Infantile Malnutrition: Changes in Body Composition During Rehabilitation

Abstract

ExtractTotal body water (TBW), intracellular (ICW) and extracellular (ECW) spaces, muscle mass and supporting tissue were measured in nine malnourished infants, 5-30 months of age, shortly after, hospitalization, and then following 4-9 months of rehabilitation. Initially all infants had severe growth deficits, height age being 4-64% (average 40 %) and weight age 0-40 % (average 15.6 %) of chronologic age. TBW ranged from 63.5 to 89.3% of body weight and ECW ranged from 38.6 to 50.6% of TBW, suggesting marked losses of cell mass and body fat, with conservation of supporting tissues. Excretory levels of creatinine and hydroxyproline ranged from 31 to 86 mg/24 h and from 10.3 to 28.5 mg/24 h, respectively. During rehabilitation all patients exhibited accelerated growth, height age becoming 28.6-69.1 % (average 58.8 %) of chronologic age; most of the children became moderately obese. With the exception of one infant, who did not gain weight well despite satisfactory linear growth, excretion of creatinine increased 23-1 36 % and excretion of hydroxyproline increased 45-360 % over the initial values. TBW became 54.7-65 % of body weight and ECW 41.8-55.9 % of TBW. Proportionally smaller increases in metabolically active protoplasm, represented by ICW, were experienced in four infants under 11 months (average 25%, than in four of five infants over 11 months of age (average 67.5 %) ; however; these four infants demonstrated proportionately greater gains in ECW (77 versus 36%).Determinations of blood ,sugar, growth hormone and insulin responses to arginine were made in five of these patients and in three additional infants. On admission, the levels of growth hormone in these infants were found to be elevated (1 1.5-18 ng/ml) and did not respond to arginine injection; determination of blood sugar also showed elevated levels (1 19-1 82 mg/ 100 ml) . One to three months later the response was usually normal. Insulin responses, initially and after partial rehabilitation, were almost invariably blunted, with only one child, at 50 days, showing a rise to 45 ng/ml.

Human Amino Acid and Protein Requirements: Current Dilemmas and Uncertainties

“…4), not observed when these subjects were fed on a surfeit of protein (Nicol & Phillips, 1976b), or in Chilean underprivileged adults fed on a minimum-protein diet (Yanez et al 1982); it has been reported in Indian men (Gopalan & Narasinga Rao, 1966) and in Indian children fed on wheat protein (Reddy, 1971). Adaptation is indicated in these children since there was no response to the lysine supplement in contrast to previous studies (Graham et al 1969). N o explanation for these responses was offered by the authors and, whilst the responses appear rare (they are not observed in Chilean urban poor adults; Yanez et al 1982), there is no reason to question their validity.…”

Serum Insulin-Like Growth Factors I and II Concentrations and Growth Hormone and Insulin Responses to Arginine Infusion in Children with Protein-Energy Malnutrition before and after Nutritional Rehabilitation

“…Basal G H levels in PEM have been studied extensively (6,(23)(24)(25)(26). There is a general agreement that despite impaired growth rates in children with kwashiorkor, G H concentrations are ele-Measurements of basal insulin levels in children with kwashiorkor have yielded inconsistent results: high (34), low (6,35,36), and normal (37) values have been reported.…”

Metabolic and Hormonal Responses to a Protein-Glucose Meal in Normal Infants and in Marasmus and Marasmic Kwashiorkor

“…The fact that all but two had serum albumin levels below 3.0 g/ 100 ml, plus their generally more advanced age, makes them have much in common with most cases of MK. In four cases studied before therapy, we previously found two with "high" fasting levels and two with responses to arginine (14). The evidence suggests that in untreated marasmus, plasma G H is already elevated, or responds appropriately to different stimuli.…”

“…Although it was recognized that impaired absorption would influence the results, and that the responses observed might not be maximal, we felt that they would be more representative of responses taking place when such infants are realimented than those to induced hyper-and hypoglycemia or to amino acid infusions (2,4,8,11,12,14,31,39,41). Because of the paucity of reported normal values in infants of different ages, and because control samples handled in the sample manner as the study samples would be more meaningful, we evaluated healthy infants selected to match the study cases in age and body size.…”

“…The poor nitrogen retentions of many of these infants, the very high energy intakes that are needed to promote weight gain and growth, and the persistently reduced lean body mass all suggest that important alterations in substrate utilization are part of the adaptation which is necessary for survival but may then hinder rehabilitation. Even when rapid weight gain is established during recovery, this may be primarily the result of fat deposition (14).…”