Plasma fatty acids in children with grade III protein-energy malnutrition in its different clinical forms: marasmus, marasmic kwashiorkor, and kwashiorkor.

Plasma fatty acid patterns were analysed in 15 children aged 2 to 42 months (median = 12 months) admitted to the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, suffering from grade III protein-energy malnutrition in its different clinical forms: marasmus (n = 5), marasmic kwashiorkor (n = 5), and kwashiorkor (n = 5). A control group of eight children from the same population aged 3 to 22 months (median = 12 months) was also studied. Plasma fatty acids were analysed by gas liquid chromatography. The plasma fatty acid patterns detected in grade III protein-energy malnutrition indicated changes characteristic of essential fatty acid deficiency, with lower linoleic acid (C18:2) levels in the three groups (p < 0.05). The major metabolite of linoleic acid, arachidonic acid (C20:4), was lower in the kwashiorkor group than in the control group (p < 0.05). Linoleic acid (C18:2) levels were lower in the marasmus group than in the kwashiorkor group (p < 0.05). Several factors may have contributed to these changes, such as a decreased content of linoleic acid in the diet, plus malabsorption and/or poor utilization of fats, and changes in the synthesis or degradation of these fatty acids. Although many questions remain unanswered, we suggest that an adequate amount of linoleic acid be added to the rehabilitation diet of these children in the form of vegetable fat.

Gastric emptying in children. IV. Studies on kwashiorkor and on marasmic kwashiorkor.

Gastric emptying of 20 ml/kg body weight of 5% glucose was assessed by the double-sample test meal in 22 malnourished hospitalized children divided into two groups according to the form of malnutrition presented: kwashiorkor (n = 11) or marasmic kwashiorkor (n = 11). Gastric emptying tests were carried out within 72 hours of admission and 30 days later when nutritional status was in net recovery. The control group consisted of seven healthy children who were submitted to a single test. The volumes remaining in the stomach of the children in the kwashiorkor group after the initial test did not differ significantly from those obtained after the second test, when recovery of nutritional status had started. In marasmic kwashiorkor children, intragastric liquid volumes 30 minutes after the test meal were significantly higher in newly-admitted children than in controls, but the differences disappeared after recovery had started. We conclude that kwashiorkor children have no detectable abnormalities of the gastric emptying of a liquid meal, whereas marasmic kwashiorkor malnourished children have delayed gastric emptying but the abnormality is reversible after recovery of nutritional status.

Gastric emptying in children. III. Study on marasmic protein-calorie malnutrition.

Gastric emptying of a liquid meal was assessed in nine malnourished hospitalized children with marasmus and in seven control children. Gastric emptying was measured by the double sample test meal after intragastric instillation of 20 ml/kg body weight of 5% glucose. In malnourished children, gastric emptying was assessed within 72 hours of admission and 30 days later when nutritional status was in net recovery. The liquid volumes ten and 20 minutes after the meal were significantly smaller in newly-admitted children with marasmus than in controls, but no differences in intragastric volumes were detected after recovery had started. We conclude that malnourished children with marasmus have a disordered early phase of gastric emptying of a liquid meal, but the abnormality is reversible following recovery of nutritional status.