RESUMO
Brain function in 10 severely malnourished children and matched controls was assessed using spectral analysis of electroencephalographic responses to photic driving during slow-wave sleep. The percentage power in the classical EEG broad-band domains was derived from temporo-occipital records. The malnourished group (5-23 months old; z-score height-for-age -3.2 +/- 0.3, weight-for-height -2.5 +/- 0.3) were tested on admission and on discharge from hospital. No significant differences were found between admission and discharge. Significant differences were found between malnourished and control groups, in the alpha 1 band in the undriven EEG, and in the alpha/beta 1 power ratio while driving at 8 Hz. These electrophysiological abnormalities, persisting despite somatic rehabilitation, must be associated with the chronic rather than the acute aspects of malnutrition, and can index the deviation of brain function from normality.
Assuntos
Encéfalo/fisiologia , Eletroencefalografia , Distúrbios Nutricionais/diagnóstico , Estatura , Peso Corporal , Feminino , Humanos , Lactente , Masculino , Índice de Gravidade de DoençaRESUMO
The enzyme glyoxalase I (Glyox I) is involved in metabolic detoxification, and requires glutathione (GSH) as a cofactor. Given the low concentration of whole blood GSH in children with oedematous malnutrition, it is possible that the function of this pathway may be compromised in these children. Glyox I activity was therefore assayed in erythrocytes taken from 133 severely malnourished children and 21 age-matched controls. The mean values (+/- SEM) for the marasmic group (Marasmus: 105 +/- 4/u/gm Hb) and the group with kwashiorkor (Kwash: 103 +/- 4/u/gm Hb) were not significantly different from controls (Cont: 104 +/- 2 u/gm Hb). In the group with marasmic-kwashiorkor (M-K: 88 +/- 4 u/g Hb) Glyox I activity was significantly lower than in controls (p < 0.005), as well as in children with Marasmus (p < 0.005), and kwashiorkor (p < 0.05). Enzyme activity was lower than normal in 45% of the MK group. Seven children died subsequent to admission; in five cases Glyox I activities were exceedingly low. There was a weak positive correlation between Glyox I activity and whole blood levels of GSH (r = 0.215). We conclude that Glyox I activity is relatively unaffected in malnutrition, except in those with M-K and especially those who do not survive the acutely malnourished state.
Assuntos
Países em Desenvolvimento , Lactoilglutationa Liase/sangue , Desnutrição Proteico-Calórica/enzimologia , Criança , Pré-Escolar , Eritrócitos/enzimologia , Feminino , Deficiência de Glucosefosfato Desidrogenase/enzimologia , Deficiência de Glucosefosfato Desidrogenase/genética , Glutationa/sangue , Humanos , Lactente , Jamaica , Masculino , Desnutrição Proteico-Calórica/diagnóstico , Valores de ReferênciaRESUMO
The autopsy records of 115 children with severe protein-energy malnutrition were reviewed. Sections of the lung histology showed evidence of bacterial pneumonia in 49% of cases. An additional 18% showed bronchitis, bronchiolitis or interstitial pneumonitis. Aspiration of gastric contents was evident in 10% of cases; 6% showed pulmonary oedema and congestion. In the remaining cases, no lung pathology was identified (17%). In 8 cases, rapid autopsy examination permitted fixation of lung tissue for electron microscopy. These included 4 cases of bronchopneumonia, one of which was associated with viral pneumonia. Another interstitial pneumonitis, probably of viral aetiology, was also studied. Both these virus-associated cases showed loss of type I pneumocytes and hyperplasia of type II pneumocytes. Another patient with herpes simplex hepatitis showed necrotic emboli in pulmonary capillaries with virions, as well as colonies of interstitial bacteria. One patient with acute pulmonary oedema displayed severe endothelial cell swelling on electron microscopy. In one case, there was no evidence of respiratory changes, apart from desquamation of type I pneumocytes. Useful information can be obtained on the fine structure of the lung, using samples taken soon after death.
Assuntos
Pulmão/patologia , Desnutrição Proteico-Calórica/patologia , Feminino , Humanos , Lactente , Jamaica , Pulmão/ultraestrutura , MasculinoRESUMO
Liver specimens obtained immediately after death from eight severely malnourished children were examined by electron microscopy, and compared with seven liver biopsy specimens from children who had recovered from malnutrition. The liver cells from the fatal cases showed mitochondrial swelling, with coarse densities in the matrix, cholestasis, depletion of the endoplasmic reticulum and Golgi apparatus, diminished glycogen stores, prominent lipid deposits and focal cytoplasmic degradation. The nucleoli were enlarged. There was marked reduction in peroxisomes. In contrast, the biopsies from recovering children showed good cellular organisation, and a normal frequency of peroxisomes. Multiple factors, including sepsis, may lead to depletion of peroxisomes. Loss of peroxisomes may interrupt beta-oxidation of long-chain fatty acids and accentuate the accumulation of lipid. Moreover, a reduction in the concentration of catalase may remove one avenue for the detoxification of free radicals. As the concentration of other anti-oxidants, notably glutathione, is also reduced, free radical damage may occur, leading to lipid peroxidation of membranes, mitochondrial damage, pump failure and influx of water and electrolytes into the cell.
Assuntos
Países em Desenvolvimento , Fígado/patologia , Microcorpos/ultraestrutura , Desnutrição Proteico-Calórica/patologia , Biópsia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Jamaica , Masculino , Microscopia Eletrônica , Mitocôndrias Hepáticas/ultraestrutura , Dilatação Mitocondrial/fisiologiaRESUMO
1. Cytokine production in vitro was assessed in 16 malnourished children, before and after nutritional recovery. 2. Tumour necrosis factor-alpha and interleukin-6 were measured in whole blood after lipopolysaccharide stimulation. 3. The total amount of both cytokines was significantly less after 24 h incubation among malnourished children when compared with the same children after nutritional rehabilitation. 4. Cytokine production in vitro is impaired in severely malnourished children.
Assuntos
Interleucina-6/biossíntese , Leucócitos/metabolismo , Distúrbios Nutricionais/sangue , Fator de Necrose Tumoral alfa/biossíntese , Feminino , Humanos , Técnicas In Vitro , Lactente , Leucócitos/efeitos dos fármacos , Lipopolissacarídeos/farmacologia , MasculinoRESUMO
Glutathione S-transferases (GSTs) are principally involved in detoxification. These enzymes can be induced by an increased flux of substrate, such as occurs during pro-oxidative stress or antioxidant deficiency. We tested the hypothesis that the postulated oxidative stress in severe malnutrition would result in induction of GSTs in erythrocytes. Erythrocyte GST activity towards 1-chloro-2,4-dinitrobenzene (CDNB) was measured in 271 malnourished children (22 undernourished; 92 marasmic; 82 kwashiorkor; 75 marasmic-kwashiorkor) and 48 healthy children. GST activity in the malnourished children was significantly higher than the control group (P < 0.01). The GST activity in the four classes of malnutrition did not differ. There was a weak relationship between GST activity and the height deficit, but not with the weight deficit, or the clinical features displayed by the children. The 11 children that died had a higher value than the survivors. There was no change in GST with anthropometric recovery. We conclude that erythrocyte GST has been induced in children with malnutrition. Induction of erythrocyte GST may be the result of exposure of the children to oxidative stress during the months prior to their presentation with severe malnutrition.
Assuntos
Transtornos da Nutrição Infantil/enzimologia , Eritrócitos/enzimologia , Glutationa Transferase/metabolismo , Kwashiorkor/enzimologia , Desnutrição Proteico-Calórica/enzimologia , Fatores Etários , Estatura , Peso Corporal , Estudos de Casos e Controles , Transtornos da Nutrição Infantil/sangue , Transtornos da Nutrição Infantil/classificação , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Doença Crônica , Eritrócitos/química , Glutationa Transferase/análise , Glutationa Transferase/fisiologia , Humanos , Lactente , Kwashiorkor/sangue , Kwashiorkor/classificação , Kwashiorkor/mortalidade , Oxidantes/efeitos adversos , Admissão do Paciente , Alta do Paciente , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/classificação , Desnutrição Proteico-Calórica/mortalidade , Índice de Gravidade de Doença , Estresse Fisiológico/induzido quimicamente , Taxa de SobrevidaRESUMO
Significant hormonal changes have been reported in childhood malnutrition, including high serum levels of growth hormone and cortisol, and low levels of circulating insulin. The ultrastructure of the endocrine pancreas in such patients has hitherto not been reported. A light microscopy survey of the pancreatic islets was carried out on 69 malnourished children dying from protein-energy malnutrition. In seven of these cases, a rapid autopsy protocol allowed tissues to be fixed for electron microscopy within 75 minutes of death. This paper presents the first ultrastructural observations on the Islets of Langerhans in childhood protein-energy malnutrition. In all cases, there was a variable degree of degeneration of all cell types with membrane damage, loss of ribosomes, vesiculation and mitochondrial swelling. In addition, the B-cells showed a high proportion of precursor granules compared to crystal forms, possibly accounting for low insulin serum levels reported by other workers. It is suggested that islet cell changes may be related to free radical damage secondary to depletion of glutathione and other antioxidants, as well as relative deficiencies of cysteine and zinc. In addition, the effects of agonal anoxia, and a short fixation delay after death must be considered.
Assuntos
Ilhotas Pancreáticas/ultraestrutura , Desnutrição Proteico-Calórica/patologia , Feminino , Hormônio do Crescimento/sangue , Humanos , Hidrocortisona/sangue , Lactente , Jamaica , Masculino , Microscopia Eletrônica , Organelas/ultraestruturaRESUMO
1. The responses of plasma levels of C-reactive protein and serum amyloid A were assessed in two groups of malnourished children. 2. Sixty-six severely malnourished children were studied at admission. Fifty of these had clinical and/or laboratory evidence of infection. C-reactive protein was not elevated in 23 (46%) and serum amyloid A was not raised in 29 (58%) of these 50 children. 3. Surviving children (n = 62) received two doses of diphtheria-pertussis-tetanus vaccine, to which the C-reactive protein and serum amyloid A responses were measured. The first was given early in recovery, the second after nutritional rehabilitation. Ten mildly malnourished children acted as controls, receiving a single dose of diphtheria-pertussis-tetanus vaccine. 4. The responses of both C-reactive protein and serum amyloid A to diphtheria-pertussis-tetanus vaccine were significantly less in early recovery than after nutritional recovery. The response of the mildly malnourished group was no different from that of the severely malnourished group in early recovery, but was less than their response on discharge. 5. The acute-phase protein response of malnourished children is impaired. This may have prognostic implications as the response plays a central role in promoting healing.
Assuntos
Proteína C-Reativa/biossíntese , Distúrbios Nutricionais/sangue , Proteína Amiloide A Sérica/biossíntese , Doença Aguda , Infecções Bacterianas/metabolismo , Pré-Escolar , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Feminino , Humanos , Lactente , MasculinoRESUMO
Immunosuppression increases the susceptibility to infection and changes the inflammatory response in children with severe protein-energy malnutrition. In this 5-year prospective study bacteremia was documented in 16% of 336 severely malnourished children, 2 to 34 months of age, who were hospitalized consecutively in the Tropical Metabolism Research Unit, Kingston, Jamaica. The 53 children had 60 episodes of nosocomial and community-acquired bacteremia with 69 blood isolates. Community-acquired bacteremia accounted for 72% (43 of 60) of bacteremic episodes. Thirty-five percent (24 of 69) of the strains were coagulase-negative staphylococci, 19% (13 of 69) were Staphylococcus aureus and 11% (8 of 69) were Streptococcus Group D. Seventeen episodes of coagulase-negative staphylococcal bacteremia were acquired in the community and 7 were nosocomial. These patients were more likely to have pneumonic consolidation than children with all other bacteremias combined (P < 0.02, Fisher's exact test). The bacteremia-related case fatality rate was 8% (5 of 60). Polymicrobial and Gram-negative septicemia were independent positive predictive factors for mortality when compared with single-agent and Gram-positive sepsis (P < 0.02). This 71% (49 of 69) prevalence of Gram-positive organisms suggests a change in the epidemiology from the predominant Gram-negative etiologies (76%) described in previous reports.
Assuntos
Bacteriemia/complicações , Bacteriemia/microbiologia , Desnutrição Proteico-Calórica/complicações , Infecções Estafilocócicas/complicações , Bacteriemia/epidemiologia , Pré-Escolar , Coagulase , Feminino , Humanos , Lactente , Jamaica/epidemiologia , Masculino , Estudos Prospectivos , Desnutrição Proteico-Calórica/epidemiologiaRESUMO
Ultrasonographic, blinded assessment was made of the extent of hepatic steatosis in 55 children with severe malnutrition: undernutrition (n = 6), marasmus (n = 18), marasmickwashiorkor (n = 17), and kwashiorkor (n = 14). The children were examined on admission, in early recovery (considered as baseline), and again at discharge. Eleven healthy control children and eight of the previously malnourished children were studied as comparison groups. Both oedematous and non-oedematous malnourished children had significantly more steatosis than the comparison groups at each time. Children with oedematous malnutrition had significantly greater steatosis than non-oedematous children at admission. Half of the non-oedematous malnourished children had appreciable hepatic steatosis at both admission and at baseline. Hepatic fat was only slowly mobilised. The rate constant was 1.4 +/- 0.3%/day. One quarter of the children did not change steatosis grades during the period they were in hospital. There was no overall correlation between the extent of steatosis and liver size. Hepatic steatosis in childhood malnutrition is not confined to oedematous children: it is frequently present in marasmic and undernourished children. Its extent is not necessarily related to the degree of hepatomegaly and accumulated lipid is only slowly mobilised.
Assuntos
Fígado Gorduroso/diagnóstico por imagem , Fígado/diagnóstico por imagem , Distúrbios Nutricionais/diagnóstico por imagem , Pré-Escolar , Edema , Fígado Gorduroso/patologia , Feminino , Humanos , Lactente , Fígado/patologia , Estudos Longitudinais , Masculino , Distúrbios Nutricionais/patologia , UltrassonografiaRESUMO
During recovery from severe wasting, malnourished children gain weight at greatly accelerated rates. To determine if additional zinc added to their basal therapeutic diets increased the retention of lean tissue and stimulated protein metabolism, we studied three groups of children taking either the basal diet alone or the basal diet supplemented with either 76 mumol (5 mg) or 153 mumol (10 mg) Zn/kg diet. The zinc-supplemented children gained similar weight and consumed the same amount of diet as the unsupplemented children. Zinc supplementation resulted in a greater net absorption of nitrogen and a higher rate of protein turnover, as estimated from urinary ammonia 15N enrichment after oral [15N]glycine. We conclude that additional zinc affected the composition of newly synthesized tissue and intermediary nitrogen metabolism.
Assuntos
Alimentos Fortificados , Desnutrição Proteico-Calórica/dietoterapia , Zinco/administração & dosagem , Pré-Escolar , Humanos , Lactente , Masculino , Nitrogênio/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Aumento de PesoRESUMO
Histological sections of pancreas and liver from 65 cases of children dying from childhood malnutrition were reviewed. The extent of pancreatic atrophy and fibrosis was compared with fatty change in the liver. Pancreatic atrophy was common, and often associated with severe fatty change in the liver, but also occurred in marasmic children with scanty liver fat. Pancreatic fibrosis, when present, was only of mild degree. Among 16 patients with marasmus, fibrosis was only seen in one pancreas. Fibrosis was recorded in 8/25 cases of kwashiorkor, and in 7/24 cases diagnosed as marasmic-kwashiorkor. Electron microscopy of the pancreas was performed in seven cases, using tissue collected at immediate autopsy. Atrophy and variable amounts of degranulation of acinar cells were seen. There was often disorganization of the endoplasmic reticulum with intracisternal sequestration. Mitochondrial swelling was consistent with terminal anoxia. Centro-acinar cells were prominent. Some acini were dilated and contained fibrillar material. These findings support the pioneer paper by Blackburn and Vinijchaikul (1969) and underline the importance of pancreatic atrophy in the pathology of protein-energy malnutrition.
Assuntos
Kwashiorkor/patologia , Pancreatopatias/patologia , Desnutrição Proteico-Calórica/patologia , Pré-Escolar , Feminino , Humanos , Lactente , Jamaica , Kwashiorkor/complicações , Masculino , Microscopia Eletrônica , Pancreatopatias/etiologia , Desnutrição Proteico-Calórica/complicaçõesRESUMO
We report a case of herpes simplex hepatitis in a child with edematous malnutrition. Electron microscopy showed virus in parenchymal cells, with pulmonary embolization of necrotic, infected hepatic cell fragments. Systemic dissemination of herpes simplex may be related both to the profound immunoincompetence associated with kwashiorkor and to a reduction in the circulating and fixed polyanions that normally inhibit viral attachment to cells.
Assuntos
Hepatite Viral Humana/complicações , Herpes Simples/complicações , Kwashiorkor/complicações , Embolia Pulmonar/etiologia , Capilares/microbiologia , Hepatite Viral Humana/patologia , Herpes Simples/patologia , Humanos , Lactente , Kwashiorkor/patologia , Fígado/microbiologia , Fígado/patologia , Fígado/ultraestrutura , Pulmão/ultraestrutura , Masculino , Microscopia Eletrônica , Embolia Pulmonar/complicações , Embolia Pulmonar/microbiologia , Embolia Pulmonar/patologia , Simplexvirus/isolamento & purificaçãoRESUMO
Peroxisomes play a role in hepatic beta-oxidation of fat, a process that results in the production of hydrogen peroxide. The fatty infiltration of the liver that occurs in severely malnourished children remains unexplained. We observed an almost total absence of peroxisomes in the hepatocytes of these children. We suggest that lack of available peroxisomes could contribute to the development of fatty liver.
Assuntos
Fígado Gorduroso/etiologia , Metabolismo dos Lipídeos , Microcorpos/metabolismo , Distúrbios Nutricionais/complicações , Criança , Sequestradores de Radicais Livres , Radicais Livres , Glutationa/metabolismo , Humanos , Fígado/metabolismo , Fígado/fisiopatologia , Mitocôndrias Hepáticas/metabolismo , Distúrbios Nutricionais/metabolismo , OxirreduçãoRESUMO
The rate of exposure to geohelminth infection of children living in 2 institutions in Jamaica, West Indies, was estimated from the product of their rates of ingestion of soil and the density of parasite eggs in the environment. The estimated mean rate of egg ingestion was 9-20 Ascaris lumbricoides eggs and 6-60 Trichuris trichiura eggs per year, although the distribution was highly overdispersed so that some individuals had an estimated annual exposure of several hundred eggs. The estimated individual rates of exposure correlated significantly with the observed worm burdens in children at one of the homes, but not at the other. It is suggested that the susceptibility of the children and the distribution of infective stages in the environment may be important in determining the relationship between exposure and the rate of acquisition of infection.
Assuntos
Ascaríase/transmissão , Solo , Tricuríase/transmissão , Adolescente , Animais , Ascaríase/epidemiologia , Ascaris/isolamento & purificação , Criança , Pré-Escolar , Humanos , Lactente , Jamaica/epidemiologia , Contagem de Ovos de Parasitas , Prevalência , Tricuríase/epidemiologia , Trichuris/isolamento & purificaçãoRESUMO
A new classification of essential nutrients is proposed based on whether the major response to a deficiency is either (a) specific defects which lead to loss of particular functions and characteristic clinical signs and symptoms or (b) a primary cessation of growth. Diagnosis of deficiency of the nutrients which give rise to growth failure (nitrogen, essential amino acids, potassium, sodium, phosphorus, sulphur, zinc, magnesium) is particularly difficult because of the nature of the response and the lack of a body store. The implications of the differences in the types of deficiency are explored in relation to assessment of the likelihood that widespread deficiency exists. Poverty is particularly likely to be associated with unrecognised deficiency of these "growth" nutrients because of the monotony of the diet. This will lead to slow growth. There is probably a difference in the nutrient requirements for longitudinal and ponderal growth. Of the growth nutrients sulphur is likely to be required in much higher amounts for skeletal growth than soft tissue growth.
Assuntos
Deficiências Nutricionais/fisiopatologia , Transtornos do Crescimento/etiologia , Necessidades Nutricionais , Deficiências Nutricionais/complicações , Deficiências Nutricionais/economia , Humanos , PobrezaRESUMO
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.
Assuntos
Glomérulos Renais/ultraestrutura , Kwashiorkor/patologia , Membrana Basal/ultraestrutura , Edema/tratamento farmacológico , Edema/etiologia , Edema/patologia , Gentamicinas/uso terapêutico , Humanos , Lactente , Kwashiorkor/complicações , Kwashiorkor/tratamento farmacológico , Microscopia Eletrônica , Análise de RegressãoRESUMO
The effect of a controlled stress (DPT inoculation) on the hormonal control of glucose homeostasis was investigated in children nutritionally rehabilitated from severe malnutrition. The age range of the 15 children studied was 6-26 months. Plasma insulin (INS), growth hormone (GH) and interleukin-1 (IL-1) were measured by radioimmunoassay; plasma glucose (GLU) by a glucose oxidase method; and red cell insulin binding (%SB) was determined, using A-14 monoiodinated insulin. Measurements were made on two occasions: (T-0) at 10 a.m., 12 hr before DPT inoculation, and (T-36) 36 hr. after inoculation. On both occasions, 4 hr post-prandial blood samples were used, and the mean body temperature (T) on the day of the test was determined. Red cell insulin binding (%SB) was significantly higher at T-36 than at T-0 (16.8 +/- 1.7 vs 12.1 +/- 1.2 (14), p = 0.005). (Results were expressed as mean +/- SEM, numbers of paired observations in parentheses). The higher %SB after DPT was accompanied by an increase in the number of receptor sites (S) (29.05 +/- 6.5 vs 15.6 +/- 2.5 (14), p = 0.025). However, insulin receptor affinity (K x 10(9) M-1) was decreased (0.7 +/- 0.1 vs 1.5 +/- 0.3 (14), p = 0.008). There were no significant differences in the plasma levels of insulin, glucose and interleukin-1, but plasma growth hormone (microU/ml) was increased after DPT, (18.0 +/- 3.0 vs. 11.5 +/- 1.2 (13), p = 0.04). Body temperature (degree C) was also significantly increased after DPT, (99.6 +/- 0.4 vs. 98.3 +/- 0.2 (14), p = 0.006).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Glicemia/metabolismo , Transtornos da Nutrição Infantil/sangue , Vacina contra Difteria, Tétano e Coqueluche/efeitos adversos , Homeostase/efeitos dos fármacos , Hormônios/sangue , Temperatura Corporal/efeitos dos fármacos , Pré-Escolar , Hormônio do Crescimento/sangue , Humanos , Lactente , Insulina/sangue , Interleucina-1/sangue , RadioimunoensaioRESUMO
The effect of a controlled stress (DPT inoculation) on the hormonal control of glucose homeostasis was investigated in children nutritionally rehabilitated from severe malnutrition. The age range of the 15 children studied was 6-26 months. Plasma insulin (INS), growth hormone (GH) and interleukin-1 (IL-1) were measured by radioimmunoassay; plasma glucose (GLU) by a glucoseoxidase method; and red cell insulin binding (%SB) was determined, using A-14 monoiodinated insulin. Measurements were made on two occasions: (T-O) at 10 a.m.,12 hr before DPT inoculation, and (T-36) 36 hr. after inoculation. On both occasions, 4 hr post-prandial blood samples were used, and the mean body temperature(T) on the day of the test was determined. Red cell insulin binding (%SB) was significantly higher at T-36 than at T-O (16.8 ñ 1.7 vs 12.1 ñ 1.2 (14), p=0.005). (Results were expressed as mean ñ SEM, numbers of paired observations in parentheses). The higher %SB after DPT was accompanied by an increase in the number of receptor sites (S) (29.05 ñ 6.5 vs 15.6 ñ 2.5 (14),p=0.025). However, insulin receptor affinity (K x 10(9)M(-1)) was decreased 0.7 ñ 0.1 vs 1.5 ñ 0.3(14), p=0.008). There were no significant differences in the plasma levels of insulin, glucose and interleukin-1, but plasma growth hormone (*U/ml) was increased after DPT, (18.0 ñ 3.0 vs 11.5 ñ 1.2 (13), p=0.04). Body temperature (-C) was also significantly increased after DPT,(99.9 ñ 0.4 vs 98.3 ñ 0.2(14), p=0.006). The change in plasma glucose from T-O to T-36 tended to be associated with both a change in plasma insulin (p=0.06) and plasma growth hormone (p=0.07). Increased insulin binding, as one index of increased insulin sensitivity during fever, can contribute to a reductionin blood glucose. However, the elevation in plasma growth hormone cold buffer the hypoglycaemic effect of insulin, and help to maintain glucose homeostasis
Assuntos
Lactente , Humanos , Glicemia/metabolismo , Transtornos da Nutrição Infantil/sangue , Vacina contra Difteria, Tétano e Coqueluche/efeitos adversos , Homeostase/efeitos dos fármacos , Hormônios/sangue , Plasma , Temperatura Corporal , Radioimunoensaio , Hormônio do Crescimento/sangue , Interleucina-1/sangue , Insulina/sangueRESUMO
Red cell insulin binding was studied in 13 Jamaican children (age range 4-24 months), while malnourished (MAL), during early recovery (GI), late recovery (GII), and after anthropometric recovery (REC). The rate of weight gain (RW), the energy intake (EN), and the protein intake (PR) were monitored at each phase of the study. Four-hour fasting blood samples were used, and the insulin binding characteristics were investigated in the physiological range of insulin concentrations (16.7-1670 pM). Analyses of variance were used to examine differences in the variables measured at the four phases. Red cell-specific insulin binding (SB) was lower in MAL than in GI (P less than 0.001) and in (GII) (P = 0.026). SB in REC and MAL were not significantly different. Insulin receptor affinity (K) was also lower in MAL than in GI (P less than 0.001). GII (P = 0.001), and REC (P = 0.012). The insulin receptor number (S) appeared to be high in malnutrition and to decrease as recovery progressed; however the decrease was not significant. Children with fever demonstrated high insulin binding. Plasma insulin (IN) rose during recovery, and was significantly higher in GII than in MAL (P = 0.01). There was no difference in plasma glucose (G) at any phase of the study. The interrelationships among the variables measured were investigated longitudinally using multiple regression analyses, SB was positively associated with S (P = 0.032), EN (P = 0.029), and PR (P = 0.0076). S was negatively associated with K (P less than 0.001). The associations of S and K with PR were positive and approached significance (P = 0.09 and P = 0.07 respectively). RW was positively associated with PR (P less than 0.001), and with EN (P = 0.001). There were no significant relationships between G and any of the other variables longitudinally. However, correlations of the variables within phases demonstrated that in MAL, G was negatively associated with SB (P less than 0.05) and with K (P less than 0.05); but in REC, G was positively associated with SB (P less than 0.05). These results demonstrated that in severe malnutrition, the red cell insulin receptor affinity was low. During catch-up growth when protein and energy intakes were increased, both insulin receptor affinity and specific insulin binding were also increased. The negative relationship between insulin binding and plasma glucose during malnutrition may be related to carbohydrate intolerance.