Serum and red cell folates, and serum vitamin B12 in protein calorie malnutrition

Khalil, Mona; A, Tanios; Moghazy, M.; Aref, M. K.; Mahmoud, S.; Lozy, Mohamed el

doi:10.1136/adc.48.5.366

Cited by 15 publications

(5 citation statements)

References 16 publications

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“…It has long been recognized that folate deficiency is common in the developing world. About 20% of children in Jamaica and Kenya are folate deficient, and similar results have been published from many countries [297,356,[372][373][374].…”

Section: Folic Acidmentioning

confidence: 55%

“…The populations where moderate malnutrition is common are almost entirely vegetarian by necessity. Surprisingly, the circulating levels of vitamin B 12 in severely malnourished children are not low [297,[353][354][355][356][357][358]. This may be because concomitant liver injury releases cobalamin into the circulation [358,359].…”

Section: Cobalamin (Vitamin B 12 )mentioning

confidence: 99%

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Proposed Recommended Nutrient Densities for Moderately Malnourished Children

2009

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Recommended Nutrient Intakes (RNIs) Key words: Ascorbate, biotin, calcium, catch-up growth, cobalamin, convalescence, copper, DRV, essential fatty acid, folic acid, growth, iodine, iron, magnesium, malnutrition, manganese, niacin, nutrient density, nutrition, nutritional deficiency, nutritional requirements, pantothenic acid, phosphorus, potassium, protein, protein-energy malnutrition, pyridoxine, RDA, recommendations, riboflavin, RNI, selenium, sodium, stunting, sulfur, thiamine, vitamin A, vitamin D, vitamin E, vitamin K, wasting, zinc SummaryThe objective is to derive nutrient requirements for moderately malnourished children that will allow them to have catch-up growth in weight and height, prevent their death from nutritional disease, strengthen their resistance to infection, allow for convalescence from prior illness, and promote normal mental, physical, and metabolic development.The malnourished population will have been exposed to nutritional stress and seasonal shortages and will have been living in unhygienic conditions; a proportion will have been severely malnourished. Typically, from 5% to 15% of children aged 6 to 59 months are moderately wasted, and 20% to 50% are stunted in height.There has been little published on the requirements for the moderately wasted or stunted child per se. However, with the change in definition of severe malnutrition from the Wellcome classification [1] based upon weight-for-age to one based upon weight-forheight, reanalysis of the data shows that many of the studies of children with less than 60% weight-for-age included children who were moderately wasted by modern criteria, albeit stunted. The physiological and other data from the older literature therefore are likely to apply to those with moderate as well as those with severe wasting.In order to derive the requirements of each nutrient for moderately malnourished children, the lower and upper boundaries were assumed to lie between the requirement for a normal, healthy child living in a clean environment and the requirement for treatment of a severely malnourished child living in a contaminated environment. The therapeutic diets used for treatment of the severely malnourished in the developing world have been remarkably successful and are capable of sustaining rates of weight gain of more than 10 g/kg/day and returning the children to physiological normality.The requirements for normal Western individuals (Recommended Nutrient Intake, RNI) were used as the minimum requirements. They were converted into nutrient:energy densities with the use of the energy

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Section: Folic Acidmentioning

confidence: 55%

Section: Cobalamin (Vitamin B 12 )mentioning

confidence: 99%

Proposed Recommended Nutrient Densities for Moderately Malnourished Children

2009

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“… 79 The variable status of cobalamin, which is sometimes reduced in kwashiorkor, has been well described. 181 , 182 , 183 , 184 However, a more comprehensive understanding of the interactions between B-vitamins, methyl donors, and methionine is needed. The likelihood that one-carbon nutrient cross-talk influences methionine requirements for undernourished children raises practical questions.…”

Section: Discussionmentioning

confidence: 99%

One-carbon metabolism in children with marasmus and kwashiorkor

et al. 2022

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Background Kwashiorkor is a childhood syndrome of edematous malnutrition. Its precise nutritional precipitants remain uncertain despite nine decades of study. Remarkably, kwashiorkor's disturbances resemble the effects of experimental diets that are deficient in one-carbon nutrients. This similarity suggests that kwashiorkor may represent a nutritionally mediated syndrome of acute one-carbon metabolism dysfunction. Here we report findings from a cross-sectional exploration of serum one-carbon metabolites in Malawian children.Methods Blood was collected from children aged 12À60 months before nutritional rehabilitation: kwashiorkor (N = 94), marasmic-kwashiorkor (N = 43) marasmus (N = 118), moderate acute malnutrition (N = 56) and controls (N = 46). Serum concentrations of 16 one-carbon metabolites were quantified using LC/MS techniques, and then compared across participant groups.Findings Twelve of 16 measured one-carbon metabolites differed significantly between participant groups. Measured outputs of one-carbon metabolism, asymmetric dimethylarginine (ADMA) and cysteine, were lower in marasmic-kwashiorkor (median µmol/L ( § SD): 0¢549 ( § 0¢217) P = 0¢00045 & 90 ( § 40) P < 0¢0001, respectively) and kwashiorkor (0¢557 ( § 0¢195) P < 0¢0001 & 115 ( § 50) P < 0¢0001), relative to marasmus (0¢698 ( § 0¢212) & 153 ( § 42)). ADMA and cysteine were well correlated with methionine in both kwashiorkor and marasmic-kwashiorkor.Interpretation Kwashiorkor and marasmic-kwashiorkor were distinguished by evidence of one-carbon metabolism dysfunction. Correlative observations suggest that methionine deficiency drives this dysfunction, which is implicated in the syndrome's pathogenesis. The hypothesis that kwashiorkor can be prevented by fortifying low quality diets with methionine, along with nutrients that support efficient methionine use, such as choline, requires further investigation.

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“…The number and size of siderotic granules within erythroblasts may be increased and in occasional patients there may be a few ringed sideroblasts. In other countries such as Sudan and Egypt, megaloblastic erythropoiesis is seen in 40-70% of cases of PEM (Orner et al 1973;Khalil et al 1973).…”

Section: Anaemia In Protein-energy Malnutrition (Pem)mentioning

confidence: 99%

“…In many cases of PEM, the anaemia is obviously not primarily caused by a deficiency of iron, vitamin B t 2 or folate; the marrow contains stainable iron, serum vitamin B t 2 levels are normal or raised and red cell folate levels are within the normal range. However, clear-cut reductions in the red cell folate level (often associated with frankly megaloblastic erythropoiesis) have been reported in a high proportion of cases from the Sudan and Egypt, suggesting that in some countries folate deficiency may contribute substantially to the anaemia (Omer et al 1973;Khalil et al 1973). The levels of serum ascorbic acid, serum vitamin E, serum iron and plasma copper are low in some untreated patients with kwashiorkor (Sandstead et al 1965), but there is little evidence that an impaired supply of any of these substances to the erythron contributes significantly to the anaemia in most cases of PEM.…”

Section: Anaemia In Protein-energy Malnutrition (Pem)mentioning

confidence: 99%