Effect of malnutrition on serum and milk antibodies in Zairian women.

Serum and human milk antimicrobial antibody titers were measured longitudinally in 17 malnourished and 14 control Zairian women during 6 to 18 months of lactation to test whether malnutrition is specifically associated with an impaired secretory antibody response. No decreases in total serum and human milk immunoglobulin concentrations, neutralizing antibody titers against rotavirus, or specific enzyme-linked immunosorbent assay antibody titers against rotavirus, respiratory syncytial virus, Escherichia coli, Streptococcus pneumoniae, and Haemophilus influenzae were detected when malnourished women were compared with control women. Malnutrition had no effect on circulating and secretory antibody concentrations in Zairian women. Daily human milk outputs, however, were about 30% lower in malnourished than in control women, resulting in a correspondingly lower ingestion of immunoglobulins by the children of malnourished women.

Biochemical study of malnutrition. Part VI: Histidine and its metabolites.

The present study, as a part of a broader investigation on protein-energy-malnutrition (PEM) in rural Zaire, was undertaken in order to clarify varying aspects of histidine metabolism in patients suffering from protein-energy malnutrition (PEM). Measurement of histidine and its derivatives was performed on blood samples, in urine and in stool ultrafiltrates of healthy rural controls, of PEM mothers and PEM children, before and during dietary treatment, and after histidine oral overloading. In stool ultrafiltrates, unusually high concentration of histidine and of three major catabolites (imidazoleacetic acid, imidazolelactic acid and imidazolepropionic acid) were identified, contrasting with undetectable levels of urocanic acid. On the contrary, very large amounts of urocanic acid may be recovered in the urine of PEM patients, especially in those characterized by very poor life expectancy. Urinary urocanic acid level thus appears as a very sensitive indicator of liver malfunction, in a manner similar to low plasma prealbumin and/or high A-alpha 1-gamma-glutamyltranspeptidase values. These findings point to the severe impairment of histidase and urocanase, two enzymes regulating the histidine catabolic pathway. Under appropriate refeeding, all biochemical abnormalities described in surviving PEM patients are reversible. The persistence of high urinary urocanic acid excretion indicates a worsening of the patient's condition.

Biochemical study of malnutrition. Part V. Metabolism of phenylalanine and tyrosine.

In order to elucidate the metabolic disorders which were observed for phenylalanine and tyrosine in protein-energy malnutrition, loads of both these amino acids were given to young mothers who showed all the clinical and biochemical symptoms of malnutrition and to healthy controls of the same age. Loads of phenylalanine resulted in higher blood levels, lower blood tyrosine formed from phenylalanine and higher urinary excretion of secondary phenylalanine and tyrosine metabolites in the patients, the former being due to a phenylalanine hydroxylase deficiency, the latter to concomitant disturbances in tyrosine catabolism. Loads of tyrosine resulted in very high urinary excretion of secondary tyrosine metabolites in two patients, due to a p-hydroxyphenylalanine-oxidase deficiency and to a high urinary excretion of tyrosine but almost normal excretion of secondary metabolites in the third patient, which is very likely to be due to a tyrosine-transaminase deficiency. Blood tyrosine levels remained lower in all patients, which may be explained by tyrosine malabsorption and increased utilization by the depleted tissues. Protein-energy malnutrition leads to enzyme deficiencies similar to those observed in some inborn errors of metabolism.

Study on malnutrition. III. Biochemical assessment of the dietary treatment and evolution of the illness.

During the course of a malnutrition study, the efficiency of two diets has been followed by clinical observations and biochemical tests. The diets were adapted to the physiological state of 25 patients (16 children, 6 young mothers, 1 adolescent and 2 men) undergoing treatment in a rural hospital at Yasa-Bonga, Zaïre. One group of patients was examined after two weeks of treatment (6 children, 2 mothers), the other group after two months (8 children, 5 adults). In order to study the evolution of the illness, 9 children and 3 young mothers were examined regularly after the return to their villages every 6 months for 2-4 years. The patients responded positively to both diets. After two months of treatment they had clinically recovered, except for the most serious cases. After two weeks of treatment a deficiency in electrolytes, low levels of prealbumin and a net increase in transferrin were noted. After 2 months of treatment the children had regained their normal growth (hydroxyproline index), and most of the biochemical parameters had reached their normal value despite a few deficiencies in electrolytes, phosphorus and magnesium. However, the prealbumin level remained low, particularly amongst children suffering from relapses. In a few cases the activities of cholinesterase (CHE) and gamma-glutamyltranspeptidase (gamma-GT) remained low, which was taken as a sign of poor response to treatment. Generally, the adults responded more slowly to treatment than the children. Regular examinations carried out on certain patients on their return to the villages permitted 2 groups to be distinguished: the first one was composed of patients recuperating well due to good social conditions; the second group of patients suffered from relapses due to lack of hygiene and of rudimentary knowledge of nutrition, and above all severe social problems. The condition of the liver of all these patients was very important; it could be estimated by the determination of the serum levels of prealbumin and the activities of CHE, gamma-GT and isoenzymes of gamma-GT.

Dietary treatment of malnutrition. Balance-sheets of the main nutrients. Part II.

Results of a balance study of nitrogen, fat, electrolytes and trace-elements (Fe, Cu, Zn, Mn) with 3 1/i to 9 years old malnourished children in the Kwilu region (Zaïre) are given. The main components of the diets were fish, lactose free milk, caseinate, partial hydrolasate of albumin, fermented corn and soya (Soy-Ogi), medium-chain triglycerides, rice and the local foods manioc, peanuts and caterpillars. The lactose free milk and the Soy-Ogi were well tolerated since we found only a small quantity of non absorbed sugar in the faeces. Our results show that in children who have secondary intestinal malabsorption the use of a partial hydrolysate of lactalbumin and the medium-chain triglycerides is recommended and the substitution of the manioc by rice also. Caseinate gave satisfactory results in adult-malnutrition. We found a good retention of nitrogen, fat and phosphorus. For the latter an addition was necessary. The potassium balance was also positive, a content of 5 meq/kg body weight in the food gave a sufficient retention time. The sodium chloride content of the diet must be moderate because of the oedemas (2 meq/kg body weight). The determination of the vitamin content in the diet and their urinary excretion gave some indication of the balance of these nutrients. Children who had intestinal troubles showed only a slight positive or negative balance of calcium, magnesium, zinc, copper and manganese, since we found a high faecel excretion for these elements. These rather unsatisfactory results emphasis the necessity of first curing any intestinal aliments.