Kwashiorkor in western Nigeria: a study of traditional weaning foods, with particular reference to energy and linoleic acid

Abstract

I. The fatty-acid composition of the plasma total lipids of children with kwashiorkor and of healthy infants was determined by gas-liquid chromatography. Breast milk from Yoruba mothers, and traditional weaning foods, were also analysed for fatty acids, and for protein, fat and carbohydrate.z. Evidence of essential fatty acid (EFA) deficiency was obtained in the children with kwashiorkor. The proportions of linoleic and arachidonic acids were reduced in the plasma lipids, whereas the endogenous eicosatrienoic acid showed a marked increase. The triene: tetraene ratio had the abnormally high value of 1.08. These changes were consistent with the prolonged ingestion of suboptimal amounts of linoleic acid.3. Breast milk was of good quality, with a particularly high concentration of retinol. The milk was also rich in linoleic acid, and was thus discounted as a factor in the development of EFA deficiency, but the weaning foods were found to provide substantially less than the minimum recommended intake of I % of the total energy as linoleic acid. 4.The maize pap with which the children with kwashiorkor had been fed for several months before the appearance of acute symptoms provided almost 7 % of the energy as protein, but only 1.21 MJ (290 kcal)/kg. To satisfy energy requirements, it would have been necessary to consume 3-4 kg of the pap each day.5. I t is concluded that the protein deficiency which leads to the development of kwashiorkor in the Yoruba community arises from a very severe restriction in energy intake rather than from the consumption of foods very low in protein at adequate or excessive levels of energy intake.The development of kwashiorkor has long been attributed to the consumption of diets low in protein and rich in carbohydrate (Brock & Autret, 1952). The lack of fat in such diets, though occasionally remarked upon (Bronte-Stewart, 1961), has not, however, been considered as an important dietary factor in the aetiology of the disease. The human infant, like the young of other species, has been shown to have a requirement for fat by virtue of its content of linoIeic acid -the essential fatty acid (EFA). Wiese, Hansen & Adam (1958) noted that a diet providing I % of the total energy as linoleic acid was just adequate to prevent the clinical manifestations of EFA deficiency, and concluded, on the basis of measurements of serum fatty acid ratios, that optimum consumption would represent 4 % of the energy intake.In the infant with kwashiorkor, a deficiency of linoleic acid might have arisen in a number of ways: in the preweaning period from inadequate nutrition of the mother, resulting in the secretion of milk with a low concentration of linoleic acid, or, in the postweaning period, from feeding the children on traditional infant foods low in fat, or from an impaired absorption of fat. 1964).

Metabolic changes in malnutrition

“…5,6 Moreover, children can recover effectively on diets that would be considered low in protein. 7 The plasma protein concentration is often not particularly low in children with oedema, and during rehabilitation the oedema may clear without any change in serum albumin concentration.…”

Metabolic and nutritional considerations in nonalcoholic fatty liver

“…The standard biochemical index to assess EFA deficiency is the triene/tetraene (20:3/20:4) ratio in which a ratio greater than 0.4 is indicative of EFA deficiency. In the earliest study of essential fatty acid deficiency in kwashiorkor, Naismith 68 noted a mean triene:tetraene ratio of 1.08 among 20 individuals with kwashiorkor. None of the control subjects had a trien:tetraene ratio greater than 0.4, whereas all of the infants with kwashiorkor had ratios greater than 0.4.…”

“…Other studies have since reported similar findings. [68][69][70] Although the consequences of EFA deficiency have not been fully defined, EFAs are essential components of phospholipids and may perhaps contribute to the development of fatty liver by affecting the hepatic biosynthesis of lipoproteins, which require the phospholipid derivative, phosphotidylcholine (discussed below). 39 …”

“…[68][69][70][71] EFAs include the polyunsaturated fatty acid linoleic acid (18:2 6) and its in vivo metabolites such as arachidonic acid (20:4 6). The same enzyme system involved in the conversion of linoleic acid to arachidonic acid, in the absence of this unsaturated precursor, will also desaturate oleic acid (18:1 9) to eicosatrinoic acid (20:3 9).…”

Production and evaluation of millet-egg-soybean hull composite flour: A weaning food

“…These foods include yam (Dioscorea spp. ), rice (Oryza sativa), gari (fermented cassava grits), and cocoyam (Xanthosoma sagittifolium), which may be eaten with sauce or soup (Morley et al, 1969;Naismith 1973). These foods are usually mashed, thinned, or pre-chewed.…”