Prenatal factors contribute to the emergence of kwoshiorkor or marasmus in severe undernutrition: evidence for the predictive adaptation model

Severe acute malnutrition in childhood manifests as oedematous (kwashiorkor, marasmic kwashiorkor) and non-oedematous (marasmus) syndromes with very different prognoses. Kwashiorkor differs from marasmus in the patterns of protein, amino acid and lipid metabolism when patients are acutely ill as well as after rehabilitation to ideal weight for height. Metabolic patterns among marasmic patients define them as metabolically thrifty, while kwashiorkor patients function as metabolically profligate. Such differences might underlie syndromic presentation and prognosis. However, no fundamental explanation exists for these differences in metabolism, nor clinical pictures, given similar exposures to undernutrition. We hypothesized that different developmental trajectories underlie these clinical-metabolic phenotypes: if so this would be strong evidence in support of predictive adaptation model of developmental plasticity

Maldigestion and malabsorption of dietary lipid during severe childhood malnutrition

Background: diets rich in lipid are used to provide energy density in treating children with severe malnutrition, but the extent to which their digestion and absorption can cope with the load effectively is uncertain.Aim: to determine the extent of impaired digestion or absorption, in three groups of eight malnourished children (aged 5–23 months) using isotopic probes of the predominant fatty acids in coconut and corn oil used to fortify the diet.Methods: each child received oral doses of one of three 13C labelled triglycerides (trilaurin, triolein, or trilinolein). The recovery of 13C label in stool either as triglyceride (TAG) or fatty acid (FA), was used to assess digestion and absorption. In a separate test, the recovery of label in stool following an oral dose of [13C]-glycocholate was measured to assess bile salt malabsorption.Results: the median recovery of label in stool was 9% (range 1–29%) of administered dose. Following treatment there was a reduction in stool 13C excretion for the labelled TAG (<1%). In half the subjects, label was recovered as TAG in stool (median 0.6%, range 0–44%). Most label in stool was recovered as FA (median 30%, range 0–100%). Following [13C]-glycocholate, label was recovered in excess in about one third of studies.Conclusion: abnormalities in the gastrointestinal handling of lipid were observed in over 50% of children with severe malnutrition, reflecting problems in absorption, although impaired solubilisation or hydrolysis could also be contributory factors. The underlying lesion improves as treatment progresses, leading to concomitant improvement in function

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Glutathione metabolism in type 2 diabetes and its relationship with microvascular complications and glycemia - Fig 3

<p>Scatterplots of HbA1c with glutathione concentration in erythrocytes (A) and absolute synthetic rate (B).</p

Birth weights of survivors of severe acute malnutrition.

<p>Key: M = marasmus; K = kwashiorkor; MK = marasmic kwashiorkor. The horizontal bars are mean values.</p