The Essential Pathology of Kwashiorkor

Davies, J. N. P.

doi:10.1016/s0140-6736(48)92087-x

Cited by 199 publications

(42 citation statements)

References 2 publications

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“…This comes in agreement with previous studies which reported that protein-deficient nutrition was accompanied by progressive atrophy of the pancreas followed by exocrine insufficiency (Barbezat & Hansen, 1968;Sauniere & Sarles, 1988). Severe malnutrition leads to a reduction in zymogen granules (Davis, 1948;Stransky & Dauis-Lawas, 1950) and basal and stimulated secretion of enzymes (Thompson & Trowell, 1952;Barbezat & Hansen, 1968). More recently, Brooks and Golden (1992) reported pancreatic atrophy in postmortem (PM) histological sections of PEM cases.…”

Section: Discussionsupporting

confidence: 91%

Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery

et al. 2004

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Background: Pancreatic exocrine dysfunction has been frequently recorded in protein energy malnutrition (PEM) because the pancreas requires optimal nutrition for enzyme synthesis. This pancreatic enzyme insufficiency may play a role in the continuation of PEM. Objective: This study was designed to assess the pancreatic head size and exocrine pancreatic functions, namely serum amylase and lipase, in PEM and its subtypes and correlate any defect present with the various clinical and laboratory data of the PEM patients with special emphasis on the effect of nutritional rehabilitation. Patients and methods: A total of 33 cases of PEM; 15 marasmus, 10 kwashiorkor (KWO) and eight marasmic kwashiorkor (MKWO) were recruited from Ain Shams University children's hospital, together with 12 matched controls. The mean age of patients was 11.8777.8 months and that of the controls was 14.8377.7 months. Detailed history taking and thorough clinical examination with special emphasis on anthropometric measurements were taken for each studied infant as well as laboratory investigations which included; complete blood count, liver and kidney functions and serum amylase and lipase. Ultrasonographic assessment of pancreatic head size was performed for the cases and controls. Nutritional rehabilitation program was carried out for 3-6 months followed by reassessment of the cases. Results: The pancreatic head size values were significantly lower in all subtypes of PEM (1.5270.6, 2.7370.12 and 3.0070.54 cm 3 in the marasmus, KWO and MKWO respectively) compared to the controls (5.1372.33 cm 3 ). The serum amylase and lipase were also significantly lower in all subgroups of PEM when compared to the controls with significant improvement following nutritional rehabilitation coupled by a significant increase in pancreatic head size too. No significant differences were recorded when we compared the subgroups together except for a significant higher rate of change in serum amylase in edematous patients compared to nonedematous ones. The length of nutritional rehabilitation period, age of the patient, weight and serum albumin were the most determinant factors for pancreatic head size as evident from the multiple regression analysis study. Conclusion: The potentially correctable exocrine pancreatic insufficiency in cases of PEM should be carefully thought of when planning the nutritional rehabilitation program for such patients as it could be responsible for the serious continued morbidity issues that they face. We thus recommend that estimation of pancreatic head size and exocrine function should be included in the evaluation of PEM patients and they could also be used as a prognostic parameter. Sponsorship: The patients enrolled were among those admitted and managed freely in the children

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Section: Discussionsupporting

confidence: 91%

Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery

et al. 2004

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“…[27][28][29] Its cardinal features include edema, dermatitis, and fatty liver in individuals who (despite their edema) are usually thin and underweight with spared subcutaneous fat stores. 22,30,31 In contrast to marasmus, serum albumin levels are usually low. 25,28,30,31 In fact, kwashiorkor is the only premoribund state of malnutrition in which serum albumin is low and is therefore the likely origin for the concept that serum albumin reflects nutritional status.…”

Section: Origin Of the Concept Of Serum Albumin As A Nutritional Markermentioning

confidence: 99%

“…22,30,31 In contrast to marasmus, serum albumin levels are usually low. 25,28,30,31 In fact, kwashiorkor is the only premoribund state of malnutrition in which serum albumin is low and is therefore the likely origin for the concept that serum albumin reflects nutritional status. This is a critical point, because kwashiorkor is often accompanied by infection and is rare in the Western industrialized world, 32 where dietary protein is plentiful.…”

Section: Origin Of the Concept Of Serum Albumin As A Nutritional Markermentioning

confidence: 99%

Reassessment of Albumin as a Nutritional Marker in Kidney Disease

Friedman¹,

Fadem

2010

Journal of the American Society of Nephrology

308

245

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“…In children, severe malnutrition leads to a reduction in the secretion of the pancreatic enzymes (2,5). The condition appears to be reversible after correction of dietary deficiency (2).…”

Section: Discussionmentioning

confidence: 99%

Effect of Feeding Regimens on the Functional Recovery of Pancreatic Enzymes in Postnatally Malnourished Weanling Rats

1983

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SummaryMalnutrition was induced in the immediate postnatal period by expanding newborn litters to 20 rat pups/dam. The reversibility of the effects of malnutrition on the pancreas was evaluated by comparing two different feeding methods. At 21 days of age, pups from the expanded litters exhibited significantly decreased body ( P < 0.0005) and pancreatic ( P < 0.0025) weights as compared to those from control litters (12 pups/dam). Malnourished pups also had less contents of amylase ( P < 0.01), lipase ( P < 0.0005) and trypsinogen ( P < 0.0025) in their pancreases. The concentrations (specific activities) of amylase (P < 0.05) and lipase ( P < 0.0125) were significantly decreased but trypsinogen (P < 0.35) was not affected.Subsequent nutritional rehabilitation by an ad libitum (food available 24 h/day) or restricted (food available 2 h/day) feeding regimen failed to allow for "catch-up" in body (P < 0.025) and pancreatic weight (P < 0.05) by 56 days of life. With ad libitum feedings, enzyme contents and concentrations of amylase and lipase in malnourished animals attained control values by 7 and 14 days, respectively. Restricted feedings, however, delayed the recovery in amylase by an additional 7 days but lipase remained depressed in both content, ( P < 0.005) and specific activity ( P < 0.0025) for the duration of the experiment (56 days). Changes in pancreatic enzymes in response to malnutrition are readily reversible with adlibitum feediigs but changes in somatic and pancreatic weights were not reversed. Restricted feedings have no advantage in promoting the rate of recovery of the pancreas after postnatal malnutrition.Pancreatic weight and enzyme content in rats have been shown previously to be markedly reduced by malnutrition during the early postnatal period (9). Both parameters are similarly reduced in rats subjected to reduced maternofetal blood flow in utero during the third trimester (17). In either case, changes in the concentrations of the different enzymes appear to be nonparallel.

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The Essential Pathology of Kwashiorkor

Cited by 199 publications

References 2 publications

Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery

Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery

Reassessment of Albumin as a Nutritional Marker in Kidney Disease

Effect of Feeding Regimens on the Functional Recovery of Pancreatic Enzymes in Postnatally Malnourished Weanling Rats

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