Calorie deficiencies and protein deficiencies
01 May 1970-American Journal of Public Health (American Public Health Association)-Vol. 60, Iss: 5, pp 952-952
About: This article is published in American Journal of Public Health.The article was published on 1970-05-01. It has received 100 citations till now.
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TL;DR: The Eighth Joint Expert Committee on Nutrition of FAO and WHO1 emphasized the need for an accepted classification and definition of protein-calorie malnutrition and evidence that there are no quantitative or qualitative differences in the diets of children who subsequendy develop kwashiorkor or marasmus.
Abstract: The Eighth Joint Expert Committee on Nutrition of FAO and WHO1 emphasized the need for an accepted classification and definition of protein-calorie malnutrition. There are two pressing reasons for this. Bengoa* summarized the available information about the frequency of protein-calorie malnutrition in different countries. There are many gaps, partly because for some countries there are no data, and partly because data which do exist are not always comparable. It is important that studies of prevalence should be extended and that the same criteria should be used everywhere. Secondly, the prevailing pattern of malnutrition in any region may give some information about the nature of the dietary deficiency and so will have a bearing on the preventive measures which are most appropriate. There are two schools of thought about this. According to what might now be called the classical theory, kwashiorkor results from a deficiency of protein with a relatively adequate energy supply, whereas marasmus is caused by an overall deficiency of energy and protein. From this it follows that where the kwashiorkor syndrome prevails, protein rich supplements would be an appropriate method of prevention. On the other hand, Gopalan and his co-workers* produced evidence that there are no quantitative or qualitative differences in the diets of children who subsequendy develop kwashiorkor or marasmus. They therefore proposed that the difference in the clinical picture reflects not a difference in diet but a difference in the capacity of the child to adapt. Whichever of these theories is correct the fact remains that according to reports in the literature the prevailing pattern does differ from one country to another.4 If the differences are real there must be some reason for them, and the first step in finding the reason is to put the observations on a firm foundation with an agreed system of classification. The need for this is urgent because an alteration in the pattern of protein-calorie malnutrition and in its age of onset has important implications for the planning of preventive policies.
869 citations
TL;DR: The high degree of sensitivity of TBPA and RBP to an inadequate protein intake is apparently related to their rapid turnover rate and to their unusual richness in tryptophan, which is known to play a key role in the control of protein synthesis.
317 citations
Journal Article•
TL;DR: A review of the literature that has appeared over the past five decades indicates that the median case fatality from severe malnutrition has remained unchanged over this period and is typically 20-30%, with the highest levels (50-60%) being among those with oedematous malnutrition as discussed by the authors.
Abstract: A review of the literature that has appeared over the past five decades indicates that the median case fatality from severe malnutrition has remained unchanged over this period and is typically 20-30%, with the highest levels (50-60%) being among those with oedematous malnutrition. A likely cause of this continuing high mortality is faulty case-management. A survey of treatment centres worldwide (n = 79) showed that for acutely ill children, inappropriate diets that are high in protein, energy and sodium and low in micronutrients are commonplace. Practices that could have fatal consequences, such as prescribing diuretics for oedema, were found to be widespread. Evidence of outmoded and conflicting teaching manuals also emerged. Since low mortality levels from malnutrition can be achieved using appropriate treatment regimens, updated treatment guidelines, which are practical and prescriptive rather than descriptive, need to be implemented as part of a comprehensive training programme.
298 citations
TL;DR: A factorial approach has been used in deriving the recommendations for both functional, protective nutrients ( type I) and growth nutrients (type II) in children with moderate malnutrition who require accelerated growth to regain normality.
Abstract: Recommended Nutrient Intakes (RNIs) are set for healthy individuals living in clean environments. There are no generally accepted RNIs for those with moderate malnutrition, wasting, and stunting, who live in poor environments. Two sets of recommendations are made for the dietary intake of 30 essential nutrients in children with moderate malnutrition who require accelerated growth to regain normality: first, for those moderately malnourished children who will receive specially formulated foods and diets; and second, for those who are to take mixtures of locally available foods over a longer term to treat or prevent moderate stunting and wasting. Because of the change in definition of severe malnutrition, much of the older literature is pertinent to the moderately wasted or stunted child. A factorial approach has been used in deriving the recommendations for both functional, protective nutrients (type I) and growth nutrients (type II).
252 citations
TL;DR: In most cases, the behavioral effects of early malnutrition were completely eliminated by supplying "additional stimulation" early in life, and two theoretical mechanisms are proposed to explain these findings.
Abstract: The behavioral effects of early malnutrition and early environmental isolation were observed in male rats. Dietary and environmental manipulations occurred during the first 7 weeks of life, after which followed a 10-week recovery period. On the basis of several different responses, it was found that the behavioral effects of early malnutrition were exaggerated by the environmental isolation. In most cases, the behavioral effects of early malnutrition were completely eliminated by supplying "additional stimulation" early in life. Two theoretical mechanisms are proposed to explain these findings.
243 citations
Cites background from "Calorie deficiencies and protein de..."
...so primarily food-oriented and, in the case of a malnourished child, the behavior may be expressed as apathy and 60s social withdrawal (19)....
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References
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TL;DR: The Eighth Joint Expert Committee on Nutrition of FAO and WHO1 emphasized the need for an accepted classification and definition of protein-calorie malnutrition and evidence that there are no quantitative or qualitative differences in the diets of children who subsequendy develop kwashiorkor or marasmus.
Abstract: The Eighth Joint Expert Committee on Nutrition of FAO and WHO1 emphasized the need for an accepted classification and definition of protein-calorie malnutrition. There are two pressing reasons for this. Bengoa* summarized the available information about the frequency of protein-calorie malnutrition in different countries. There are many gaps, partly because for some countries there are no data, and partly because data which do exist are not always comparable. It is important that studies of prevalence should be extended and that the same criteria should be used everywhere. Secondly, the prevailing pattern of malnutrition in any region may give some information about the nature of the dietary deficiency and so will have a bearing on the preventive measures which are most appropriate. There are two schools of thought about this. According to what might now be called the classical theory, kwashiorkor results from a deficiency of protein with a relatively adequate energy supply, whereas marasmus is caused by an overall deficiency of energy and protein. From this it follows that where the kwashiorkor syndrome prevails, protein rich supplements would be an appropriate method of prevention. On the other hand, Gopalan and his co-workers* produced evidence that there are no quantitative or qualitative differences in the diets of children who subsequendy develop kwashiorkor or marasmus. They therefore proposed that the difference in the clinical picture reflects not a difference in diet but a difference in the capacity of the child to adapt. Whichever of these theories is correct the fact remains that according to reports in the literature the prevailing pattern does differ from one country to another.4 If the differences are real there must be some reason for them, and the first step in finding the reason is to put the observations on a firm foundation with an agreed system of classification. The need for this is urgent because an alteration in the pattern of protein-calorie malnutrition and in its age of onset has important implications for the planning of preventive policies.
869 citations
TL;DR: In most cases, the behavioral effects of early malnutrition were completely eliminated by supplying "additional stimulation" early in life, and two theoretical mechanisms are proposed to explain these findings.
Abstract: The behavioral effects of early malnutrition and early environmental isolation were observed in male rats. Dietary and environmental manipulations occurred during the first 7 weeks of life, after which followed a 10-week recovery period. On the basis of several different responses, it was found that the behavioral effects of early malnutrition were exaggerated by the environmental isolation. In most cases, the behavioral effects of early malnutrition were completely eliminated by supplying "additional stimulation" early in life. Two theoretical mechanisms are proposed to explain these findings.
243 citations
TL;DR: Findings suggest either that the children with kwashiorkor have a greater exposure to aflatoxins or that their ability to transport and excrete a flatoxins is impaired by the metabolic derangements associated with kWashiorkors.
Abstract: Blood and urine samples from 252 Sudanese children were investigated for their aflatoxin content by high-performance liquid chromatography. The children comprised 44 with kwashiorkor, 32 with marasmic kwashiorkor, 70 with marasmus, and 106 age-matched, normally nourished controls. Aflatoxins were detected more often and at higher concentrations in sera from children with kwashiorkor than in the other malnourished and control groups. Aflatoxicol, a metabolite of aflatoxins B1 and B2, was detected in the sera of children with kwashiorkor and marasmic kwashiorkor but not in the controls and only once in a marasmic child. The difference between children with kwashiorkor or marasmic kwashiorkor and those in the control or marasmus groups was significant. Urinary aflatoxin was most often detected in children with kwashiorkor but their mean concentration was lower than in the other groups. Aflatoxicol was not detected in urine in any group. These findings suggest either that the children with kwashiorkor have a greater exposure to aflatoxins or that their ability to transport and excrete aflatoxins is impaired by the metabolic derangements associated with kwashiorkor. The presence of aflatoxicol in the sera of children with kwashiorkor but not in the others suggests a difference in metabolism between the two groups. Further studies are needed, and measurement of aflatoxins in the food eaten by these children is already underway.
129 citations
TL;DR: The young malnourished rats showed increased exploratory activity, transient head tremors and an increased sensitivity to noise, the latter being long-lasting if not permanent, and it was difficult to attract and hold their attention.
Abstract: 1. Colonies of rats have been maintained for twleve generations on diets adequate (dietary protein energy: total metabolizable energy (NDp: E) 0-1) or marginally deficient in protein (NDp: E 0-068). 2. In the malnourished colony, the proportion of "small-for-gestational-age" offspring was ten times as high as amongst the well-nourished colony, growth was slow, sexual maturation delayed, especially in the females, and, when adult, both sexes were significantly lighter and shorter than adults of the well-nourished colony. Organs, other than the eye, weighed less than those of well-nourished "age" controls, but when expressed relative to body-weight, the brain, pituitary, thyroid, adrenals, testes, thymus and eyes were larger, the pancreas unchanged and the kidneys smaller than those of the well-nourished "age" controls. The relative weight of the liver showed little change, being slightly increased in the males and, like the ovaries, slightly reduced in the females. On a body-weight basis, the brains were about 50 percent heavier than normal, but in absolute terms were 5-5-5 percent lighter than those of the well-nourished animals, the cerebellum (10-5 percent lighter in males and 12-9 percent lighter in females) being more severely affected than the cerebrum (4 percent lighter). 3. The young malnourished rats showed increased exploratory activity, transient head tremors and an increased sensitivity to noises, the latter being long-lasting if not permanent. When adult, they showed marked differences in behaviour and learning patterns and it was difficult to attract and hold their attention. In situations demanding a choice the animals were very excited, emitted loud squeals and tried to escape from what was clearly a stressful situation. However, a casual examination of the malnourished adults revealed a rather small, badly groomed, excitable rat without gross abnormalities. 4. The findings are discussed in relation to changes found in malnourished human communities.
108 citations
TL;DR: A consistent finding is that children with oedematous SCM have oxidative stress as there is evidence of oxidant-induced cellular damage and impaired synthesis of the primary cellular anti-oxidant glutathione.
Abstract: The major clinical syndromes of severe childhood malnutrition (SCM) are marasmus (non-oedematous SCM), kwashiorkor and marasmic-kwashiorkor (oedematous SCM). Whereas treatment of marasmus is straightforward and the associated mortality is low, kwashiorkor and marasmic-kwashiorkor are difficult to treat and have high morbidity and mortality rates. Despite extensive research, the pathogenic factors which cause a child to develop the oedematous instead of the non-oedematous form of SCM in response to food deprivation are still not clear. Over the years, two attractive hypotheses have been put forward. The first proposed that a dysadaptation in protein metabolism was involved and the second proposed that free radical damage of cellular membranes might be involved. To address aspects of these hypotheses, in this article we have reviewed work done by our group and by others on protein metabolism and pro-oxidant/anti-oxidant homeostasis in children with the oedematous and non-oedematous syndromes of SCM. A significant finding is that when there is chronic food deprivation children with non-oedematous SCM can maintain body protein breakdown at the same rate as when they are well nourished, but children with oedematous SCM cannot. The slower protein breakdown rate of children with oedematous SCM reduces the supply of most amino acids, resulting in decreased availability for the synthesis of plasma proteins involved in nutrient transport and the acute phase response to infection. Another consistent finding is that children with oedematous SCM have oxidative stress as there is evidence of oxidant-induced cellular damage and impaired synthesis of the primary cellular anti-oxidant glutathione.
80 citations