Fasting pancreatic glucagon in Jamaican children during malnutrition and subsequent recovery

Fasting pancreatic glucagon was observed in Jamaican infants during malnutrition and subsequent recovery. Rehabilitation in two groups of children with isocaloric diets rich either in carbohydrate or fat produced no differences in the rate of weight gain. During malnutrition, plasma pancreatic glucagon concentration was 104ñ11 (n=20) pg/ml (meanñS.E.) significantly lower than during recovery when the maximum value was 180ñ24 (n=13) pg/ml during the later recovery phase. After clinical recovery glucagon levels declined to 127ñ13 (n=15) pg/ml. Plasma insulin followed a similar pattern, increasing significantly during catch-up growth and declining after recovery. Slower rates of growth were associated with the simultaneous decline in the concentrations of both hormones after clinical recovery. (Summary)

Total body water in malnutrition: the possible role of energy intake

Total body water (TBW) was measured using tritiated water in sixty-five children. The measurements were distributed throughout rehabilitation in order to define the effect of changing energy intakes. Oedematous children had a high TBW which decreased to the normal range during loss of oedema providing they were not receiving more than maintenance amounts of energy during this period. Marasmic children who had not received greater than maintenance amounts of energy had a normal TBW. Treatment with a high-energy diet was associated with an initial increase in TBW. The possible mechanisms for this phenomenon are discussed.(AU)

Serum and liver triglycerides in malnourished Jamaican children with fatty liver

Measurements were made of triglyceride concentrations in the liver, serum, and serum lipoproteins in malnourished Jamaican children with fatty liver. The fasting serum triglyceride concentrations of the patients, before treatment, were highly variable, ranging from 55.6 to 353 mg/100ml. The patterns of change for serum triglyceride concentration during treatment were also variable. Patients were grouped according to whether the concentrations of serum triglycerides after recovery were higher than, lower than, or unchanged from, the concentrations before treatment. The three groupings then exhibited concentrations before treatment that fell in discrete ranges, being respectively low, high, or normal. There was no clinical difference among the three groups of patients. There was also no difference in the serum lipoprotein pattern nor in the composition of the serum very low density lipoprotein. The latter did not change during treatment. In most patients the fasting serum triglyceride concentrations before treatment appeared to be correlated with age. The difference between these findings and those reported from other countries are discussed. (AU)

The effect of coconut oil on serum lipids in children recovering from malnutrition - abstract

In order to achieve high calorie intakes, children recovering from malnutrition in our wards are given feeds containing oil in which 60 percent of the total calories is derived from fat. Fasting serum triglyceride and cholesterol concentrations were measured in two groups of 20 children. In one group the diet contained arachis oil and in the other group, coconut oil. The protein, carbohydrate and fat content of the diets was the same so that they differ only in the type of fat. The calorie intakes and the growth rates of the two groups were the same. It has been shown previously that recovered children who had received the arachis oil diet throughout treatment had very low concentration of fasting serum triglycerides. This was confirmed and was found also in the children receiving coconut oil, but these children had higher concentrations. However in each group there were some children with fatty liver on admission to hospital. When the group were sub-divided into those children with and without fatty liver, it was found that the increased concentrations of serum lipids early in treatment with coconut oil, occurred only in the children with fatty liver, suggesting different effects of the 2 oils on the rate of mobilization of fat from the liver (AU)

Accelerated recovery from infant malnutrition with high calorie feeding

Rapid recovery from infant malnutrition with associated weight deficit can be expected if the calorie density of the milk formula is doubled by adding oil. An intake of 200 kcal per kg should result in a rate of weight gain 15 times that of a normal one year old. Nearly complete recovery of weight deficit can be expected in severe cases in around six weeks, on the average. Approximately 100 kcal per kg are required to maintain constant weight plus six excess kcal for each gm of weight gain. Of these six kcal, approximately 0.6 are oxidized, 0.9 wasted, and the remainder retained as stored energy, mostly fat. These observations are of considerable practical importance for efficient treatment of infant malnutrition. If the amount of diet offered is sufficent for rapid recovery (200 kcal/kg/day) the most likely cause of failure to gain weight is infection. These generally beneficial results tend to minimize the significance of many apparent functional abnormalities observed in acutely malnourished children (AU)

Lipid metabolism in kwashiorkor - abstract

The pathogenic mechanisms of fatty infiltration of the liver have been grouped into two categories: those causing a reduction in the synthesis of lipoprotein responsible for the removal of liver triglycerides, and those leading to an increase in the synthesis of triglycerides in the liver beyond its normal capacity to dispose of them. A relative inability of the liver to synthesize low density lipoprotein has been poistulated to explain the fatty liver so often found in kwashiorkor. Consistent with this hypothesis is the finding in untreated kwashiorkor of very low levels of serum lipids, especially triglycerides. These levels rise early in recovery to above normal values and later return to normal levels. During the rise in serum lipids, there is a marked reduction in liver fat. In this study of Jamaican children with kwashiorkor a markedly different pattern was observed. On admission of the patients, a very wide range of serum triglycerides was found including some very high levels. During recovery different patterns were observed - the general tendency being toward a decrease from the initial values. The average value of serum lipids after recovery was lower than that on admission. One possible explanation for this difference is that liver fat in these children is not mainly triglyceride, as has been described in kwashiorkor, therefore changes in this metabolite would not reflect changes in liver fat. Measurements of triglyceride and total fat in liver biopsies showed this not to be the case - triglycerides did account for virtually all the excess liver fat. A second possibility is that there is an abnormality in the serum lipoprotein patterns and that the triglycerides are in a fraction not normally associated with their transport from the liver. Measurement of triglyceride in d<1.019 lipoprotein showed that the proportion of the total triglyceride in this fraction was the same in patients on admission and after recovery. Moreover, there is no evidence for chylomicronaemia or abnormal composition of the very low density lipoprotein d<1.006. It was found that the amounts of triglyceride in this fraction correlate well with other components (protein cholesterol and phospholipid) of this complex in malnourished and recovery patients. On the whole, the accumulated evidence does not support the hypothesis of reduced synthesis of low density lipoprotein as the main or only major cause of fatty infiltration of the liver in kwashiorkor (AU)

Dietary fat and serum triglycerides

Fasting serum triglyceride levels from children in our ward who have recovered from malnutrition are about 30 percent of the values reported by others for normal children or similarly recovered patients. Our patients have been treated for malnutrition with a diet containing 60-70 percent of total calories as fat. We have investigated the effects of the dietary fat intake on the fasting level of serum triglycerides by feeding these children a diet containing 30 percent of the calories as fat. Two to 4 days after changing the diet, fasting serum triglycerides rose 200 to 700 percent; thereafter the values stabilized within the normal values usually found in the literature. The rise was accounted for mainly by the d<1.019 lipoprotein triglycerides. Advantage was taken of the wide range of values obtained to study the composition of the d<1.019 lipoprotein. The data obtained support the hypothesis that the components of this lipoprotein fraction are in a constant proportion, thus it would constitute a definite chemical entity. The high sensitivity of infants to changes in the dietary fat intake and the rapidity of this response are being considered in the studies concerning the pathogenic mechanism of the fatty infiltration of the liver produced by protein malnutrition (AU)

Hydroxyproline and creatinine excretion in infantile protein malnutrition

Total urinary hydroxyproline and urinary creatinine were measured in ten malnourished male infants shortly after admission to hospital and at intervals until they had fully recovered. Urinary hydroxyproline excretion was initially low and later rose to levels higher than reported for normal controls. This high level of hydroxyproline excretion was maintained for severalweeks. The pattern of urinary creatinine was similiar to that of urinary hydroxypoline. It is suggested that the rate of catabolism of collagen is greatly reduced in the malnourished infant (Summary)

Hydroxyproline and creatinine excretion in protein depleted infants

Total urinary hydroxyproline (HOP) and creatinine output were measured in 10 malnourished male infants aged 8-18 months shortly after admission to hospital, and at intervals for 70 days or more until they had fully recovered. Urinary HOP output was initially very low; the average was 2.6 mg/kg body weight/day, and the excretion was lowest in the children with the greatest deficit in body weight. On treatment the HOP excretion rose to a plateau which was maintain for several weeks. The average output 70-80 days after admission was 6.5mg/kg/day. The final level reached was considerably higher than that reported in normal infants of the same age. This may be related to the more rapid growth rate and higher metabolic rate of these children recovering from malnutrition. Creatinine excretion followed a similar pattern, but the increase during treatment was no so great. One factor which may account in part for the low initial excretion of both creatinine and HOP is a low renal clearance, since a marked reduction has been found in glomerular filtration rate, as measured by insulin clearance. Apart from this, however, it is probably that the underlying phenomena are different. In the case of creatinine the low excretion reflects a reduction in muscle mass, both absolute and in relation to body weight. In the absence of growth there is a reduction in the size of the soluble collagen pool, but this alone can hardly account for the extremely low levels of HOP excretion, since from experiments in rats it has been calculated that only about a 1/3 of the urinary HOP is derived from the turnover of soluble collagen. It has been shown in animal experiments, and there is evidence also from measurements in man that in malnutrition the total amount of collagen in the body is not reduced, but is actually increased. It is suggested therefore, that the low HOP excretion in the main reflects a reduction in turnover rate of collagen. This may, perhaps, be a useful index of early growth failure before there are significant changes in body weight (AU)