Fasting energy utilization in the smaller of twins with epinephrine-deficient hypoglycemia

The possible role of epinephrine deficiency in abnormal utilization of energy sources during fasting was investigated in three pairs of discordant identical twins with recurrent fasting hypoglycemia. The hypoglycemic twins, ages 2, 8 and 9 years, each had beens smaller at birth. Defective epinephrine responsiveness to hypoglycemia was established by administration of 2-deoxyglucose, 50 mg/kg, i.v. In the control twins, this resulted in a rapid increase of plasma glucose (+39 mg/100 ml), free fatty acids (+0.3 mM), and urinary epinephrine (+224 ng/mg creatine). These changes did not occur in the affected twins. Fasting metabolism in the epinephrine-deficient twins was compared to the unaffected twins as controls. Oxidation of carbohydrate and fat were estimated from hourly measurements of oxygen consumption and carbon dioxide production, and utilization of protein was determined from nitrogen excretion. PLasma glucose decreased more rapidly in the affected twins during the 8 hours prior to appearance of symptoms. During this period, carbohydrate was oxidized more rapidly than in the controls (average: 3.1 versus 1.7 mg/kg/min). Plasma á-hydroxybutyrate and free fatty acids was frequently less in relation to glucose. Symptoms occurred when the sum of both glucose and á-hydroxybutyrate was lower than in the controls. Urinary epinephrine excretion increased from an average baseline of 18 to a maximum of 134 ng/mg creatinine in the control twins. The average maximum urinary epinephrine reached in the deficient twins was only 51 ng/mg creatinine, in spite of lower glucose. Plasma insulin decreased in relation to glucose below 40 mg/100 ml in the control twins (r = 0.65), but this did not occur in the deficient twins (r = -0.38). Cortisol and growth hormone responses were similar in the two groups. THerefore, the consequences of inability to increase epinephrine when availability of glucose became acutely limiting were inappropriate persistent oxidation of carbohydrate, decreased circulating alternate substrates from fat, and lack of suppression of insulin. (AU)

Fetal growth in different racial groups

Three racial groups of mothers and their new born babies - North European 75, Negro 75, and "Indian" Asian 37 - were matched for parity, gestational age, maternal age, maternal smoking habits, and social class. Multiple anthropometric measurements, including skin fold thickness, limb circumfrences, and various linear measurements were made on mothers and their infants to determine the effects of race and smoking on fetal size. Indian-Asian mothers, though shorter and lighter than Europeans and Negroes, had similar skin fold thickness and weight:heightý ratios and gained as much weight during pregnancy. Their infants however, were lighter than the others, and had smaller head and limb circumfrences, although their linear measurements were the same. Negro and European infants were almost identical in size. We found no effect on any of the fetal measurements which could be attributed to smoking. (Summary)

High energy feeding in protein-energy malnutrition

The use of high-fat diet in malnourished children produced accelerated growth of lean tissues as well as adipose tissue, and resulted in rapid nutrition rehabilitation in 25 seriously malnourished babies. Such diets are easy to prepare and relatively cheap, and they offer important advantages over conventional feeding in the hospital treatment of malnourished children.(AU)

Resting metabolic rate in malnourished babies in relation to total body potassium

Fasting metabolic rate was investigated in 53 malnourished children and 17 controls of similar age. Total body potassium (TBK) was also measured in 18 of the malnourished children and in all the controls, so that metabolic rates could be compared in relation to a measure of metabolically active tissue. In newly admitted malnourished children specific potassium depletion was corrected orally while they were given a maintenance diet. Resting metabolism correlated better with TBK than with weight, height or surface area in control and recovered children, but metabolic rate per unit TBK decline with increasing body-weight (r=-0.51). This negative correlation became insignificant if metabolic rate was expressed in terms of TBK3/4. In the malnourished children resting metabolic rate was reduced compared with control and recovered values, when expressed in terms of weight, height or surface area. The results were confirmed by a comparison of metabolic rates per unit TBK3/4, which showed a reduction of about 27 percent in the malnourished children. No significant difference was found between children with marasmus and those with oedematous malnutrition. During rapid growth fasting metabolism was increased. We conclude that oxygen consumption in metabolically active tissues is reduced in all forms of untreated infantile malnutrition. (AU)

Hypothermia in malnourished Jamaican children

An analysis was made of the 4-hourly temperature records of 137 malnourished Jamaican children, the consecutive admissions to a metabolic ward during a 3-year period. Mean rectal temperature of afebrile children during the first week in hospital was 0.52§C lower than it was in 19.7 percent of the children. It was related to low weight losses and height but not to serum or whole body potassium, serum sodium, or seasonal variation in ambient temperature. The incidence of of hypothermia in the survivors of this group of children was the same as it was in 42 children who died from severe malnutrition in the ward during the period 1960-1970. It is concluded that hypothermia is not an unfavourable prognostic sign in malnutritoned Jamaican children. Hypothermia was commoner in marasums than it was in kwashiorkor. In 11 afebrile chidren with kwashioker, rapid loss of oedema was associated with a fall in mean rectal temperature, suggesting that the insulating properties of oedema fluid may protect against hypothermia in kwashiorkor (AU)

Serum and liver triglycerides in malnourished Jamaican children with fatty liver

Measurements were made of triglyceride concentrations in the liver, serum, and serum lipoproteins in malnourished Jamaican children with fatty liver. The fasting serum triglyceride concentrations of the patients, before treatment, were highly variable, ranging from 55.6 to 353 mg/100ml. The patterns of change for serum triglyceride concentration during treatment were also variable. Patients were grouped according to whether the concentrations of serum triglycerides after recovery were higher than, lower than, or unchanged from, the concentrations before treatment. The three groupings then exhibited concentrations before treatment that fell in discrete ranges, being respectively low, high, or normal. There was no clinical difference among the three groups of patients. There was also no difference in the serum lipoprotein pattern nor in the composition of the serum very low density lipoprotein. The latter did not change during treatment. In most patients the fasting serum triglyceride concentrations before treatment appeared to be correlated with age. The difference between these findings and those reported from other countries are discussed. (AU)

Thermal insulation in malnourished Jamaican children

The mean summed skinfold at 6 sites in 20 malnourished Jamaican children was 24.5mm on admission to hospital and 49.8mm on discharge. Marasmic children initially had thinner skinfolds than children with oedematous malnutrition, and they had a highly significant reduction in total specific thermal insulation. During their first week in hospital there was a significant positive correlation between nocturnal mean rectal temperature in the malnourished children and their skinfold thickness and specific thermal insulation. Similar correlations for daytime rectal temperature were not statistically significant. We conclude that loss of thermal insulation may be of importance in the genesis of hypothermia in the sleeping malnourished child, whose posture and inactivity favour a negative heat balance. (AU)

The response of malnourished babies to cold

Twelve malnourished Jamaican children, aged 4-6 months, were studied before and after treatment, to see whether malnutrition impared their response to cold. When they were studied in the post-absorptive state and in a neutral thermal environment, they had a lower rate of oxygen consumption per kg body weight, a slower pulse rate, lower body temperatures, lower R.Q., and evidence of a smaller peripheral blood flow on admission to hospital than they did after recovery. The malnourished children failed to increase their heat production above resting levels at 25§ C, and their rectal temperature fell at a rate of 1§ C/hr in spite of a further decrease in peripheral circulation. When they had recovered they maintained their body temperature within the normal range on exposure to this temperature, while increasing their heat production by 20 percent. The thermogenesis was apparently of the non-shivering type. There was evidence of increased metabolic activity in the interscapular brown fat pad at 25§ C both on admission and before discharge. In the malnourished children this activity was not sufficient to produce a measurable increase in total oxygen consumption. Interscapular brown fat was examined at autopsy in thirteen malnourished and fifteen well nourished children aged 1-24 months. Lipid depletion was found in this tissue in the former but not in the latter. This may explain the impared response of the malnourished child to cold. (AU)

Thermoregulatory instability in kernicterus

A child with kernicterus and severe marasmus had marked thermoregulatory instability. An initial episode of hypothermia was attributed to deficient energy reserves, while experimental evidence suggested that subsequent intermittent fever was due to an unstable set-point of the hypothalmic thermoistat. Impaired vasomotor reactivity as a result of autonomic dysfunction may also have contributed to the unstable body temperature (AU)

A simple metabolism chamber allowing determinations of evaporative water loss in large babies

Apparatus is described for measuring total evaporative water loss by wet and dry bulb thermometry in babies of up to 10 kg weight. The metabolism chamber is suitable for thermaregulatory and metabolic studies in infants, and measurements of respiratory gas exchange are made by an open circuit sampling technique. The particular advantages of the apparatus are its low cost, its ease of construction, and its accuracy in determining evaporative water loss in large babies. (AU)

Defective thermoregulation in malnourished Jamaican babies - abstract

Twelve malnourished babies were exposed, in sleep, to an environmental temperature of 24§C for 30 minutes. Their oxygen consumption decreased by 13.5 percent and their mean rectal temperature fell from 37.05§C to 35.95§C. When these children, after recovery, were exposed to the same environmental stress, their oxygen consumption increased by 19 percent and their rectal temperature fell from 37.36§C to 36.65§C. These findings provide more evidence that thermoregulation is impaired in malnourished children, and may help to explain the occurrence of hyperthermia in some of them (AU)

The influence of infantile malnutrition on central body temperature - abstract

The purpose of study was to determine the effect of malnutrition and subsequent recovery upon central body temperature. Ten children were studied, all of whom had moderately severe protein-calorie malnutrition. None had evidence of systemmic infection. Core temperature was measured with a thermistor probe in the external auditory meatus and continously recorded during three 48-hour periods, on admission, during the phase of rapid growth and after recovery. A total of 1140 hours of continous temperature recording was analysed. Mean temperature for each 48-hour period was calculated by determining the arithmetical mean of 96 values during each period (1/2 hour intervals). The variance of each set of temperatures was analysed. Simultaneous recordings of ambient temperature were made. Results showed that mean core temperature was significantly depressed in the malnourished child. This may represent an adaptive phenomenon designed to reduce calorie requirements. In addition there was a tendency for the core temperature to follow the ambient temperature during the malnourished state, and the variability of the core temperature was greater before than it was after recovery from infantile malnutrition. Core temperature was profoundly influenced by sleep in the malnourised child. During the phase of rapid growth core temperature was significantly elevated above recovery values. This probably reflects the effect of post-randial heat production during the period, which is believed to be due to the energy cost of growth (AU)

Influence of malnutrition on the body temperature of children

The mean auricular temperature of 10 malnourished Jamaican infants was 0.84§C lower on admission to hospital than it was after recovery. Body temperature was influenced by ambient temperature in the malnourished state. During the rapid growth that accompanies recovery the mean auricular temperature was raised. Five malnourished children with hypothermia were given a standard high-calorie feed, and this caused the body temperature to return to normal levels within two hours in every case. These results suggested that reduced temperature in malnourished children may be an adaptation to conserve calories, and that severe hypothermia in malnutrition results from an acute shortage of energy reserves. Frequent feeding of malnourished chhildren is most important in their management. (Summary)

The influence of malnutrition on the postprandial metabolic rate and respiratory quotient

Pre- and post-prandial metabolic rates were measured in twelve malnourished Jamaican infants. On admission to hospital, minimal increases in postprandial metabolic rate were found, whereas during the recovery phase when growth was rapid, increases in postprandial metabolic rate of up to 38 percent occurred. After recovery only the five children who were still gaining weight at a rate of more than 4 g/kg body-weight.d continued to show a substantial increase in postprandial metabolism. A highly significant correlation was found between growth rate and the increase in postprandial metabolic rate. Marked differences existed in the respiratory quotient measured 4h after the last meal, the values being low on admission and high during the phase of rapid growth. After a test meal, the respiratory quotient rose sharply both in newly admitted and in recovered children, but fell slightly when the children were studied during the phase of rapid growth. (AU)

Iron absorption and pyrexia

An incidental finding led to a more detailed study of the effect of fever on iron absorption. The absorption of 59Fe-labelled ferrous ascorbate was measured by whole-body counting in nineteen malnourished Jamaican infants and young children. Tests were done at various stages of refeeding, and it was found that the presence of a febrile illness or the febrile response to diptheria-pertussis-tetanus immunisation profoundly depressed iron absorption. This effect was not related to the nutritional state of the patient. Recurrent minor febrile illnesses are common in this group of children and may contribute to the production of iron deficiency.(Summary)

The prediction of total body fat from simple field anthropometry

This paper postulates a simple method of deriving total body fat from measurements commonly taken in field anthropometry. It proposes a model and tests it with a sample of young children in Jamaica against alternative measurements of body composition derived from estimates of total body potassium obtained in a liquid scintillation counter