(1973). Laboratory Tests for the Assessment of Nutritional Status. CRC Critical Reviews in Clinical Laboratory Sciences: Vol. 4, No. 3, pp. 215-340.

Laboratory Tests for the Assessment of Nutritional Status

Nippostrongylus brasiliensis: A review of immunity and the host/parasite relationship in the rat

A close relationship between the four human treponematoses is suggested by their clinical and epidemiological characteristics and by such limited knowledge of the treponemes as there is at present. No treponeme of this group (except for that of the rabbit) is known other than in man, but the human treponemes probably arose long ago from an animal infection. The long period of infectiousness of pinta suggests that it may have been the earliest human treponematosis. It may have been spread throughout the world by about 15 000 B.C., being subsequently isolated in the Americas when the Bering Strait was flooded. About 10 000 B.C. in the Afro-Asian land mass environmental conditions might have favoured treponeme mutants leading to yaws; from these, about 7000 B.C., endemic syphilis perhaps developed, to give rise to venereal syphilis about 3000 B.C. in south-west Asia as big cities developed there. Towards the end of the fifteenth century A.D. a further mutation may have resulted in a more severe venereal syphilis in Europe which, with European exploration and geographical expansion, was subsequently carried throughout the then treponemally uncommitted world. These suggestions find some tentative support in climatic changes which might have influenced the selection of those treponemes which still survive in humid or arid climates. Venereal transmission would presumably remove the treponeme from the direct influence of climate. The author makes a plea for further investigation of many aspects of this subject while this is still possible.

On the origin of the human treponematoses (pinta, yaws, endemic syphilis and venereal syphilis).

Multiple transverse trabeculae which could not be related to any infective process were recently found in radiographs of the bones of pigs maintained on low-protein diets (Stewart & Platt, 1958); it was suggested that they were evidence of disturbances in the balance between chondrogenic and osteogenic activity. The occurrence of transverse bands of dense tissue in bone has been recognized for many decades-even before the introduction of radiology, and in 1923 Harris (1924-5) drew attention to the transverse lines seen in radiographs of the growing ends of the long bonesof children. The conclusion reached from subsequent investigations (Harris, 1926; Eliot, Souther & Park, 1927; Harris, 1931a, b ; Sontag, 1938; Sontag & Harris, 1938; Follis & Park, 1952; Dreizen, Currie, Gilley & Spies, 1956) is that, though such lines are common in the bones of malnourished children, they are also found in the bones of those without obvious signs of malnutrition, and can often be related to some illness such as measles or whooping cough. Changes in bone are shown in this paper to be associated with protein-calorie deficiency. The term protein-calorie deficiency has recently been proposed as the name for a class of diseases which includes marasmus, marasmic kwashiorkor and kwashiorkor, diseases which are also known by numerous other names. This proposal was made in the course of a revision of the international classification of nutritional diseases ‘in keeping with the advances and understanding of those conditions’ (Joint FAO/WHO Expert Committee on Nutrition, 1962). The hyphen in the expression protein-calorie deficiency is intended to indicate that the two dietary factors are always interrelated; this is true for the proportion of protein to the calorie content of a diet; also the protein value for the consumer of a given diet varies with the energy content of the food eaten in relation to the consumer’s caloric needs (Platt, Miller & Payne, 1961). The protein value of a diet to the consumer is reduced proportionately much more than the extent of the caloric restriction. In assessing the caloric needs of a growing animal from its weight, consideration should be given to the effects of previous malnutrition. Thus in making adjustments for body size in cases of ‘emaciation resulting from prolonged undernutrition, the actual body-weight should be ignored and a “target” or desired body-weight should be used instead’ (FAO, 1957). In our experiments, diets and dietary regimens have been devised on which the pig develops disorders closely resembling those found at the two ends of the spectrum of protein-calorie deficiency disease in human subjects-marasmus and kwashiorkor.

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Transverse trabeculae and osteoporosis in bones in experimental protein-calorie deficiency.

Growth measurements and clinical data were obtained from 2,250 children on six Aboriginal settlements In Queensland. Growth retardation affected up to 50% of Aboriginal children aged between six months and three years. Severe retardation occurred in 16% of this age group and was accompanied by anaemia and infection. At two missions where early infant feeding was supervised children showed normal growth patterns, suggesting that Caucasian growth standards also apply to Aboriginal children. Genetic factors influenced growth variations In some areas. Clinical and dietary findings, lower concentrations of nutritional factors in the blood of growth‐retarded children in relation to normal controls, and growth responses following the addition of specific nutrients to the diet, suggested a deficiency of multiple nutritional factors In these children. Commonest deficiencies detected were of iron, ascorbic acid and total calories, but low serum concentrations of albumin, cholesterol, folate and other vitamins were frequently found.

Growth retardation, anaemia and infection, with malabsorption and infestation of the bowel. The syndrome of protein-calorie malnutrition in Australian Aboriginal children.

B.S. Platt

Papers

The contribution of infections to protein-calorie deficiency

Malnutrition and the pathogenesis of disease.