Data obtained in a study of chemical composition of tissues in malnourished pre-school children are reported. In most cases, muscle and skin show an increase in total content of water, sodium and chloride. These changes are less striking but persist during "dehydration" judged on clinical grounds. The content of potassium in muscle was slightly to moderately decreased particularly in clinically edematous children. Edematous patients also had a markedly decreased intracellular concentration of potassium. In general, no correlation between intracellular concentration of sodium and potassium was found in muscle. Muscle obtained shortly before death or immediately after death frequently showed a marked shift of water and sodium into the intracellular compartment. A low ratio of concentration of potassium to noncollagenous nitrogen as compared to normals generally was observed. The skins of subjects without clinically demonstrable edema had comparable amounts of water but less fat per unit of dry fat-free solids than those of children with pitting edema. No particular correlation was found between overhydration and increase in content of the ("excess") chloride of the non-extracellular phase.
Absorption and retention of nitrogen from a typical poor Mexican diet BY F. GOMEZ, R. RAMOS-GALVAN, J. CRAVIOTO (Received 28 M a y 1956-Revised 26 February 1957 Variously known by such names as kwashiorkor (Africa), shibi gachaki (Japan), protein malnutrition (WHO), Mehlnahrschaden (Germany), chronic severe malnutrition is one of the most prevalent pathological conditions suffered by children living in underdeveloped countries. Surveys carried out in different parts of the world have shown that the diets of such children are very similar, not only in their nutritional value, but also in the foodstuffs actually eaten. A typical dietary history is as follows: (I) prolonged breast feeding on an inadequate lactation; (2) improper weaning with cereals (especially corn (maize) meal cooked by the action of quicklime), beans and peppers; ( 3 ) lack of milk, meat, fish and eggs after weaning. That is to say the diet after weaning is low in calories, fats and proteins, high in carbohydrates, and contains insufficient amounts of vitamins and minerals. The intake of most of the children meets no more than 50% of the caloric, and from 20 to 60% of the protein, requirement. Fats, usually vegetable fats, are consumed in amounts one-third below normal (Lozoya-
The plasma concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were measured in 250 underprivileged boys (UP boys) aged 9.0 to 15.9 years living in a State orphanage and in 357 clinically healthy boys of the same age (with weight and height between the 3rd and 97th percentile for Mexican standards) and correlated with chronological age (CA), weight, height and calculated lean body mass (LBM) and total body fat (TBF). On a group basis, UP boys had a 2 years delay in the onset of clinical signs of puberty as well as a mild degree of malnutrition. In both groups of boys, the mean weights at time of initiation of the adolescent growth spurt in weight and at time of peak velocity of weight gain were very close to each other and similar to the values reported for Caucasian boys. The same phenomenon was true for their heights and the amounts of LBM and TBF (whether as an absolute value or as a percentage of body weight). Based on CA mean plasma FSH concentrations in UP boys were lower than normal from 11.0 to 13.9 years and the subsequent steep rise of this hormone occurred 2 years later than in healthy boys; however, when analyzed as a function of body weight, height or LMB, no such quantitative or qualitative differences emerged. On the other hand, mean plasma LH concentrations in UP boys were higher than in healthy boys only up to certain CA (< 12.9 years), weight (< 42.9 kg), height (< 147.0 cm), LBM (< 35.0 kg) or TBF (< 9.0 kg); however, no steep rise in plasma LH was observed in contrast to healthy boys. Therefore, although from a chronologic view point UP boys had a delayed onset in plasma gonadotrophins changes, they did occur in association with the attainment of similar weight, height and LBM as in healthy boys. This observation seems to support further the hypothesis of a close association between a 'critical' level of LBM (and not body fat) and the initiation of puberty, both in healthy and multiply deprived boys.
IN SPITE of recent progress in the study of severe malnutrition of dietary origin, the mortality still is very high. In the 733 cases studied by Gómez et al. the over-all mortality was 35%. The majority of deaths occurred during the first 48 hours after admission to the hospital, and the outstanding features were electrolyte disturbances associated with diarrhea and/or bronchopneumonia. Similar observations have been reported from other areas of the world. Although the ultimate goal in the solution of the problems of malnutrition, as in any other disease, lies in prevention, or at least in earliest treatment, not enough emphasis has been given to the study of those factors responsible for the high mortality observed in this condition. Actually very little is known about the homeostatic mechanisms of children affected with severe chronic malnutrition. Water and electrolyte imbalances occurring in malnourished infants, such as attend superimposed diarrheal dehydration, usually are evaluated according to concepts derived from studies on well-nourished infants, without taking into consideration the fact that the chronically malnourished child has been abnormal for a long time before an episode of severe dehydration necessitates hospitalization. A great variety of environmental factors play a role in chronic malnutrition but, in general, the course of the disease is more or less constant. The chronically underfed child apparently becomes adapted to his metabolic status by slowing or almost complete cessation of growth, but suffers bouts of mild diarrhea which persist for a week or two, then disappear for a period of 8 to 10 days only to reappear with increased severity. Frequently the first bout coincides with convalescence from one of the infantile exanthematous diseases.
Summary Nitrogen balances were done on children affected with chronic severe malnutrition while on a diet of corn‐meal and beans with and without lysine and tryptophane supplements. Calculated as per cent of intake both absorption and retention of nitrogen were greater when the supplement was added to the basal diet. Du métabolisme protóique dans la sous‐alimentation chronique grave (Kwashiorkor). 2. Influence des supplements amino‐acides sur l'absorption et la retention d'azotes dans le régime diététique au maïs et aux légumineuses. Chez des enfants souffrant de sous‐alimentation chronique grave, des balances ont étéétablies pendant un régime diététique de farine de maïs et des légumineuses, avec et sans suppléments de lysine et de tryptophane. Calculées en pourcentages de matière ingérée, l'absorption aussi bien que la rétention d'azotes ont été plus grandes lorsque le suppléement était ajoutó au régime fondamental. Eiweißstoffwechsel in schwerer chronischer Unterernährung (Kwashiorkor). 2. Einfluss ergänzender Aminosäuren auf die Absorption und Retention von Stickstoff bei einer Mais‐und Bohnendiät. Stickstoffbilanzuntersuchungen wurden bei Kindern mit schwerer chronischer Unternährung, die an einer Maismehl‐und Bohnendiät mit und ohne Zusatz von Lysin und Tryptophan gehalten waren, durchgeführt. Es zeigte sich, dass sowohl die Absorption als auch die Retention von Stickstoff, ausgedrückt in Prozenten der Einnahme, grösser war, wenn die zugrundeliegende Diät die zusätzlichen Aminosäuren enthielt. Metabolismo proteico en la desnutrición crónica grave (Kwashiorkor) 2. Influencia de los suplementos aminoácidos en la absorción y retención nitrogénicas bajo un régimen dietético de maíz y legurninosas. Estableciéronse balanzas nitrogénicas de niños afectos de desnutrición crónica grave, mientras quedaban sometidos a un régimen dietético de harina de maíz y leguminosas, con y sin suplementos de lisinas y triptófano. Calculadas en porcentajes de materia ingerida, tanto la absorción como la retención del nitrógeno, fueron mayores al ser añadido el suplemento a la dieta fundamental.
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