Severe protein malnutrition

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... 

In arterioles, the hydrostatic pressure is about 37 mm Hg, with an interstitial (tissue) pressure of 1 mm Hg opposing it. The osmotic pressure (oncotic pressure) exerted by the plasma proteins is approximately 25 mm Hg. Thus, a net outward force of about 11 mm Hg drives fluid out into the interstitial spaces. In venules, the hydrostatic pressure is about 17 mm Hg, with the oncotic and interstitial pressures as described above thus, a net force of about 9 mm Hg attracts water back into the circulation. The above pressures are often referred to as the Starling forces. If the concentration of plasma proteins is markedly diminished (eg, due to severe protein malnutrition), fluid is not attracted back into the intravascular compartment and accumulates in the extravascular tissue spaces, a condition known as edema. Edema has many causes protein deficiency is one of them. 

In rabbits with undemutrition due to a shortage of calories there was a depressed agglutinin production against typhoid vaccine (C3, R4). A similar incapacity to produce antibodies to typhoid vaccine was reported in children with severe protein malnutrition (Bll). During treatment of 5 children, mean age 24 months, with chronic primary malnutrition, it was observed that their response to a single standard dose of 100 imits of purified diphtheroid toxoid was small and slow. Furthermore there was no correlation between specific antibody response and serum protein levels (02). 

Isoleucine MSUD Lipoamide dehydrogenase deficiency Severe protein malnutrition... 

Sullivan, D.A., Vaermanj, J.-P, and Soo, C. 1993. Influence of severe protein malnutrition on rat lacrimal, salivary and gastrointestinal immune expression during development, adulthood and ageing. Immunology 78(2) 308-317. 

A Dermatitis, night blindness, keratomalacia, xerophthalmia Serum vitamin A Teratogenic effects, liver toxicity with excessive intake alcohol intake, liver disease, hyperlipidemia, and severe protein malnutrition increase susceptibility to adverse effects of high intake , 6-carotene supplements recommended only for those at risk of deficiency (fat malabsorption)... 

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 total body water content increases in patients with severe protein malnutrition. The increase involves both the extracellular fluid, in which the water content may rise up to 400 ml/kg compared to 250 ml/kg in normal individuals, and in the intracellular fluid, in which the water content may reach values above 80%, compared to the normal 67% values in normally fed individuals. Fluid accumulation in the extracellular tissues leads to edema. The severity of the edema may be masked somewhat by the loss of body solids and fats. However, in the later stages of the disease, edema becomes obvious. The edema fluid is not distributed uniformly throughout the body of the victim—swelling usually starts in the inferior limbs, probably as a result of gravity and deficient circulation. The back of the hand and the face are frequently swollen. A patient with kwashiorkor— particularly an older patient— may have edema in the lower part of the body and be dehydrated in the upper part. In younger children, this does not occur because the upright position is not maintained constantly and does not play such an important role in the accumulation of fluid in the inferior limbs. The pathogenesis of the edema in protein deficiency is discussed in the section on body fluids. 

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). 

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... 

Leichsenring M, Sutterlin N, Less S, et al. Polyunsaturated fatty acids in erythrocyte and plasma lipids of children with severe protein-energy malnutrition. Acta Paediatr 84 516-520,1995. 

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. 

Velazjt)uez,. A., Teran, M., Baez, A., Gutierrez, J., and Rodriguez, R. (1995). Biotin supplementation affects lymphocyte carboxylases and plasma biotin in severe protein-energy malnutrition. Am. /. CJiti. j jdr. 61, 3S5-39L... 

Doherty CP, Sarkar MA, Shakur MS, Ling SC, Elton RA, Cutting WA. Zinc and rehabilitation from severe protein-energy malnutrition higher-dose regimens are associated with increased mortality. Am J Clin Nutr 1998 68 742-8. 

Mixedmarasmus/kwashiorkor is a form of severe protein-calorie malnutrition that develops in chronically ill, starved patients during periods of hypermetabolic stress. There is reduced visceral protein synthesis superimposed on wasting of somatic protein and energy (adipose tissue) stores. Immunocompetence is lowered, increasing the incidence of infection, and wound healing is compromised. 

ALB was one of the first identified biochemical markers of malnutrition and has long been used in population studies. ALB is a relatively insensitive index of early protein malnutrition because there is a large amount normally found in the body (4 to 5 g/kg of body weight), it is highly distributed in the extravascular compartment (60%), and it has a long half-life (18 to 20 days). However, chronic protein deficiency in the setting of adequate nonprotein calorie intake leads to marked hypoalbuminemia because of a net ALB loss from the intravascular and extravascular compartments (kwashiorkor). Serum ALB concentrations also are affected by moderate-to-severe calorie deficiency hepatic, renal, and GI disease and infection, tramna, stress, and burns. In many cases, interpretation of serum ALB concentrations relative to nutrition status is difficult however, a positive correlation between decreased serum ALB concentrations and poor clinical outcome has been demonstrated in a variety of settings. Additionally, serum ALB concentrations of 2.5 g/dL or less can be expected to exacerbate ascites and peripheral, pulmonary, and GI mucosal edema due to decreased colloid oncotic pressure. 

A negative nitrogen balance represents a state of protein deficiency, in which the body is breaking down tissues faster than they are being replaced. The ingestion of insufhcient amounts of protein, or food with poor protein quality, cau result in serious medical conditions in which an individual s overall health is compromised. The immune system is severely affected the amount of blood plasma decreases, leading to medical conditions such as anemia or edema aud the body becomes vulnerable to infectious diseases and other serious conditions. Protein malnutrition in infants is called kwashiorkor, and it poses a major health problem in developing countries, such as Africa, Central and South America, and certain parts of Asia. An infant with kwashiorkor suffers from poor muscle and tissue development, loss of appetite, mottled skin, patchy hair, diarrhea, edema, and, eventually, death (similar symptoms are preseut in adults with protein deficiency). Treatment or prevention of this condition lies in adequate consumption of protein-rich foods [106]. 

Marasmus is a term used for severe protein-energy malnutrition in children where the patient s weight is compared with an age-matched reference weight Classifications vary but normal nutrition is 90-110% of reference wdght. Mild malnutrition is 75-90% and severe malnutrition (marasmus) is less than 60% of reference weight matched for age. 

Although the sodium content in the body fluid and the tissues varies considerably in children with protein malnutrition, potassium depletion of various degrees of severity is a constant finding in severely malnourished children. Alterations in mineral metabolism observed in malnutrition may result from increased metabolic breakdown with a decrease in available energy sources. 

More important are the changes in the enzyme content of the pancreatic juice. During the seige of Budapest, lipase, trypsin, and amylase activities of the pancreatic juices were measured in several individuals. No milk was available during the seige. A marked reduction of the activity of these three enzymes was observed. This finding, which was later confirmed under different conditions of protein malnutrition by... 

The exact causes of the water retention in protein malnutrition are not clear. It has been suggested that the wasting of cellular tissues provides more places for water, and therefore contributes to the edema. In malnutrition, the hypoproteinemia is about 45 g/ 100 ml (albumin 1.7 g/100 ml) this suggests that the Starling law of reduced colloid osmotic pressure in the plasma may apply in protein malnutrition. However, it is believed that hypoproteinemia is a modifying rather than a determinant factor in water retention due to malnutrition. Potassium depletion may lead to the water accumulation however, the potassium loss in gastroenteritis (a disease usually not associated with edema) is more severe than that observed in malnourished children. 

What are the interactions between diet/nutrition and cognitive capacity Presumably, neuronal function is most vulnerable during brain cell division and myelin maturation, i.e., during gestation and infancy. Chronic, severe protein-calorie malnutrition at this stage is associated with mental retardation. Conclusions as to whether nutritional supplementation prevents this behavioural pathology are hampered by intervention effects not easily dissected, notably amelioration of other medical conditions and of the psychosocial milieu. Early childhood malnutrition has been extensively reviewed, and only the salient aspects will be considered in this paper. 

The evidence presented supports the contention that severe global malnutrition in early life is deleterious to cognitive development. Such a premise is not particularly relevant in developed countries, where marked protein-energy starvation is rare. Are there demonstrable effects of selective nutrient lack or of milder degrees of malnutrition ... 

The use of plasma amino acid levels as an index of nutritive status has been extensively explored (see review by Munro, 1970). Characteristic changes are seen in established protein malnutrition, there being a fall in the levels of most essential amino acids, combined with a rise in the levels of several non-essential amino acids. 

Protein supplementation of a diet to overcome the harmful effects of tannin may not be feasible in practical terms. In the semi-arid tropics of Asia and Africa, high-tannin grain varieties are more popular with the farmers because of their resistance to bird attacks and adverse climatic conditions. On the other hand, protein malnutrition is also a severe problem in this part of the world. Thus, growing high-tannin grain varieties because of their beneficial agronomic effects, may add to the already existing nutritional problem. 

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