Malnutrition kwashiorkor

Single dose infusions of iron dextran appear to have increased the occurrence of malaria in endemic regions. There was an increased mortality after oral or parenteral iron therapy in children with severe malnutrition (kwashiorkor), perhaps due to overwhelming infections (36). Reactivation of quiescent infections of various other types has been observed in African nomads following ferrous sulfate therapy (SEDA-4,171). Iron dextran has similarly been associated with a flaring up of latent tuberculosis in children. 

Iron toxicity can be expected if the amount of free iron released into the plasma exceeds the plasma iron-binding capacity. This is more likely to occur when using iron sorbitol-citric acid complex (iron sorbitex), since the iron is less firmly bound than with iron dextran. Several conditions associated with low iron-binding capacity, such as malnutrition (kwashiorkor, malnutrition syndrome) and previous or simultaneous oral iron therapy appear to predispose to the development of these toxic reactions. In addition, folic acid deficiency has been reported to be a predisposing factor (SED-9, 516), the likely mechanism being altered iron utilization secondary to folic acid deficiency, which results in an increased saturation of ironbinding capacity. 

In cases of severe protein malnutrition (kwashiorkor), the concentration of the plasma proteins decreases, as a result of which the osmotic pressure of the blood decreases. As a result, fluid is not drawn back to the blood and instead accumulates in the interstitial space (edema). The distended bellies of famine victims are the result of fluid accumulation in the extravascular tissues because of the severely decreased concentration of plasma proteins, particularly albumin. Albumin synthesis decreases fairly early under conditions of protein malnutrition. 

The urinary excretion of glycosaminoglycans by juvenile cases of vitamin A deficiency and of protein-calorie malnutrition (kwashiorkor) is less than normal (M41). The predominant differences are the absence of hyaluronic acid and the presence of chondroitin sulfate of low sulfate content (C12). Treatment of the cases with vitamin A deficiency restored the glycosaminoglycan spectrum to normal. Decreased urinary glycosaminoglycan levels have also been noted in primary hepatoma (K6). It has been suggested that the urinary excretion pattern of individual glycosaminoglycans is pathognomic of certain hereditary bone diseases (T3). 

Protein deficiency see Protein-energy malnutrition, Kwashiorkor, Marasmus. 

Dietary Protein and Energy Supplies Around the World Types of Protein-Energy Malnutrition Kwashiorkor Marasmus... 

Organoselenium compounds in particular, once ingested, are slowly released over prolonged periods and result in foul-smelling breath and perspiration. The element is also highly toxic towards grazing sheep, cattle and other animals, and, at concentrations above about 5 ppm, causes severe disorders. Despite this, Se was found (in 1957) to play an essential dietary role in animals and also in humans — it is required in the formation of the enzyme glutathione peroxidase which is involved in fat metabolism. It has also been found that the Incidence of kwashiorkor (severe protein malnutrition) in children is associated with inadequate uptake of Se, and it may well be involved in protection... 

Types of protein-energy malnutrition are marasmus (deficiency in total intake or nutrient utilization), kwashiorkor (relative protein deficiency), and mixed marasmus-kwashiorkor. 

A special form of undemutrition that particularly affects children is known as protein-energy malnutrition (PEM) which is a spectrum of syndromes from marasmus (lack of energy intake) to kwashiorkor (deficient protein intake). 

The higher than normal serum IgA in many children with protein calorie malnutrition may be related to increased synthesis of IgA by the intestinal lamina propria in resjionse to increased antigenic stimuli from bacteria and virus. This is probably supported by the observation that children with kwashiorkor were found to maintain their polio antibodies during malnutrition, and their immune mechanism seemed to be quite capable of inhibiting poliovirus infection, indicating that the intestinal receptor cell for poliovirus operates normally in kwashiorkor (B8). It is now known that polio antiliodies are mainly associated with IgA. 

The antibody response to yellow fever vaccine was impaired in protein-deficient children with kwashiorkor compared to the well-nourished controls. Polio antibody production was normal in the malnourished children, all of whom also responded in the normal fashion to smallpox vaccination. They had no evidence of disseminated vaccinia (B8). In Guatemala, on the other hand, smallpox vaccination of children who had fully recovered from severe protein-calorie malnutrition led to a drop in their nitrogen retention with the added complication of disseminated vaccinia (V3). 

G5. Gomez, F., Galvan, R. R., Cravioto, J., Munoz, J., and Frenk, S., Malnutrition in infancy and childhood with special reference to kwashiorkor. Advan. Pediat. 7, 131-169 (1955). 

In countries where food Is In short supply or the diet is inadequate, protein-calorie malnutrition can take two extreme forms, kwashiorkor and marasmus. 

Vitamin A deficiency can result from insufficient dietary intake, from malabsorption and it has been recognized that also malfunction of RAR-receptors can lead to symptoms of vitamin A deficiency. These symptoms include skin lesions, night blindness, corneal ulcerations and conjunctivitis and poor bone remodeling. Vitamin A deficiency associated with malnutrition is wide spread in large parts of the world and may be fatal in infants and young children suffering from kwashiorkor or marasmus. 

Renal dialysis patients fed semipurified, liquid formulas as a sole nutrition source for 3 weeks showed significantly decreased blood plasma TAC (D6). TAC of blood plasma of children with kwashiorkor, a severe edematous manifestation of malnutrition, was below 50% of that of healthy controls (F4). 

F4. Fechner, A., Bohme, C., Gromer, S., Funk, M., Schirmer, R., and Becker, K., Antioxidant stams and nitric oxide in the malnutrition syndrome kwashiorkor. Pediatr. Res. 49, 237—243 (2001). F5. Feillet-Coundray, C., Rock, E., Coudray, C., Grzelkowska, K., Azais-Braesco, V., Dardevet, D., and Mazur, A., Lipid peroxidation and antioxidant status in experimental diabetes. Clin. Chim. Acta. 284, 31-43 (1999). 

The gut microbiome is also being investigated for its role in severe malnutrition states such as kwashiorkor (156,157). Indeed, a complex interplay exists between the gut microbiota and host metabolism, and likely has far-ranging implications on normal metabolic homeostasis as well as several disease states, the mechanisms of which we are just beginning to elucidate. 

The signs and symptoms of protein-energy malnutrition (PEM) depend on various factors, including the duration of the nutritional inadequacy, age at onset, and frequency/types of concomitant infections. Figure 24-1 shows children diagnosed with kwashiorkor and marasmus and outlines some of the diagnostic features discussed in this section (Scrimshaw and Behar, 1961). 

Studies indicated that cysteine supplementation is beneficial in restoring glutathione levels in children with severe edematous malnutrition (Badaloo et al., 2002). If the reduced rate of glutathione synthesis in kwashiorkor is convincingly attributed to a shortage of protein in the... 

Kwashiorkor is a type of malnutrition associated with insufficient protein intake, usually affecting children aged 1-4 years, although it can also occur in older children and adults. It is likely caused by a combination of factors (protein deficiency, energy and micronutrient deficiency). The absence of lysine in low-grade cereal proteins (used as a dietary mainstay in many underdeveloped countries) can lead to kwashiorkor. 

Cachexia is loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite. It is seen in patients with cancer, acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease and congestive heart failure. Underlying causes are poorly understood, but there is an involvement of inflammatory cytokines, such as TNF-a, IFN-y, IL-6 and tumour-secreted proteolysis-inducing factor. Related syndromes are kwashiorkor and marasmus, although these are most often symptomatic of severe malnutrition. 

Kwashiorkor. The most common form of malnutrition in children in the world, kwashiorkor is caused by a diet having ample calories but little protein. The high levels of carbohydrate result in high levels of insulin. What is the effect of high levels of insulin on... 

I.6. Various Diseases. Abbassy et al. (Al) observed in 12 cases of malnutrition (including kwashiorkor), toxic dyspepsia, 8 cases of acute nephritis, 8 cases of infective hepatitis, and muscular dystrophy an increased spontaneous excretion of xanthurenic acid, the amount of which was found to depend on the severity of the case. In all these cases, with the exception of acute nephritis and hepatitis, the amount of xanthurenic acid was restored to normal levels after vitamin Be therapy. In 8 children with mental retardation, cerebral palsy, recurrent convulsions, 5 with nephrotic syndrome, and 5 with pellagra the amount of xanthurenic acid spontaneously excreted was found to be within the normal range, indicating that pyridoxine is probably not concerned in these cases. 

There is a wide variation of deficiencies between energy and protein deficient diseases as in the cases described by marasmus and kwashiorkor. The term protein-energy malnutrition (PEM) is used to describe those differences. PEM is the result of poverty as well inadequate information on diet. In some countries there is the mistaken belief that the child should not be given high protein food, which is served to the father, while the child drinks the fluid the meat was cooked in. 

Severe protein-energy malnutrition often occurs after weaning, the transition frcim nursing to the consumption of foods from other sources (i.e.. Solid foods). The marasmus common in Latin America is caused by early weaning, followed by use of overdiluted commercial milk formulas. Kwashiorkor occurs in Africa, where babies arc fed starchy roots, such as cassava, that arc low in protein. It also occurs in the Caribbean, where babies are fed sugar cane. The major symptom of kwashiorkor is edema, mainly of the feet and legs. Edema is the condition produced when water normally held in the bloodstream by osmotic pressure leaks into (jther extracellular spaces. It can result from reduced osmotic pressure in the bloodstream caused by catabolism and depletion of serum albumin. 

A consequence of the lower levels of plasma RBP produced by pmtein malnutrition is impairment cjf vitamin A transport from the liver to other tissues however, vitamin A deficiency can also result from heavy reliance on foods that are extremely poor sources of vitamin A, such as rice or cassava. Both factors (lack of RBP or of vitamin A) can lead to deterioration of the epithelial cells of the ga.stm-intestlnal tract, respiratory tract, and eye, all signs of vitamin A deficiency. Another sign is nlghtblindness. Table 4.19 illustrates how feeding protein to malnourished children can result in an improvement in vitamin A status, even when the source of proteins contains little or no vitamin A. Some children with kwashiorkor were fed skim milk. The concentrations of RBP and vitamin A measured in the serum of these children before and after feeding show an increase in plasma RBP. A dramatic rise in plasma vitamin A also occurred, probably as a result of the liver s... 

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