A Study on Comparison between WHO Protocol and Locally Adapted Dietary Protocol in the Management of Nutritional Marasmus At Hospitals in Bangladesh

Objectives: To compare the efficacy of locally adapted DMCHdietary protocol with the WHO protocol for the management ofnutritional marasmus in Bangladesh.Materials & Methods: A Hospital based Randomizedcontrolled Trial (RCT) was conducted on Marasmic children(06-59 years) with weight for height/length ≤ 3SD of themedian WHO references (n=62). Children treated with eitherWHO protocol (group-1, n=31) or DMCH protocol (Group-2,n=31). Clinical improvement, rate of weight gain, time taken toachieve target weight gain, return of appetite, return of smileand total cost of treatment were evaluated in both groups.Results: In DMCH group the time taken to achieve targetweight was 13.43 days which was around one day less thanthat of WHO group (14.33 days) and rate of weight gain washigher by around 2.6 gm/kg/day. Child receiving DMCHregimen took on average 3.47 days to return to smile the timewas 4.47 in WHO group (P< 0.01). Most importantly dailytreatment cost was higher by around 17 taka per day in WHOgroup. Neither of the group experienced any serious adverseeffect or fatality.Conclusion: Peanut based DMCH dietary regimen can beused effectively in the treatment of nutritional marasmus(without oedema) in the facility.

Phototherapy promotes healing of cutaneous wounds in undernourished rats

BACKGROUND: Various studies have shown that phototherapy promotes the healing of cutaneous wounds. OBJECTIVE: To investigate the effect of phototherapy on healing of cutaneous wounds in nourished and undernourished rats. METHODS: Forty rats, 20 nourished plus 20 others rendered marasmus with undernourishment, were assigned to four equal groups: nourished sham, nourished Light Emitting Diode treated, undernourished sham and undernourished Light Emitting Diode treated. In the two treated groups, two 8-mm punch wounds made on the dorsum of each rat were irradiated three times per week with 3 J/cm2 sq cm of combined 660 and 890nm light; wounds in the other groups were not irradiated. Wounds were evaluated with digital photography and image analysis, either on day 7 or day 14, with biopsies obtained on day 14 for histological studies. RESULTS: Undernourishment retarded the mean healing rate of the undernourished sham wounds (p < 0.01), but not the undernourished Light emission diode treated wounds, which healed significantly faster (p < 0.001) and as fast as the two nourished groups. Histological analysis showed a smaller percentage of collagen in the undernourished sham group compared with the three other groups, thus confirming our photographic image analysis data. CONCLUSION: Phototherapy reverses the adverse healing effects of undernourishment. Similar beneficial effects may be achieved in patients with poor nutritional status. .

Dislipidemia en niños con desnutrición aguda. Turbo, Colombia / Dyslipidemia in children with acute malnutrition. Turbo, Colombia

Objetivo: comparar el perfil lipídico de niños menores de 5 años con desnutrición aguda con un grupo control. Metodología: estudio descriptivo, de corte transversal, en 43 niños, 26 con desnutrición aguda y 17 con adecuado peso para la talla (P/T). Entre los grupos de estudio se compararon las concentraciones séricas de CT, c-LDL, c-HDL y TG. Resultados: el grupo con desnutrición presentó una frecuencia significativamente mayor de c-HDL bajas comparados con controles (19 vs 7% respectivamente, p=0,036) y un riesgo 1,8 veces mayor de c-HDL bajas (OR=1,8; IC 0,960-3,280). Los TG fueron mayores en los desnutridos, pero sin diferencia significativa con los controles. Las concentraciones de CT, c-LDL y c-HDL disminuyeron significativamente a medida que aumentó el grado de desnutrición, mientras que los TG aumentaron pero no significativamente; en los niños con desnutrición grave el índice arterial TG/c-HDL fue significativamente mayor que en los moderados y en los controles. Los niños con kwashiorkor presentaron las concentraciones más bajas de CT, c-LDL y c-HDL, las más altas de TG y el mayor índice arterial. Conclusiones: los niños con desnutrición aguda grave, especialmente tipo kwashiorkor, presentan concentraciones más bajas de c-HDL y más altas de TG, con un índice arterial alto que los expone a desarrollar ateroesclerosis.

Objective: to compare the lipid profile between preschools with and without acute malnutrition. Methods: a cross sectional study was developed in 43 preschools; 26 with and 17 without acute malnutrition. Malnutrition was assessed by weight for height ratio (P/T). Among the study groups were compared serum levels of TC, c-LDL, c-HDL and TG. Results: malnourished group showed a significantly higher frequency of c-HDL levels classified as lower compared with controls (19 vs 7%, respectively, p = 0.036) and a 1.8 times higher risk to c-HDL levels classified as lower (OR = 1,8; CI 0,960-3,280). TG levels were higher in malnourished, but no significant difference with controls. TC, c-LDL, and c-HDL concentration sincreased significantly by increasing the acute malnutrition degree. TG increased but not significantly, in preschool with severe acute malnutrition arterial index TG/HDL-C was significantly higher thanin control group. The lowest concentrations of TC, LDL-C, and HDL-C were detected in preschool affected by kwashiorkor. The highest TG, and arterial index were detected in preschool affected by kwashiorkor. Conclusions: preschool affected by severe acute malnutrition, especially kwashiorkor, has lower HDL-C concentrations, higher TG, and a high index which exposed them to develop atherosclerosis.

Modelos experimentais de desnutrição e sua influência no trofismo cutâneo / Experimental models of malnutrition and its effect on skin trophism

FUNDAMENTOS: A pele, para exercer suas funções, necessita de níveis adequados de nutrientes. OBJETIVO: Analisar o trofismo cutâneo de ratos nutridos e desnutridos por meio de dois modelos de desnutrição. MÉTODOS: No Modelo Marasmo, utilizaram-se 60 ratos Wistar em controle dietético, dos quais 30 foram selecionados aleatoriamente para receber metade da dieta diária durante 60 dias. No Modelo Gelatina, empregaram-se 60 ratos, dos quais 30 receberam dieta associada a proteína de baixa qualidade (gelatina) durante 30 dias. Avaliou-se o estado nutricional dos animais por meio da massa corporal, dos sinais clínicos e da dosagem de albumina sérica. Após o período de desnutrição, fez-se a histologia da pele dos animais para análise da espessura da derme e epiderme com o software Leica Application Suite; nas lâminas coradas com tricrômio de Gomori, analisou-se a colagênese com o software ImageJ. RESULTADOS: A massa corporal dos animais desnutridos pelo marasmo e gelatina foi significativamente menor (p<0,0001 e p<0,0001) do que a dos grupos nutridos. Quanto à albumina sérica, não houve diferença entre os grupos nos dois modelos. Em relação à análise histológica da espessura da pele, os desnutridos apresentaram a derme significativamente menos espessa em comparação aos nutridos (p<0,0001 e p<0,0001). No que respeita à colagênese, os grupos desnutridos apresentaram menores percentuais de colágeno em relação aos nutridos (p<0,0005 e p<0,003). CONCLUSÕES: Os animais desnutridos pelos dois modelos apresentaram diminuição na espessura dérmica, confirmada histologicamente pelo menor percentual de colágeno, mostrando a influência negativa da desnutrição no trofismo cutâneo.

BACKGROUND: The skin requires adequate levels of nutrients to function properly. OBJECTIVE: To analyze skin trophism in well-nourished and undernourished rats using two models of malnutrition. METHODS: In the marasmus model, 60 Wistar rats were kept on a controlled diet, 30 being randomly selected to receive half the established diet for 60 days. In the gelatin model, 60 rats were used, 30 of which received a diet consisting of poor quality protein (gelatin) for 30 days. The nutritional status of the animals was evaluated according to body mass index, clinical signs and serum albumin measurement. After the period of malnutrition, histology was performed on the animals' skin to analyze the thickness of the dermis and epidermis using the Leica Application Suite software. Collagen was analyzed on slides stained with Gömöri trichrome using the ImageJ software program. RESULTS: The body mass index of the malnourished animals in the marasmus and gelatin groups was significantly lower than that of the well-nourished animals in the two groups (p<0.0001 in both models). With respect to serum albumin, there was no difference between the groups in either of the two models. In relation to the histological analysis of skin thickness, the dermis of the malnourished animals was significantly thinner compared to that of the well-nourished animals (p<0.0001 in both models). The percentage of collagen was lower in the malnourished animals compared to the well-nourished animals (p<0.0005 and p<0.003 in the marasmus and gelatin model, respectively). CONCLUSIONS: Skin thickness measurements were lower in the malnourished animals in both models, and this finding was histologically confirmed by the lower percentage of collagen, showing the negative effect of malnutrition on skin trophism.