Famine Oedema

Beattie, John; Herbert, Philippa H.; Bell, David

doi:10.1079/bjn19480008

Cited by 23 publications

(9 citation statements)

References 11 publications

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“…The relative blood and plasma volume per kg body weight appeared to be elevated and was associated with anaemia. Beattie et al (1948) provided data on plasma and ECF volumes in two groups of severely undernourished Dutch and German adults. There was little change in the absolute plasma volume although the relative plasma volume per unit of body mass increased in proportion to the body weight loss.…”

Section: Responses To Low Energy Intakes In Adultsmentioning

confidence: 99%

Adaptation to low energy intakes: the responses and limits to low intakes in infants, children and adults

1999

Eur J Clin Nutr

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Reduction in energy intake below the acceptable level of requirement for an individual results in a series of physiological and behavioural responses, which are considered as an adaptation to the low energy intake. This ability of the human body to adapt to a lowering of the energy intake is without doubt bene®cial to the survival of the individual. However, what is more controversial is the view held by some that the body can metabolically adapt in a bene®cial manner to a lowered intake and consequently that the requirements for energy are variable given the same body size and composition and physical activity levels. Much of this confusion is the result of considerable evidence from studies conducted in well-nourished adults who, for experimental or other reasons, have lowered their intakes and consequently demonstrated an apparently enhanced metabolic ef®ciency resulting from changes in metabolic rates which are disproportionate to the changes in body weight. Similar increases in metabolic ef®ciency are not readily seen in individuals who on long-term marginal intakes, probably from childhood, have developed into short-statured, low-body-weight adults with a different body composition. It would thus appear that the generally used indicator of metabolic ef®ciency in humans, that is a reduced oxygen consumption per unit fat free mass, is fraught with problems since it does not account for variations in contributions from sub-compartments of the fat free mass which include those with high metabolism at rest such as brain and viscera and those with low metabolism at rest such as muscle mass. Metabolic rate per unit fat free mass thus, does not re¯ect true variations in metabolic ef®ciency and is due largely to variations in body composition. This ®nding combined with the evidence that behavioural adaptation in habitual physical activity patterns which occurs on energy restriction is not necessarily bene®cial to the individual raises doubts about the role of adaptation to low intakes in determining one's requirement for energy. The evidence is overwhelming that both in children and adults, changes in body size and composition as well as in levels of habitual physical activity may be the most important consequences of a lowered energy intake and cannot be assumed to be a part of a bene®cial adaptation that in¯uences energy requirements.

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Section: Responses To Low Energy Intakes In Adultsmentioning

confidence: 99%

Adaptation to low energy intakes: the responses and limits to low intakes in infants, children and adults

1999

Eur J Clin Nutr

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“…As has been indicated by a number of investigators, the presence of edema in this condition is not dependent solely upon the serum concentration of albumin (11,12).…”

Section: Discussionmentioning

confidence: 94%

Albumin Metabolism in Children With Protein Malnutrition1

Gitlin¹,

Cravioto²,

Frenk³

et al. 1958

J. Clin. Invest.

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“…Lack of trained staff and an extremely high patient load prevented detailed recording of individual food intake. Pitting edema was graded by using the classification of Beattie et al (12) as grade 0 (absent), 1 (minimal edema on the foot or ankle, demonstrable but not visible), 2 (visible on foot or ankle), 3 (demonstrable up to knee), 4 (demonstrable up to inguinal ligament), and 5 (anasarca). Pitting edema that was recorded as present but unquantified was assumed to be moderate (grade 3); unquantified edema was recorded in 4.3% of patients.…”

Section: Methodsmentioning

confidence: 99%

“…Although recovery from severe adult malnutrition has been systematically studied only rarely, there have been reports of similar poor responses to HP diets wherein edema was slow to disappear and sometimes even appeared during treatment (26)(27)(28). Ex-inmates of Belsen concentration camp, who experienced degrees of weight loss comparable with those in patients in Baidoa (mean weight loss of 38%, corresponding to a BMI of [12][13][14] frequently suffered from famine edema and ascites (9). During rehabilitation with a diet containing 64.8 g protein and 3.4 MJ (P:E, 32.4%), famine edema often appeared or increased (10).…”

Section: Importance Of Lower-protein Diets During the Initial Treatmementioning

confidence: 99%

“…The difficulties of feeding severely malnourished adults, especially those with edematous malnutrition, have long been recognized (6). During the first half of this century, these problems received considerable attention from the scientific community and, generally, diets containing relatively high amounts of protein were recommended (7)(8)(9)(10)(11)(12). In the early 1950s, scientific attention shifted toward malnourished children, in whom the quantity and quality of dietary protein required for successful rehabilitation became the focus of much research (13,14).…”

Section: Introductionmentioning

confidence: 99%

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Dietary treatment of severe malnutrition in adults

Collins¹,

Myatt²,

Golden³

1998

The American Journal of Clinical Nutrition

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The aim of this study was to compare the effects of two diets, differing primarily in protein content, on the nutritional rehabilitation of severely malnourished adults. The study took place in the Concern Worldwide Adult Therapeutic Feeding Centre in Baidoa, the town at the epicenter of the 1992 famine in Somalia. The response to treatment in 573 patients admitted to the center between November 1992 and March 1993 was studied. Mortality, appetite, rates of edema loss, and weight gain in 2 groups of patients receiving either a higher-protein (16.4% of energy from protein) or lower-protein (8.5% of energy from protein) diet were compared. Among edematous patients, the use of the lower-protein diet during the initial phase of treatment was associated with a threefold decrease in mortality (P < 0.05) and accelerated resolution of edema (P < 0.05). Among marasmic patients, no differences in mortality or rate of weight gain were observed. The large reduction in mortality associated with the use of the lower-protein diet in edematous patients appeared to be due to the lower amount of dietary protein. However, differences in the 2 diets other than or in addition to the protein content may have contributed. Notwithstanding, the data obtained suggest strongly that severely malnourished adults, particularly those with edema, recover more successfully with a diet of lower protein content than usually recommended. The lower-protein diet used in this study was much cheaper and more easily obtained than the conventional higher-protein diets in Baidoa.Am J Clin Nutr 1998;68:193-9.

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Famine Oedema

Cited by 23 publications

References 11 publications

Adaptation to low energy intakes: the responses and limits to low intakes in infants, children and adults

Adaptation to low energy intakes: the responses and limits to low intakes in infants, children and adults

Albumin Metabolism in Children With Protein Malnutrition1

Dietary treatment of severe malnutrition in adults

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