A Case of Multi-Organ Failure Secondary to Malabsorption Occurring in the Presence of Acute-on-Chronic Pancreatitis.

This case report highlights a concerning and complex case of a middle-aged female presenting with severe malabsorption, diarrhea, and subsequent malnutrition. The patient's weight dramatically dropped from 85 lbs to 50 lbs over the course of two to four months. The medical history included ongoing pancreatitis, esophageal ulcers, and previous surgeries for a dermoid cyst in the brain and cervical neoplasia. Upon admission to the hospital, the patient received total parenteral nutrition (TPN) on the first day, but this led to delirium due to refeeding syndrome. Refeeding syndrome is a well-known condition that can occur when malnourished individuals receive too much nutrition too quickly, causing metabolic imbalances and potentially serious complications. Subsequently, during the second hospitalization, the patient did not receive TPN but was instead administered 5% dextrose with 20 mEq of potassium chloride (KCl). Unfortunately, her condition worsened, leading to multiorgan failure. During the third hospitalization, TPN was reintroduced under consultation and hospitalist evaluation, and the patient's symptoms improved. Overall, this case report outlines a complex case with multiple medical issues, including severe malnutrition, which required careful management and consideration of the patient's unique needs. It underscores the importance of cautious nutritional support for severely malnourished individuals to avoid complications such as refeeding syndrome. The case also emphasizes the value of interdisciplinary collaboration and continuous monitoring to achieve successful outcomes in such complex situations.

Protein-energy malnutrition and worse outcomes after major cancer surgery: A nationwide analysis.

Background: Protein-energy malnutrition (PEM) has been recognized as a poor prognostic factor in many clinical issues. However, nationwide population studies concerning the impact of PEM on outcomes after major cancer surgery (MCS) are lacking. We aimed to evaluate the postoperative outcomes associated with PEM following MCS. Methods: By using the Nationwide Inpatient Sample database, data of patients undergoing MCS including colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy, or prostatectomy were analyzed retrospectively from 2009 to 2015, resulting in a weighted estimate of 1,335,681 patients. The prevalence trend of PEM, as well as mortality and major complications after MCS were calculated. Multivariable regression analysis was applied to estimate the impact of PEM on postoperative outcomes after MCS. Results: PEM showed an estimated annual percentage increase of 7.17% (95% confidence interval (CI): 4-10.44%) from 2009 to 2015, which contrasts with a 4.52% (95% CI: -6.58-2.41%) and 1.21% (95% CI: -1.85-0.56%) annual decrease in mortality and major complications in patients with PEM after MCS. PEM was associated with increased risk of mortality (odds ratio (OR)=2.26; 95% CI: 2.08-2.44; P < 0.0001), major complications (OR=2.46; 95% CI: 2.36-2.56; P < 0.0001), higher total cost ($35814 [$22292, $59579] vs. $16825 [$11393, $24164], P < 0.0001), and longer length of stay (14 [9-21] days vs. 4 [2-7] days, P < 0.0001), especially in patients underwent prostatectomy, hysterectomy and lung resection. Conclusions: PEM was associated with increased worse outcomes after major cancer surgery. Early identification and timely medical treatment of PEM for patients with cancer are crucial for improving postoperative outcomes.

Impact of Early Childhood Malnutrition on Adult Brain Function: An Evoked-Related Potentials Study.

More than 200 million children under the age of 5 years are affected by malnutrition worldwide according to the World Health Organization. The Barbados Nutrition Study (BNS) is a 55-year longitudinal study on a Barbadian cohort with histories of moderate to severe protein-energy malnutrition (PEM) limited to the first year of life and a healthy comparison group. Using quantitative electroencephalography (EEG), differences in brain function during childhood (lower alpha1 activity and higher theta, alpha2 and beta activity) have previously been highlighted between participants who suffered from early PEM and controls. In order to determine whether similar differences persisted into adulthood, our current study used recordings obtained during a Go-No-Go task in a subsample of the original BNS cohort [population size (N) = 53] at ages 45-51 years. We found that previously malnourished adults [sample size (n) = 24] had a higher rate of omission errors on the task relative to controls (n = 29). Evoked-Related Potentials (ERP) were significantly different in participants with histories of early PEM, who presented with lower N2 amplitudes. These findings are typically associated with impaired conflict monitoring and/or attention deficits and may therefore be linked to the attentional and executive function deficits that have been previously reported in this cohort in childhood and again in middle adulthood.

A Case of Hepatitis C-Related Decompensated Cirrhosis Observed by MRI Imaging Data During Treatment With Direct-Acting Antiviral Agents.

Sofosbuvir/velpatasvir therapy can safely treat hepatitis C virus (HCV)-related decompensated cirrhosis and has been shown to improve liver function at an early stage. However, the pathophysiology of the liver during treatment remains unclear. In this case report, we analyzed hepatic morphology on magnetic resonance imaging during the treatment period and confirmed that liver function and malnutrition were greatly improved with the elimination of HCV, and that rapid hemodynamic changes were occurring in the liver.

Protein Knowledge of Older Adults and Identification of Subgroups with Poor Knowledge.

The aim was to investigate the protein knowledge of community-dwelling older adults. A survey was conducted among 1825 adults aged ≥65 years and living in Finland, Netherlands, Poland, Spain and United Kingdom in 2017. Protein knowledge was measured with nine objective knowledge statements provided only to participants who indicated to know what the nutrient "protein" is (64.7% of sample). Demographic, socioeconomic and health determinants of poor protein knowledge were investigated using multiple logistic regression analyses. The sample was 49.6% female and 87.0% reported no walking difficulties. Participants scored best on the true statement "You need protein in the diet for repairing bones and muscles" (89.3% correct), and worst on the false statement "One meal per day with a good protein source is sufficient" (25.4% correct). Median knowledge score was 5.0 (scale 0-9) and poor knowledge was present in 49.4% of the sample. Males (Odds Ratio 1.57), those unable to walk for 5 min (2.66), not always making their own food decision (1.36) and having lower income (1.44) were more likely to have poor knowledge. Large differences were observed across countries. In conclusion, poor protein knowledge is present in about half of community-dwelling older adults. Communication strategies should be tailored to target the identified risk groups with poor knowledge.

Protein-Energy Malnutrition Increases Mortality in Patients Hospitalized With Bacterial Pneumonia: A Retrospective Nationwide Database Analysis.

Background Malnutrition is a less commonly recognized risk factor for various infections. It encompasses both undernutrition or protein-energy malnutrition (PEM) and overnutrition, including obesity. This study aimed to evaluate whether PEM impacts bacterial pneumonia (BP) and, if so, to quantify the degree of impact on inpatient outcomes. Methods This was a retrospective cohort study involving adult hospitalizations for BP using the nationwide inpatient database. Outcomes included comparing inpatient mortality, total hospital charges, length of hospital stay, as well as complications from bacterial pneumonia. Results The in-hospital mortality for adults with BP was 2.62%. Patients with PEM had a higher adjusted odds ratio (aOR) of inpatient mortality (adjusted odds ratio (aOR): 2.31, 95% confidence interval (CI): 2.14 - 2.48, p<0.001) as compared to non-PEM patients. PEM was also associated with higher odds of sepsis (aOR: 2.24, 95% CI: 2.04 - 2.46, p<0.001), septic shock (aOR: 3.29, 95% CI: 2.82 - 3.85, p<0.001), requiring mechanical ventilation (aOR: 2.51, 95% CI: 2.31 - 2.71, p<0.001), requiring vasopressors (aOR: 2.90, 95% CI: 2.20 - 3.83, p<0.001), acute respiratory distress syndrome (ARDS) (aOR: 1.63, 95% CI: 1.33 - 2.00, p<0.001), acute kidney failure (AKI) (aOR: 1.24, 95% CI: 1.18 - 1.29, p<0.001), deep vein thrombosis (DVT) (aOR: 1.80, 95% CI: 1.62 - 2.00, p<0.001), and pulmonary embolism (PE) (aOR: 1.25, 95% CI: 1.08 - 1.45, p=0.003). Conclusion The study concluded that PEM was an independent mortality predictor for those with BP, with an increased risk of systemic complications, as well as increased healthcare utilization costs.

An Age-Adjusted EEG Source Classifier Accurately Detects School-Aged Barbadian Children That Had Protein Energy Malnutrition in the First Year of Life.

We have identified an electroencephalographic (EEG) based statistical classifier that correctly distinguishes children with histories of Protein Energy Malnutrition (PEM) in the first year of life from healthy controls with 0.82% accuracy (area under the ROC curve). Our previous study achieved similar accuracy but was based on scalp quantitative EEG features that precluded anatomical interpretation. We have now employed BC-VARETA, a novel high-resolution EEG source imaging method with minimal leakage and maximal sparseness, which allowed us to identify a classifier in the source space. The EEGs were recorded in 1978 in a sample of 108 children who were 5-11 years old and were participants in the 45+ year longitudinal Barbados Nutrition Study. The PEM cohort experienced moderate-severe PEM limited to the first year of life and were age, handedness and gender-matched with healthy classmates who served as controls. In the current study, we utilized a machine learning approach based on the elastic net to create a stable sparse classifier. Interestingly, the classifier was driven predominantly by nutrition group differences in alpha activity in the lingual gyrus. This structure is part of the pathway associated with generating alpha rhythms that increase with normal maturation. Our findings indicate that the PEM group showed a significant decrease in alpha activity, suggestive of a delay in brain development. Childhood malnutrition is still a serious worldwide public health problem and its consequences are particularly severe when present during early life. Deficits during this critical period are permanent and predict impaired cognitive and behavioral functioning later in life. Our EEG source classifier may provide a functionally interpretable diagnostic technology to study the effects of early childhood malnutrition on the brain, and may have far-reaching applicability in low resource settings.

Older Consumers' Readiness to Accept Alternative, More Sustainable Protein Sources in the European Union.

Protein-energy malnutrition (PEM) is a growing concern on account of an aging population and its negative health consequences. While dietary protein plays a key role in the prevention of PEM, it also plays a pivotal role in the environmental impact of the human diet. In search for sustainable dietary strategies to increase protein intake in older adults, this study investigated the readiness of older adults to accept the consumption of the following alternative, more sustainable protein sources: plant-based protein, insects, single-cell protein, and in vitro meat. Using ordinal logistic regression modeling, the associations of different food-related attitudes and behavior and sociodemographics with older adults' acceptance to consume such protein sources were assessed. Results were obtained through a consumer survey among 1825 community-dwelling older adults aged 65 years or above in five EU countries (United Kingdom, the Netherlands, Poland, Spain, and Finland). Dairy-based protein was generally the most accepted protein source in food products (75% of the respondents found its consumption acceptable or very acceptable). Plant-based protein was the most accepted alternative, more sustainable protein source (58%) followed by single-cell protein (20%), insect-based protein (9%), and in vitro meat-based protein (6%). We found that food fussiness is a barrier to acceptance, whereas green eating behavior and higher educational attainment are facilitators to older adults' acceptance to eat protein from alternative, more sustainable sources. Health, sensory appeal, and price as food choice motives, as well as gender and country of residence were found to influence acceptance, although not consistently across all the protein sources. Findings suggest that there is a window of opportunity to increase older adults' acceptance of alternative, more sustainable protein sources and in turn increase protein intake in an environmentally sustainable way in EU older adults.

Nutritional Properties and Consumer's Acceptance of Provitamin A-Biofortified Amahewu Combined with Bambara (Vigna Subterranea) Flour.

Amahewu is a fermented non-alcoholic cereal grain beverage, popular in Southern Africa. This study evaluates the possibility of producing an acceptable provitamin A (PVA)-biofortified maize amahewu, complemented with bambara flour, to contribute towards the alleviation of protein energy malnutrition (PEM) and vitamin A deficiency (VAD). Germinated, roasted, and raw bambara flours, were added at 30% (w/w) substitution level, separately, to either white maize or PVA-biofortified maize flour, and processed into amahewu. Wheat bran (5% w/w) was used as reference inoculum. Amahewu samples were analyzed for nutritional properties and acceptability. The protein and lysine contents of amahewu almost doubled with the inclusion of germinated bambara. Protein digestibility of amahewu samples increased by almost 45% with the inclusion of bambara. PVA-biofortified maize amahewu samples complemented with bambara were extremely liked for their color, aroma, and taste when compared with their white maize counterparts. The principal component analysis explained 96% of the variation and PVA-biofortified maize amahewu samples were differentiated from white maize amahewu samples. The taste of amahewu resulting from roasting and germination of bambara was preferred in PVA-biofortified maize amahewu, compared to white maize amahewu. We conclude that PVA-biofortified maize amahewu, complemented with germinated bambara, has the potential to contribute towards the alleviation of PEM and VAD.

Appetite and Protein Intake Strata of Older Adults in the European Union: Socio-Demographic and Health Characteristics, Diet-Related and Physical Activity Behaviours.

Considerable efforts have been directed towards stimulating healthy ageing regarding protein intake and malnutrition, yet large-scale consumer studies are scarce and fragmented. This study aims to profile older adults in the European Union (EU) according to appetite (poor/good) and protein intake (lower/higher) strata, and to identify dietary and physical activity behaviours. A survey with older (aged 65 years or above) adults (n = 1825) in five EU countries (Netherlands, United Kingdom, Finland, Spain and Poland) was conducted in June 2017. Four appetite and protein intake strata were identified based on simplified nutritional appetite questionnaire (SNAQ) scores (≤14 versus >14) and the probability of a protein intake below 1.0 g/kg adjusted BW/day (≥0.3 versus <0.3) based on the 14-item Pro55+ screener: "appi"-Poor appetite and lower level of protein intake (12.2%); "APpi"-Good appetite but lower level of protein intake (25.5%); "apPI"-Poor appetite but higher level of protein intake (14.8%); and "APPI"-Good appetite and higher level of protein intake (47.5%). The stratum of older adults with a poor appetite and lower level of protein intake (12.2%) is characterized by a larger share of people aged 70 years or above, living in the UK or Finland, having an education below tertiary level, who reported some or severe financial difficulties, having less knowledge about dietary protein and being fussier about food. This stratum also tends to have a higher risk of malnutrition in general, oral-health related problems, experience more difficulties in mobility and meal preparation, lower confidence in their ability to engage in physical activities in difficult situations, and a lower readiness to follow dietary advice. Two multivariate linear regression models were used to identify the behavioural determinants that might explain the probability of lower protein intake, stratified by appetite status. This study provides an overview and highlights the similarities and differences in the strata profiles. Recommendations for optimal dietary and physical activity strategies to prevent protein malnutrition were derived, discussed and tailored according to older adults' profiles.

Quantitative EEG Tomography of Early Childhood Malnutrition.

The goal of this study is to identify the quantitative electroencephalographic (qEEG) signature of early childhood malnutrition [protein-energy malnutrition (PEM)]. To this end, archival digital EEG recordings of 108 participants in the Barbados Nutrition Study (BNS) were recovered and cleaned of artifacts (46 children who suffered an episode of PEM limited to the first year of life) and 62 healthy controls). The participants of the still ongoing BNS were initially enrolled in 1973, and EEGs for both groups were recorded in 1977-1978 (at 5-11 years). Scalp and source EEG Z-spectra (to correct for age effects) were obtained by comparison with the normative Cuban Human Brain Mapping database. Differences between both groups in the z spectra (for all electrode locations and frequency bins) were assessed by t-tests with thresholds corrected for multiple comparisons by permutation tests. Four clusters of differences were found: (a) increased theta activity (3.91-5.86 Hz) in electrodes T4, O2, Pz and in the sources of the supplementary motor area (SMA); b) decreased alpha1 (8.59-8.98 Hz) in Fronto-central electrodes and sources of widespread bilateral prefrontal are; (c) increased alpha2 (11.33-12.50 Hz) in Temporo-parietal electrodes as well as in sources in Central-parietal areas of the right hemisphere; and (d) increased beta (13.67-18.36 Hz), in T4, T5 and P4 electrodes and decreased in the sources of bilateral occipital-temporal areas. Multivariate Item Response Theory of EEGs scored visually by experts revealed a neurophysiological latent variable which indicated excessive paroxysmal and focal abnormality activity in the PEM group. A robust biomarker construction procedure based on elastic-net regressions and 1000-cross-validations was used to: (i) select stable variables and (ii) calculate the area under ROC curves (AUC). Thus, qEEG differentiate between the two nutrition groups (PEM vs Control) performing as well as visual inspection of the EEG scored by experts (AUC = 0.83). Since PEM is a global public health problem with lifelong neurodevelopmental consequences, our finding of consistent differences between PEM and controls, both in qualitative and quantitative EEG analysis, suggest that this technology may be a source of scalable and affordable biomarkers for assessing the long-term brain impact of early PEM.

Protein energy malnutrition associates with different types of hearing impairments in toddlers: Anemia increases cochlear dysfunction.

OBJECTIVES: This work aimed to highlight a challenging asymptomatic problem which is early detection of hearing impairment in toddlers with protein energy malnutrition (PEM) as a neuro-cognitive effect of PEM on developing brain in relation to hemoglobin level. METHODS: 100 toddlers, aged 6-24 months, fifty with moderate/severe PEM and fifty healthy children, were included in study. Both TEOAEs and ABR testing were used to assess auditory function. RESULTS: Study reported an association between malnutrition and hearing impairment, 26% of cases had conductive deafness secondary to otitis media with effusion using tympanometry; 84.6% showed type B and 15.4% type C which may suggest developing or resolving otitis media. Their ABR showed 46% mild and 53% moderate impairment. 32% of PEM cases had sensory neural hearing loss and with type (A) tympanometry. Those were assessed using ABR; 58% had mild, 34% moderate and 8% profound impairment. 10% of PEM cases had mixed hearing loss with 50% type B and 50% type C tympanometry and their ABR showed moderate to profound impairment. TEOAEs latencies at different frequencies correlate negatively with hemoglobin level. CONCLUSIONS: Toddlers with moderate/severe PEM had hearing impairments of different types and degrees. Neuro-physiological methods could be early and safe detectors of auditory disorders especially in high-risk toddlers. Anemia increases risk for auditory dysfunction.

Biometric and food consumption parameters of rats subjected to hypoproteic and hipercaloric diet / Parâmetros biométricos e de consumo alimentar de ratos submetidos à dieta hipoprotéica e hipercalórica / Parámetros biométricos y de consumo alimentar de ratones sometidos a la dieta hipoprotéica e hipercalórica

A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Para estudos experimentais, o rato tem sido o principal modelo para avaliar as conseqüências de ingestão de dietas com diferentes teores protéicos, contudo ainda não estão claros os níveis de severidade dessas dietas para essa espécie. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Para tanto, utilizaram-se 30 ratos Wistar (90 dias de idade), os quais foram divididos em dois grupos: controle (GC) e experimental (GC). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos, durante 12 semanas. No final do experimento, avaliaram-se o peso, o crescimento, a massa gorda e massa magra dos animais. Os animais do GE não ganharam peso, tiveram retardo no crescimento, formaram menos massa gorda e menos massa muscular.

ABSTRACT: The protein lack causing Kwashiorkor is the most prevalent kind of malnutrition, because the food sources of proteins are usually more expensive. For experimental investigations, the rat has provided the primary model to evaluate the consequences of the ingestion of diets with different protein levels; however, the degrees of severity of these diets for thesespecies are still not clear. In this sense, we aimed at evaluating the severity of a 4%-hypoproteic diet on young rats. We used30 Wistar rats (90 days old), which were divided in two groups: control (CG) and experimental (EG). CG rats were fed with normoprotein chow, while EG rats were fed with a chow having 4% protein, for 12 weeks. At the end of the experiment, we evaluated the weight, growth, and fat and lean masses of the animals. The rats from EG did not gain weight, they had growth retardation, and built less fat and muscle masses.

RESUMO: A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Para estudos experimentais, o rato tem sido o principal modelo para avaliar as conseqüências de ingestão de dietas com diferentes teores protéicos, contudo ainda não estão claros os níveis de severidade dessas dietas para essa espécie. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Para tanto, utilizaram-se 30 ratos Wistar (90 dias de idade), os quais foram divididos em dois grupos: controle (GC) e experimental (GC). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos, durante 12 semanas. No fi nal do experimento, avaliaram-se o peso, o crescimento, a massa gorda e massa magra dos animais. Os animais do GE não ganharam peso, tiveram retardo no crescimento, formaram menos massa gorda e menos massa muscular.

Hematologic and biochemical parameters of rats subjected to hypoproteic and hipercaloric diet / Parâmetros hematológicos e bioquímicos de ratos submetidos à dieta hipoprotéica e hipercalórica / Parámetros hematológicos y bioquímicos de ratones sometidos a la dieta hipoprotéica e hipercalórica

A má-nutrição é um problema de saúde pública que ainda assola crianças e adultos no mundo inteiro, principalmente em países em desenvolvimento. A carência de proteínas, causando Kwashiorkor, é o tipo de má-nutrição mais prevalente, pois fontes de alimentos protéicos, geralmente, são mais onerosas. Uma dieta hipoprotéica causa alterações metabólicas num animal em intensidades diretamente proporcionais ao nível de depleção de proteínas, bem como o tempo em que o indivíduo permanece sob o estado de subnutrição. Nesse sentido, propõe-se avaliar a severidade de uma dieta hipoprotéica a 4% para ratos jovens. Utilizam-se 30 ratos Wistar (90 dias de idade), divididos em grupo controle (15) e experimental (15). O GC recebeu dieta normoprotéica, enquanto o GE recebeu dieta com 4% de teor de proteínas, ambos durante 12 semanas. No final do experimento, sangue foi coletado para realização de hemograma e dosagem de atividade de fosfatase alcalina, alanina aminotrasferase, além da concentração de proteínas totais e frações, colesterol total, triglicerídeos, uréia, ácido úrico, T3, T4 e aminoácidos plasmáticos. Os animais do GE demonstraram menor atividade defosfatase alcalina no sangue, anemia microcítica normocrômica, hipoproteinemia, hipoglobulinemia, reduação na concentração plasmática de triglicerídeos, aumento da concentração plasmática de T3 e T4 e diminuição da concentração plasmática dos seguintes aminoácidos: metionina, fenilalanina, valina, leucina e isoleucina.

ABSTRACT: Malnutrition is a public health issue which still affects children and adults all over the world, especially in developing countries. Protein defi ciency causing Kwashiorkor is the most prevalent type of malnutrition, because protein-rich foods are generally expensive. A hypoproteic diet causes metabolic alterations in an animal which are directly proportional to the degree of protein depletion, as well as to the duration of the malnutrition. In this sense, we proposed to evaluate the severity of a 4%-hypoproteic diet in young rats. We used 30 Wistar rats (90 days of age), divided in control (CG, n=15) and experimental (EG, n=15) groups. CG was fed with a normoprotein chow, while EG was fed with a diet having 4% protein, for 12 weeks. At the end of the experiment, blood was collected for determination of the hemogram, activities of alkaline phosphatase and alanine aminotransferase, and concentration of total and fractional proteins, total cholesterol, triglycerides,urea, uric acid, T3, T4 and plasma aminoacids. The animals from EG had lower activity of the alkaline phosphatase enzyme in blood, normochromic microcytic anemia, hypoproteinemia, hypoglobulinemia, decreased plasma triglyceride concentration, increased plasma concentrations of T3 and T4, and decreased plasma concentrations of the following aminoacids: methionine, phenylalanine, valine, leucine and isoleucine

RESUMEN: La mala nutrición es un problema de salud pública que todavía aniquila niños y adultos en el mundo entero, principalmente en países en desarrollo. La falta de proteínas, causando Kwashiorkor, es el tipo de mala nutrición más común, pues fuentes de alimentos proteicos, generalmente, son más caras. Una dieta poco proteica causa alteraciones metabólicas en un animal en intensidades directamente proporcionales al nivel de depleción de proteínas, así como el tiempo en que el individuo queda bajo el estado de baja nutrición. En ese sentido, proponemos evaluar la severidad de una dieta de bajo contenido proteico al 4% para ratones jóvenes. Utilizamos 30 ratones Wistar (90 días de edad), divididos en grupo control (15) y experimental (15). El GC recibió dieta normoproteica, mientras el GE recibió dieta con el 4% de cantidad de proteínas, ambos durante 12 semanas. Al fi nal del experimento, sangre fue recolectado para realización del examen de la sangre y cantidad de actividad de fosfatase alcalina, alanina aminotrasferase, además de la concentración de proteínas totales y fracciones, colesterol total, triglicerídeos, urea, ácido úrico, T3, T4 y aminoácidos plasmáticos. Los animales del GE demostraron menor actividad de fosfatase alcalina en la sangre, anemia microcítica normocrómica, hipoproteinemía, hipoglobulinemia, reducción en la concentración plasmática de triglicerídeos, aumento de la plasmática de T3 y T4 y disminución de la concentración plasmática de los siguientes aminoácidos: metionina, fenilalanina, valina, leucina y isoleucina