CO2 production during acute infection in malnourished Malawian children

Manary, Mark J.; Yarasheski, Kevin E.; Berger, Richard A.; Broadhead, Robin L.

doi:10.1038/sj.ejcn.1601757

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…The constant [ 13 C]sodium bicarbonate infusion reached an isotopic steady-state in breath 13 CO 2 after 55 min of infusion and the plasma [ 13 C]leucine enrichment equilibrated within 4 h as previously documented in a subset of these children (Manary et al 2002(Manary et al , 2003.…”

Section: Resultssupporting

confidence: 59%

“…The protocol and calculations for the metabolic study have been previously described and validated from a subset of the children included in the present report (Manary et al 2002(Manary et al , 2003(Manary et al , 2004. Briefly, at 19 h after admission each child's CO 2 appearance rate was determined with a primed (2•5 mmol/kg), constant (5 mmol/kg per h) 70 min infusion of [ 13 C]sodium bicarbonate (99 % 13 C; Cambridge Isotopes, Andover, MA, USA).…”

Section: Metabolic Studymentioning

confidence: 99%

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Protein quantity, not protein quality, accelerates whole-body leucine kinetics and the acute-phase response during acute infection in marasmic Malawian children

et al. 2004

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The present study compared leucine kinetics and acute-phase-protein concentrations in three groups of marasmic, acutely infected Malawian children fed one of three isoenergetic diets. These were: an enhanced-protein-quality diet (egg-whiteþtryptophan, providing 1·2 g protein/kg per d; n 14); an increased-protein-content diet (egg-whiteþtryptophan, providing 1·8 g protein/kg per d; n 14); a standard-protein diet (1·2 g milk protein/kg per d; n 25). The hypotheses tested were that children receiving a diet with more protein would have greater rates of non-oxidative leucine disposal and that children receiving an isonitrogenous diet with a higher protein quality would have lower rates of leucine oxidation. The children were studied after 24 h of therapy using standard [ 13 C]leucine stable-isotope tracer techniques. The children receiving the higher-protein-content diet had greater leucine kinetic rates than those receiving the standard-protein-content diet; non-oxidative leucine disposal was 170 (SD 52) v. 122 (SD 30) mmol leucine/kg per h (P, 0·01). Leucine oxidation was less in the children receiving the enhanced-protein-quality diet than in those receiving the standard-protein-quality diet; 34 (SD 12) v. 45 (SD 13) mmol leucine/kg per h (P,0·05). The children receiving the high-protein-content diet increased their serum concentration for five of six acute-phase proteins 24 h after starting therapy, while those receiving the standard-protein-content diet did not. These data suggest that there was greater whole-body protein synthesis, and a more vigorous acute-phase response associated with the higher-protein-content diet. The clinical benefits associated with a higher protein intake in marasmic, acutely infected children need further study.

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Section: Resultssupporting

confidence: 59%

Section: Metabolic Studymentioning

confidence: 99%

Protein quantity, not protein quality, accelerates whole-body leucine kinetics and the acute-phase response during acute infection in marasmic Malawian children

et al. 2004

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“…The constant 13 C-sodium bicarbonate infusion reached an isotopic steady state for 13 CO 2 after 55 min and the 13 C-leucine infusion after 4 h as previously documented in a subset of these children (11,12).…”

Section: Resultsmentioning

confidence: 70%

“…This work, coupled with our recently published work comparing energy expenditure in these children (12), indicates that severe malnutrition suppresses the normal metabolic response to acute infection. Malnutrition blunts increases in protein turnover and with it the acute-phase response and limits increases in energy expenditure that facilitate fever.…”

Section: Metabolism In Malnutrition and Infectionmentioning

confidence: 76%

“…The protocol and calculations for the metabolic study have been described and validated previously from a subset of the children included in this report (11,12). Briefly, at 19 h after admission, each child's CO 2 appearance rate was determined with a primed (2.5 mol/kg), constant (5 mol · kg Ϫ1 · h Ϫ1 ) 70-min infusion of 13 C-sodium bicarbonate (99% 13 C; Cambridge Isotopes, Andover, MA, U.S.A.).…”

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confidence: 99%

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Whole-Body Leucine Kinetics and the Acute Phase Response during Acute Infection in Marasmic Malawian Children

et al. 2004

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This study compared leucine kinetics and acute-phase protein and cytokine concentrations in three groups of Malawian children who were fed an isoenergetic, isonitrogenous diet: children with marasmus with (n ϭ 25) and without (n ϭ 17) infection and well-nourished children with infection (n ϭ13). The hypotheses tested were that whole-body leucine kinetics will be less in marasmic acutely infected children than in well-nourished acutely infected children but greater than in marasmic uninfected children. Children were studied after 24 h of therapy using standard 13 C-leucine stable isotope tracer techniques. Wellnourished children with acute infection had greater leucine kinetic rates than did marasmic children with acute infection; nonoxidative leucine disposal was 153 Ϯ 31 versus 118 Ϯ 43 mol leucine · kg Ϫ1 · h Ϫ1 , leucine derived from whole-body proteolysis was 196 Ϯ 34 versus 121 Ϯ 47, and leucine oxidation was 85 Ϯ 31 versus 45 Ϯ 13 (p Ͻ 0.01 for all comparisons).Leucine kinetic rates were similar in marasmic children with and without acute infection. Well-nourished children with acute infection increased their serum concentration of five of six acutephase proteins during the first 24 h, whereas marasmic children with infection did not have any increases. The serum concentrations of IL-6 were elevated in well-nourished and marasmic children with infection. These data suggest that the cytokine stimulus for the acute-phase protein kinetic response to acute infection is present in marasmic children but that the acute-phase protein metabolic response is blunted by malnutrition. Severe malnutrition and acute systemic infection are often coincident and synergistic in children (1). In adults, these two physiologic states are important determinants of whole-body protein kinetics. Whole-body protein kinetics are characterized by the dynamic sum of factors that add to the free amino acid pool, primarily dietary protein intake and the release of amino acids during proteolysis, and those factors that subtract from this pool, namely the use of amino acids in the synthesis of new protein and the oxidation of amino acids (2). Protein synthesis is limited by the availability of free amino acids, and muscle proteolysis can be accelerated to increase the pool of free amino acids. Malnutrition decreases protein turnover by lowering dietary intake of amino acids and limiting proteolysis to conserve amino acids (3). Acute infection increases protein turnover (4) by invoking the acute-phase response, the accelerated synthesis of a group of proteins useful to the host in successfully responding to the infection (5, 6). Understanding how malnutrition and acute infection together affect protein metabolism in children may give insight into the optimum dietary therapy to facilitate recovery, as well as increase the knowledge of the interaction between nutritional status and immunity.Unfortunately, little is known about these relationships, primarily because of the complexity and challenges in measuring protein kinetics in young childr...

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Home‐based therapy for oedematous malnutrition with ready‐to‐use therapeutic food

et al. 2006

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CO2 production during acute infection in malnourished Malawian children

Cited by 4 publications

References 26 publications

Protein quantity, not protein quality, accelerates whole-body leucine kinetics and the acute-phase response during acute infection in marasmic Malawian children

Protein quantity, not protein quality, accelerates whole-body leucine kinetics and the acute-phase response during acute infection in marasmic Malawian children

Whole-Body Leucine Kinetics and the Acute Phase Response during Acute Infection in Marasmic Malawian Children

Home‐based therapy for oedematous malnutrition with ready‐to‐use therapeutic food

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