RESUMO
Childhood malnutrition is known to be associated with visible lightening of hair colour (hypochromotrichia). Nevertheless, no systematic investigations have been carried out to determine the biochemical basis of this change. We used an HPLC method to measure melanins in the scalp hair of thirteen Jamaican children, diagnosed as having primary malnutrition, during various stages of their treatment and after recovery. During treatment for malnutrition, a progressive decrease in total melanin content along the hair shaft from tip to root (root:tip ratio: 0.62 (sd 0.31)) was observed. This ratio was significantly different (P = 0.003) from the ratio observed among children sampled several months after discharge from hospital (0.93 (sd 0.23)) and among normal control children (0.97 (sd 0.12)). Thus, it appears that a decrease in melanin content is associated with periods of malnutrition. The low root:tip ratio during malnutrition presumably arises because the tips reflect prior hair growth during 'normal' nutrition and the roots reflect hair growth during malnutrition; a return of the root:tip ratio to that seen among controls reflects 'recovery' from malnutrition. It is possible that reduced intake or availability of tyrosine, a key substrate in melanin synthesis, may play a role in the reduction of hair melanin content during periods of malnutrition. The precise mechanisms by which melanin content is reduced, and the role of aromatic amino acid availability in hair colour change and other features of childhood malnutrition remain to be explored.
Assuntos
Cor de Cabelo , Cabelo/química , Transtornos da Nutrição do Lactente/metabolismo , Melaninas/análise , Couro Cabeludo , Doença Aguda , Feminino , Folículo Piloso/química , Humanos , Lactente , Transtornos da Nutrição do Lactente/terapia , Kwashiorkor/metabolismo , Kwashiorkor/terapia , Masculino , Desnutrição Proteico-Calórica/metabolismo , Desnutrição Proteico-Calórica/terapiaRESUMO
BACKGROUND: It has been hypothesized that one factor associated with poor prognosis in kwashiorkor, but not in marasmus, is impaired lipid catabolism, which limits the supply of energy that is essential for survival when dietary intake is inadequate. However, this hypothesis has not been tested. OBJECTIVE: The objective was to measure lipid kinetics in malnourished children with kwashiorkor or marasmus. DESIGN: Glycerol concentration and flux (index of total lipolysis), palmitate concentration and flux (index of net lipolysis), and palmitate oxidation rate (index of fatty acid oxidation) were measured in 8 children (n = 5 boys and 3 girls) with kwashiorkor and 7 (n = 4 boys and 3 girls) with marasmus, aged 4-20 mo, in the postabsorptive state. The measurements were made approximately 3 d after admission, when the children were malnourished, and after the children attained normal weight-for-length, ie, at recovery. RESULTS: The glycerol concentration was higher in the malnourished stage than at recovery for the marasmus and kwashiorkor groups combined. Glycerol flux tended to be lower (P = 0.067) and palmitate flux significantly lower (P < 0.05) in the kwashiorkor group than in the marasmus group. Palmitate oxidation was significantly lower in the malnourished stage than at recovery in the kwashiorkor group but not in the marasmus group. In the malnourished stage, palmitate oxidation was slower in the kwashiorkor group than in the marasmus group, but no significant differences between groups were observed at recovery. CONCLUSIONS: Children with kwashiorkor break down fat and oxidize fatty acids less efficiently than do children with marasmus; this factor may explain the better survival rate in marasmus.
Assuntos
Glicerol/metabolismo , Kwashiorkor/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Feminino , Humanos , Lactente , Kwashiorkor/dietoterapia , Lipólise , Masculino , Palmitatos/metabolismo , Desnutrição Proteico-Calórica/dietoterapiaRESUMO
Along with the onset of severe kwashiorkor symptoms, a 20-month-old child showed biochemical signs of markedly increased lipid peroxidation, with a decrease of plasma antioxidants and decreased proportions of polyunsaturated fatty acids in plasma and red cell phospholipids. Additionally, plasma concentrations of the lipid peroxidation products malondialdehyde and hexanal, as well as the urinary excretion of leukotriene E4, were found to be increased. All biochemical alterations normalized along with subsequent clinical improvement. These findings suggest that the extent of lipid peroxidation is strongly related to the severity of the kwashiorkor syndrome.
Assuntos
Ácidos Graxos Insaturados/sangue , Kwashiorkor/metabolismo , Peroxidação de Lipídeos , Aldeídos/sangue , Humanos , Lactente , Kwashiorkor/dietoterapia , Kwashiorkor/fisiopatologia , Masculino , Malondialdeído/sangue , Vitamina E/sangueRESUMO
Two animal models of infantile malnutrition were produced where some aspects of carbohydrate metabolism can be studied: protein-depleted (PD, "kwashiorkor") rats, fed a protein-free diet for 18 days, starting 3 days before weaning, and chronically malnourished animals during suckling (PED, "marasmus") where 20-22 pups were fed by the same dam. PED and PD rats were sacrificed at 21 and 36 days of age, respectively. Body weight was 35% in PD, and 50% in PED groups when compared to their age-matched controls. After an overnight fast, some of the PD animals presented with low blood glucose levels, and the levels of lactic and pyruvic acids were depressed in PED, while lactic acid was increased in PD animals. Blood glucose utilization was reduced in PED, and increased in PD rats, while the opposite was true for the kidney gluconeogenic capacity. When compared to the respective control values, muscle glycogen was high in both groups, while the level of liver glycogen was unchanged. The rate of muscle glycolysis was decreased in both groups. These results are in agreement with clinical observations, suggesting that these models may be used to study some of the metabolic changes brought about by infantile malnutrition.
Assuntos
Metabolismo dos Carboidratos , Kwashiorkor/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Animais , Carboidratos/sangue , Modelos Animais de Doenças , Feminino , Masculino , Ratos , Ratos Sprague-DawleyRESUMO
After a brief discussion of some of the aspects of importance, sources, deficiencies and excesses of selenium the great differences of ingestion between different countries are mentioned. Breast fed children from an area in Venezuela ingest 10 times the amount compared with children from Finland. Among sesame seed samples from 20 different countries used as Se indicators, the highest and the lowest values were found in those of Latin-American origin. With very few exceptions the highest and the lowest urinary and serum Se levels reported in the literature came from this region. The performance of more studies in Latin-America on Se is recommended. Urinary excretion and analysis of finger nails or egg-white of freely foraging hens could be used as suitable indicators.
Assuntos
Selênio/fisiologia , Adulto , Animais , Cardiomiopatias/etiologia , Bovinos , Doenças dos Bovinos/induzido quimicamente , Criança , Feminino , Análise de Alimentos , Saúde Global , Doenças dos Cavalos/induzido quimicamente , Cavalos , Humanos , Lactente , Kwashiorkor/tratamento farmacológico , Kwashiorkor/metabolismo , América Latina/epidemiologia , Masculino , Neoplasias/prevenção & controle , Necessidades Nutricionais , Proteínas de Plantas/química , Intoxicação/veterinária , Aves Domésticas , Doenças das Aves Domésticas/induzido quimicamente , Gravidez , Selênio/efeitos adversos , Selênio/análise , Selênio/deficiênciaRESUMO
Red cells in oedematous malnutrition (kwashiorkor) have an increased sodium content, 'leakiness' to sodium and enhanced sodium pumping. In non-oedematous malnutrition (marasmus) there is a reduction in the sodium pump activity. The explanation has hitherto been unknown but the glutathione content of red cells is low in kwashiorkor and normal in marasmus. We artificially lowered the glutathione content of normal red cells to values characteristic of mild oedematous malnutrition, using the enzyme inhibitors bischloronitrosourea (BCNU) and buthionine sulfoximine (BSOX). After preincubation, the cells were washed to remove the inhibitors and oxidized glutathione. Cellular content of sodium and potassium, and 86Rb influx were then measured. The reduction in glutathione reproduced the abnormalities of sodium content and flux observed in kwashiorkor. We suggest that oxidant stress in kwashiorkor, by reducing cellular glutathione, may affect cell membrane electrolyte transport. This may act through alterations in membrane sulfhydryl groups. Glutathione depletion may therefore play an important role in the clinical picture and natural history of oedematous malnutrition and may have relevance to other conditions where oxidant stress occurs.
Assuntos
Eritrócitos/enzimologia , Glutationa/metabolismo , Kwashiorkor/metabolismo , Sódio/metabolismo , Adulto , Antimetabólitos/farmacologia , Butionina Sulfoximina , Carmustina/farmacologia , Membrana Eritrocítica/metabolismo , Eritrócitos/efeitos dos fármacos , Glutationa/deficiência , Humanos , Técnicas In Vitro , Kwashiorkor/sangue , Kwashiorkor/induzido quimicamente , Masculino , Metionina Sulfoximina/análogos & derivados , Metionina Sulfoximina/farmacologia , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/metabolismo , Canais de Sódio/metabolismoRESUMO
Red cells in oedematous malnutrition (kwashiorkor) have an increased sodium content, 'leakiness' to sodium and enhanced sodium pumping. In non-oedematous malnutrition (marasmus) there is a reduction in the sodium pump activity. The explanation has hitherto been unknown but the glutathione content of red cells is low in kwashiorkor and normal in marasmus. We artifically lowered the glutathione content of normal red cells to values characteristic of mild oedematous malnutrition, using the enzyme inhibitors bischloronitrosourea (BCNU) and buthionine sulfoximine (BSOX). After preincubation, the cells were washed to remove the inhibitors and oxidized glutathione. Cellular content of sodium and potassium, and 86Rb influx were then measured. The reduction in glutathione reproduce the abnormalities of sodium content and flux observed in kwashiorkor. We suggest that oxidant stress in kwashiorkor, by reducing cellular glutathione, may affect cell membrane electrolyte transport. This may act through alterations in membrane sulfhydryl groups. Glutathione depletion may therefore play an important role in the clinical picture and natural history of oedematous malnutrition and may have relevance to other conditions where oxidant stress occurs. (AU)
Assuntos
Humanos , Adulto , Masculino , Técnicas In Vitro , Eritrócitos/enzimologia , Glutationa/metabolismo , Kwashiorkor/metabolismo , Sódio/metabolismo , Antimetabólitos/farmacologia , Carmustina/farmacologia , Membrana Eritrocítica/metabolismo , Eritrócitos/efeitos dos fármacos , Glutationa/deficiência , Kwashiorkor/induzido quimicamente , Metionina Sulfoximina/análogos & derivados , Metionina Sulfoximina/farmacologia , Desnutrição Proteico-Calórica/metabolismo , Canais de Sódio/metabolismo , Kwashiorkor/sangue , Desnutrição Proteico-Calórica/sangueRESUMO
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.
Assuntos
Países em Desenvolvimento , Kwashiorkor/epidemiologia , Desnutrição Proteico-Calórica/epidemiologia , Proteínas Alimentares/metabolismo , Fígado Gorduroso/metabolismo , Glutationa/sangue , Glicina/metabolismo , Humanos , Lactente , Jamaica , Kwashiorkor/metabolismo , Desnutrição Proteico-Calórica/metabolismo , DesmameRESUMO
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)
Assuntos
Humanos , Lactente , Países em Desenvolvimento , Kwashiorkor/epidemiologia , Desnutrição Proteico-Calórica/epidemiologia , Proteínas Alimentares/metabolismo , Fígado Gorduroso/metabolismo , Glutationa/sangue , Glicina/metabolismo , Jamaica , Kwashiorkor/metabolismo , Desnutrição Proteico-Calórica/metabolismo , DesmameAssuntos
Humanos , Criança , 21003 , Proteínas de Transporte/análise , Deficiência de Proteína/diagnóstico , Proteínas Alimentares/administração & dosagem , Alimentos Formulados , Kwashiorkor/metabolismo , Obesidade/dietoterapia , Pré-Albumina/análise , Proteínas de Ligação ao Retinol/análise , Albumina Sérica/análise , Proteínas de Ligação a Tiroxina/análise , Transferrina/análise , Zinco/sangueRESUMO
The degree of which the ability to absorb lactose can be regained after recovery from an acute episode of severe malnutrition is in doubt. Lactase activity was indirectly assessed by means of a standard lactose tolerance test (2 g lactose per kilogram of body weight) in 71 Peruvian Mestizo infants and children (age 5 to 55 months) who had suffered such an episode. All were studied just before discharge after several months of hospital rehabilitation, during which linear growth and weight gain had accelerated and signs of significant malabsorption of other nutrients had disappeared. Only 39% of the total group had a positive test (delta blood glucose greater than 25 mg/dl); there was a decreasing proportion of positive responders with increasing age. No difference in response attributable to type or severity of malnutrition was found. Comparison of the present data with previous data from children in the same community who had never been acutely malnourished suggests that acute malnutrition may hasten the permanent decline of lactase activity normally expected later in life.
Assuntos
Lactose/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Doença Aguda , Envelhecimento , Estatura , Peso Corporal , Pré-Escolar , Humanos , Lactente , Absorção Intestinal , Kwashiorkor/complicações , Kwashiorkor/metabolismo , Intolerância à Lactose/etiologia , Intolerância à Lactose/genética , Teste de Tolerância a Lactose , Peru , Desnutrição Proteico-Calórica/complicações , Desnutrição Proteico-Calórica/dietoterapiaRESUMO
Most indican excreted in the urine comes from the degradation of tryptophan through the action of microorganisms dwelling within the intestinal lumen. Based on this knowledge, the excretion of this compound was investigated during the recovery process of 19 malnourished infants; thus, attempts were made to recognize indirectly whether quantitative modifications take place in the intestinal flora as the state of nutrition is re-established. The results do not suggest the presence of an important variation of the bacterial content within the intestine of these children, at least during the first four weeks of their recovery.
Assuntos
Indicã/urina , Kwashiorkor/urina , Análise de Variância , Animais , Bovinos , Creatinina/urina , Diarreia Infantil/metabolismo , Diarreia Infantil/urina , Dietoterapia , Escherichia coli/metabolismo , Feminino , Humanos , Lactente , Intestino Delgado/microbiologia , Kwashiorkor/metabolismo , Kwashiorkor/terapia , Masculino , Leite/metabolismo , Triptofano/metabolismoRESUMO
Previous evaluation of diagnostic tests for acute renal failure in children demonstrated that osmolality urine/plasms (U/P) ratio below 1.3, urea ratio below 4.8 and a negative mannitol test (absence of a diurteic response within one hour after intravenous administration of 60 ml/m2 of 12.5% mannitol solution) may be considered as valuable factors in this diagnosis. However, the validity of those ratios were in doubt in selected populations such as newborns and in severe malnourished children in whom an impairment in concentrating urine capacity can be anticipated. With the purpose to test the validity of these parameters, a group of 53 newborns and 68 children with severe malnutrition were studied. They were admitted to the hospital with dehydration secondary to acute diarrhea presenting oliguria and hyperpnea and before any treatment was given, urine and blood samples were taken to determine urea and osmolality U/P ratios besides routine chemistries. Mannitol test was performed when urine could not be obtained and in some cases in whom U/P results deserved confirmation with the biological test. Seven of the 53 newborn patients developed acute renal failure with negative mannitol test and further clinical course of persistent oliguria. Urea and osmolality U/P ratios were 3.0 +/- 1.5 and 1.07 +/- 0.01 respectively, whereas the remaining 46 newborns had afterwards an uneventful recovery presenting U/P ratios of 12.4 +/- 8.5 for urea and 1.32 +/- 0.57 for osmolality. The difference between the average values of urea U/P ratio of the patients with acute renal failure and those with functional oliguria, were statistically significant at the level of p less than 0.01, but there was no significant difference between osmolality ratio values.
Assuntos
Injúria Renal Aguda/diagnóstico , Kwashiorkor/metabolismo , Concentração Osmolar , Ureia/urina , Injúria Renal Aguda/etiologia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Testes de Função Renal , Kwashiorkor/complicações , Kwashiorkor/urina , Masculino , Manitol , Ureia/sangueRESUMO
Modifications in energy metabolism and endocrine homeostasis (plasma insulin and growth hormone values, glucose and free fatty acid levels, serum thyroxine and TSH, free thyroxine index, and urinary catecholamines) were investigated in eight children with edematous protein-calorie malnutrition. Caloric expenditure was low at admission and correlated linearly with increased caloric intake throughout the study. The hormonal changes at admission were characterized by a negligible insulin response to intravenous arginine or glucose and by markedly elevated growth hormone levels which were neither increased by arginine nor suppressed by intravenous glucose. Serum thyroxine values were low, but free thyroxine index and serum TSH levels were within normal limits. At admission to the study, 24-hour urinary excretion of dopamine and norepinephrine was relatively reduced in relation to the excretion of epinephrine. All these modifications were corrected at time of the recovery study. It is suggested that in edematous protein-calorie malnutrition, insulin acts as the primary regulator of peripheral fuel release and that the high, nonsuppressible growth hormone levels may form part of an important homeostatic mechanism to provide substrates for brain metabolism via lipolysis.
Assuntos
Glândulas Endócrinas/fisiopatologia , Metabolismo Energético , Kwashiorkor , Antropometria , Arginina/administração & dosagem , Arginina/farmacologia , Glicemia/análise , Proteínas Sanguíneas/análise , Encéfalo/metabolismo , Catecolaminas/urina , Pré-Escolar , Creatinina/análise , Dopamina/urina , Epinefrina/urina , Ácidos Graxos não Esterificados/sangue , Feminino , Glucose/administração & dosagem , Glucose/farmacologia , Hormônio do Crescimento/sangue , Homeostase , Humanos , Lactente , Insulina/sangue , Ilhotas Pancreáticas/fisiopatologia , Kwashiorkor/metabolismo , Kwashiorkor/fisiopatologia , Mobilização Lipídica , Masculino , Norepinefrina/urina , Hipófise/fisiopatologia , Glândula Tireoide/fisiopatologia , Tireotropina/sangue , Tiroxina/sangueRESUMO
Normal infants exhibited circadian rhythmicity of plasma F concentration. Infants from 2.1 to 3.2 months of age had CSR significantly higher than those of older infants. THF/THE urinary excretion ratios increased with age. The 17OHCS excretion was higher in the younger infants. Urinary excretions of free corticoids and cortisol were similar in all age groups. In marasmus, plasma F concentrations in the morning and evening were significantly elevated. Normal diurnal variation returned following therapy. CSR and 17OHCS excretions were not different from age controls, but were significantly lower than size controls, THF/THE ratios, urinary excretion of free corticoids and cortisol were normal. In marasmic kwashiorkor, plasma F concentrations were significantly elevated in the morning and evening. There was a suggestive decrease with therapy. CSR was low before and after treatment. THF/THE ratios, urinary 17OHCS excretion, and urinary free corticoids and cortisol were not significantly different from infants matched for size or patients with marasmus.
Assuntos
Glândulas Suprarrenais/fisiopatologia , Transtornos da Nutrição do Lactente/fisiopatologia , Kwashiorkor/fisiopatologia , Desnutrição Proteico-Calórica/fisiopatologia , 17-Hidroxicorticosteroides/urina , Corticosteroides/urina , Glândulas Suprarrenais/fisiologia , Cromatografia em Papel , Ritmo Circadiano , Humanos , Hidrocortisona/sangue , Hidrocortisona/metabolismo , Hidrocortisona/urina , Lactente , Transtornos da Nutrição do Lactente/dietoterapia , Transtornos da Nutrição do Lactente/metabolismo , Kwashiorkor/dietoterapia , Kwashiorkor/metabolismo , Ligação Proteica , Desnutrição Proteico-Calórica/dietoterapia , Desnutrição Proteico-Calórica/metabolismo , Tetra-Hidrocortisol/urina , Tetra-Hidrocortisona/urina , TrítioRESUMO
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)