducción en la concentración plasmática de triglicerídeos, aumento de la plasmática de T3 y T4 y disminución de la concentración plasmática de los siguientes aminoácidos: metionina, fenilalanina, valina, leucina y isoleucina

[Malnutrition, environment and children's development]. / Desnutrición, medio ambiente y desarrollo infantil.

Protein energy malnutrition (PME) affects negatively children's somatic and cognitive development. Micronutrient deficiencies which usually coexist with PEM also have a negative influence on the cognitive development of children. The social and familiar environment in which disadvantaged children usually grow is very poor from the point of view of psychological and sensorial stimulation. All these factors together severely impede the full expression of poor children's genetic potential.

Primary malnutrition. Can we always tell?

Patterns of disease in the English-speaking Caribbean have changed considerably over the past two decades. There has been a decrease in the incidence of common infectious diseases, an increase in the prevalence of chronic non-communicable disorders and an increase in the incidence and prevalence of HIV/AIDS. However, published estimates suggest that malnutrition continues to be a serious public health problem. It is possible that changing patterns of disease within the epidemiological transition may affect patterns of presentation of severe forms of childhood malnutrition. We have examined records of 435 children admitted to the clinical research ward of the Tropical Metabolism Research Unit (TMRU) from January 1, 1990, to December 31, 1999; among these were 25 children who were subsequently found to have severe childhood malnutrition (SCM) due to a defined medical or surgical disorder (i.e. secondary SCM). Among children with secondary SCM, the HIV/AIDS group was the largest and comprised 60% of these admissions. Regression analyses show that, over the ten-year period, there was a small, non-significant decline in the number of cases of primary SCM (incidence rate ratio, IRR = 0.99, 95% confidence interval = 0.96, 1.02, p = 0.98), while the number of cases of secondary SCM increased (IRR = 1.18, 95% CI = 1.03, 1.35, p = 0.02). These data are indicative of the need for continued vigilance in the evaluation of children who have clinical features of the syndromes of severe malnutrition and draw attention to the potential impact of HIV/AIDS in yet another area of healthcare delivery.

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination.

This is one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on the 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than healthy comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition.

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination

This one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years. We report that children with histories of either type of malnutrition confined to infancy had significantly lower scores on the national high school examination than health comparison children. Reduced 11-plus scores were closely associated with teacher reports of attention deficits in the classroom documented when the children were as young as 5 to 8 y of age and also with IQ and academic performance. Early malnutrition had independent effects on performance on the 11-plus examination even when home environmental conditions were controlled for. These findings have important implications for future opportunities available to children with histories of infantile malnutrition. (AU)

Severe undernutrition in Jamaica. Kwashiorkor and marasmus: the disease of the weanling.

The syndromes of severe undernutrition, marasmus and kwashiorkor, have causes related to the interplay of social and medical considerations in the society. Kwashiorkor supervenes when the individual is exposed to a level of stress that exceeds the body's ability to cope. One final common pathway, through which a variety of environmental factors exert an effect, may be associated with oxidant damage to cells. In kwashiorkor there is a severe decrease in the level of both oxidised and reduced glutathione in the red cell. This could be caused by a decreased production, increased consumption or a combination of the two. This is discussed with specific reference to the metabolism of glycine and the possible causal relationship to the pathophysiology of the disease process.

Severe undernutrition in Jamaica - kwashiorkor and marasmus: the disease of the weanling

The syndromes of severe undernutrition, marasmus and kwashiorkor, have causes related to the interplay of social and medical considerations in the society. Kwashiorkor supervenes when the individual is exposed to a level of stress that exceeds the body's ability to cope. One final common pathway, through which a variety of environmental factors exert an effect, may be associated with oxidant damage to cells. In kwashiorkor there is a severe decrease in the level of both oxidised and reduced glutathione in the red cell. This could be caused by a decreased production, increased consumption or a combination of the two. This is discussed with specific reference to the metabolism of glycine and the possible causal relationship to the pathophysiology of the disease process.(AU)

Ocorrência de desnutriçäo proteico-calórica na clínica infantil Dr. Juvêncio Mattos, Säo Luís-MA / Occurrence of protein-calorie malnutrition in the Dr. Juvencio Mattos Infantil Clinic, Säo Luís-MA

Os autores apresentam um levantamento de crianças desnutridas internadas na Clínica Infantil Dr. Juvencio Mattos no período de um ano. Objetivam demonstrar neste estudo como dois tipos de desnutriçäo (Kwashiorkor e marasmo) se comportam quanto aos seguintes aspectos: incidência, distribuiçäo etária, sexo, patologias associadas e permanência hospitalar

[Admissions for protein-calorie malnutrition at the National Children's Hospital, Costa Rica, 1975]. / Admisiones por desnutrición energético-proteínica en el Hospital Nacional de Niños, Costa Rica, 1975.

The hospital records of 478 children with protein-calorie malnutrition (PCM) were reviewed. These represented all children diagnosed as malnourished during 1975 (3.6 per cent of all hospital admittances in the National Children's Hospital); 52% of the cases were infants less than 6 months of age; 28% had low birth weight, a rate much in excess of the prevalence of low birth weight in the general population of Costa Rica (7%). In general, malnourished children had been weaned early, 75% during the first month of life. A considerable number of children belonged to "malnourishing families" which have particular characteristics favorable to establishment of malnutrition in the family. Thus, 36% of their siblings had also been admitted with malnutrition at a previous date to that of this study.

Kwashiorkor not associated with poverty.

Four infants are described with kwashiorkor that was unassociated with poverty or infection as predisposing factors of their disease. The condition followed various dietary regimens deficient in protein of five weeks to seven months in duration. Features of this "sugar-bady" form of kwashiorkor included a low level of physician awareness of malnutrition as a diagnostic consideration, growth retardation, edema, muscle wasting, mental changes, and mild lymphocytosis. Initially, recovery was associated with rapid loss of weight and anemia and subsequently with weight gain and return to good health.

[Kwashiorkor. Dermatological and clinical aspects (Analysis of 100 cases)]. / Kwashiorkor. Aspectos clínicos e dermatológicos (Análise de 100 casos)

The Authors study 100 children with "kwashiorkor", treated at Municipal Hospital Jesus (Rio de Janeiro). The children came from prolitic families of low economical resources. Their age is between 4 months and 8 years, 53% of them beiney halfbreed, 32% white people and 15% negroes. Diagnosis was based on alimentary deficiency in high caloric value proteins (100%), oedema (100%), muco-cutaneous alterations (78%), capillary changes (65%), apathy (75%), muco-cutaneous pallox (67%), and complementary examinations (total and fraction proteins, sodium, potassium hemoglobin). They emphasize the role of intercurrent infections (verminosis, pneumopathies, virosis, otitis, etc.). Treatment was carried out through correction of desnutrition, hydro-electrolytical troubles and infectious diseases.