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

Effects of Protein Deficiency on Perinatal and Postnatal Health Outcomes

There are a variety of environmental insults that can occur during pregnancy which cause low birth weight and poor fetal health outcomes. One such insult is maternal malnutrition, which can be further narrowed down to a low protein diet during gestation. Studies show that perinatal protein deficiencies can impair proper organ growth and development, leading to long-term metabolic dysfunction. Understanding the molecular mechanisms that underlie how this deficiency leads to adverse developmental outcomes is essential for establishing better therapeuticstrategies that may alleviate or prevent diseases in later life. This chapter reviews how perinatal protein restriction in humans and animals leads to metabolic disease, and it identifies the mechanisms that have been elucidated, to date. These include alterations in transcriptional and epigenetic mechanisms, as well as indirect means such as endoplasmic reticulum (ER) stress and oxidative stress. Furthermore, nutritional and pharmaceutical interventions are highlighted to illustrate that the plasticity of the underdeveloped organs during perinatal life can be exploited to prevent onset of long-term metabolic disease

EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on Dietary reference values for water

This Opinion of the EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA) deals with the setting of dietary reference values for water for specific age groups. Adequate Intakes (AI) have been defined derived from a combination of observed intakes in population groups with desirable osmolarity values of urine and desirable water volumes per energy unit consumed. The reference values for total water intake include water from drinking water, beverages of all kind, and from food moisture and only apply to conditions of moderate environmental temperature and moderate physical activity levels (PAL 1.6). AIs for infants in the first half of the first year of life are estimated to be 100-190 mL/kg per day. For infants 6-12 months of age a total water intake of 800-1000 mL/day is considered adequate. For the second year of life an adequate total water intake of 1100-1200 mL/day is defined by interpolation, as intake data are not available. AIs of water for children are estimated to be 1300 mL/day for boys and girls 2-3 years of age; 1600 mL/day for boys and girls 4-8 years of age; 2100 mL/day for boys 9-13 years of age; 1900 mL/day for girls 9-13 years of age. Adolescents of 14 years and older are considered as adults with respect to adequate water intake. Available data for adults permit the definition of AIs as 2.0 L/day (P 95 3.1 L) for females and 2.5 L/day (P95 4.0 L) for males. The same AIs as for adults are defined for the elderly. For pregnant women the same water intake as in non-pregnant women plus an increase in proportion to the increase in energy intake (300 mL/day) is proposed. For lactating women adequate water intakes of about 700 mL/day above the AIs of non-lactating women of the same age are derive

EARLY SUCROSE ACCUMULATION, A PROMISING CHARACTERISTIC TO USE IN SUGARCANE IMPROVEMENT PROGRAMS

Abstract IN MAURITIUS, sucrose content of cultivars harvested during the early part of the season is sub-optimal due to a shost ripening phase. Changes to the selection program and adoption of agronomic measures, such as artificial ripening, only partially solved the problem. The success recorded in other sugarcane industries on this aspect prompted basic studies. They were undertaken to understand the sucrose accun~ulation mechanism in parents, standasds, and seedling populations to redefine breeding and selection strategies for producing cultivars with substantially higher levels of sucrose for earlier harvest. Physiological and cane quality characters were assessed during the expoltential phase of growth at the age of seven months and at harvest early in the season at the age of eleven months. Statistically significant differences were recorded among parents and families, at the 99% level, for all characters irrespective of sampling date, and among standards, at the 95% level, in March only. Both significance level and variance were much higher during the growth phase. The best cane quality indicator, pol % cane diy matter, varied from 27.67% to 39.45% in,the growth phase and from 50.39% and 54.84% at harvest for the families. Categorisation of the parents according to their pol % cane dry matter in the exponential phase of growth was a better indicator of their sucrose accumulation pattern and maturity behaviour than their sucrose content on a fresh weight basis at harvest. Three distinct maturity groups, early, midlhigh sucrose and late were identified when considering sucrose accumulated during the growth phase. The early group accumulated more than 75% of its harvestable sucrose percent cane dly matter at the age of 7 months as opposed to about 55% in the late group. This is a clear indication of the genetic control for earliness, as environmental conditions were not conducive to sucrose accumulation. Proposals for improving breeding and selection for earliness are categorisation of all parents for their sucrose accuinulation pattern and mat~~rity behaviour to enable a better choice, screening during the growth phase on pol % dry matter, and the adoption of appropriate standards or increasing the selection pressure

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

Glutathione S-transferase polymorphisms may be associated with risk of oedematous severe childhood malnutrition.

It has been estimated that more than 50 % of deaths before the age of 5 years have undernutrition as an underlying cause. Severe childhood malnutrition, an extreme form of undernutrition, occurs as oedematous and non-oedematous syndromes. The reasons why only some children develop oedematous severe childhood malnutrition (OSCM) have remained elusive, but the heterogeneity of clinical appearances among children from relatively homogeneous backgrounds suggests that interindividual variation in susceptibility to OSCM may exist. We investigated variants of four glutathione S-transferase (GST) genes in a retrospective study among subjects (n 136) previously admitted to the Tropical Metabolism Research Unit, Jamaica, for the treatment of either OSCM (cases) or non-oedematous severe childhood malnutrition (controls). We found that GSTP1 Val(105) homozygotes were significantly more common among the cases (odds ratio (OR) 3.5; 95 % CI 1.1, 10.8). We also found an association of borderline significance between non-deletion GSTT1 genotypes (i.e. +/+ or +/0) and OSCM (OR 2.4; 95 % CI 1.0, 5.9). There was no significant association between OSCM and any of the other GST variants. These preliminary findings suggest that genetic variation within the GST superfamily may contribute to the risk of OSCM. Additional, larger data sets and studies of variants in other candidate genes are required in order to properly assess the true contribution, if any, of genetic variation to risk of OSCM. Such studies may improve our understanding of the causes of clinical heterogeneity in malnutrition