Is the adult protein-energy malnutrition syndrome the same as that described in the infant?

Protein-energy malnutrition, a multi-factorial disease, has been described predominantly in the infant. It was the aim of this research to give a biochemical assessment of the adult form and to compare it to the infantile syndrome within the same socio-cultural context of central Zaïre (Kwilu region). Thirty-four children, 22 women and 2 men suffering from marasmic kwashiorkor at the hospital of Yasa-Bonga (Kwilu) were submitted to a complete set of 7 anthropometric and 60 biochemical tests.

Biochemical study of malnutrition. Part VI: Histidine and its metabolites.

The present study, as a part of a broader investigation on protein-energy-malnutrition (PEM) in rural Zaire, was undertaken in order to clarify varying aspects of histidine metabolism in patients suffering from protein-energy malnutrition (PEM). Measurement of histidine and its derivatives was performed on blood samples, in urine and in stool ultrafiltrates of healthy rural controls, of PEM mothers and PEM children, before and during dietary treatment, and after histidine oral overloading. In stool ultrafiltrates, unusually high concentration of histidine and of three major catabolites (imidazoleacetic acid, imidazolelactic acid and imidazolepropionic acid) were identified, contrasting with undetectable levels of urocanic acid.

Zinc balances in preterm infants.

Zinc balances were studied in three groups of preterm babies. The first group received bank human milk of 25% concentration, the second group bank human milk enriched with 1 g/100 ml of lactalbumin hydrolysate, and the third group an industrial formula in which 40% of the fats were replaced with medium chain triglycerides (MCT). Zn intakes (microgram/kg/day) were, respectively, 796 +/- 136 (group 1), 689 +/- 231 (group 2), and 252 +/- 67 (group 3).

Biochemical study of malnutrition. Part IV. Determination of amino acids in the serum, erythrocytes, urine and stool ultrafiltrates.

Before dietary treatment, no significant differences, except for alanine, were found in the amino acid pattern for 22 young mothers and 33 children with protein-energy malnutrition (PEM), the characteristic feature of the serum pattern being the imbalance between essential and non essential amino acids. Apart from lysine, the essential amino acid levels were all below normal. This imbalance may be detected readily from the abnormal values of some particularly sensitive ratios: phenylalanine/tyrosine, valine/glycine, non essential amino acids/essential amino acids and, above all, serine/threonine.

Biochemical study of malnutrition. Part V. Metabolism of phenylalanine and tyrosine.

In order to elucidate the metabolic disorders which were observed for phenylalanine and tyrosine in protein-energy malnutrition, loads of both these amino acids were given to young mothers who showed all the clinical and biochemical symptoms of malnutrition and to healthy controls of the same age. Loads of phenylalanine resulted in higher blood levels, lower blood tyrosine formed from phenylalanine and higher urinary excretion of secondary phenylalanine and tyrosine metabolites in the patients, the former being due to a phenylalanine hydroxylase deficiency, the latter to concomitant disturbances in tyrosine catabolism. Loads of tyrosine resulted in very high urinary excretion of secondary tyrosine metabolites in two patients, due to a p-hydroxyphenylalanine-oxidase deficiency and to a high urinary excretion of tyrosine but almost normal excretion of secondary metabolites in the third patient, which is very likely to be due to a tyrosine-transaminase deficiency.

Tyrosinemia without liver or renal damage with plantar and palmar keratosis and keratitis (hypertyrosinemia type II).

A boy of 3 2/12 years of age with Richner-Hanhart syndrome (plantar and palmar keratosis and chronic keratitis) was found to have hypertyrosinemia and to excrete the hydroxyacids derived from tyrosine. A diet poor in phenylalanine and tyrosine cured the skin and corneal lesions. Clinical and biochemical observations are reported.

Study on malnutrition. III. Biochemical assessment of the dietary treatment and evolution of the illness.

During the course of a malnutrition study, the efficiency of two diets has been followed by clinical observations and biochemical tests. The diets were adapted to the physiological state of 25 patients (16 children, 6 young mothers, 1 adolescent and 2 men) undergoing treatment in a rural hospital at Yasa-Bonga, Zaïre. One group of patients was examined after two weeks of treatment (6 children, 2 mothers), the other group after two months (8 children, 5 adults).

[Still another cause of hypermethioninemia in children: S-adenosylmethionine synthetase deficiency].

One case of hypermethioninaemia discovered on systematic neonatal screening examination is reported. This metabolic disorder was associated with growth retardation, anorexia, digestive disturbances, and a strong smell of "boiled cabbage" in urine and sweat. With a 6-year follow up, psychomotor and growth developments were excellent under a low methionine containing diet, in spite of a persistent pathological hypermethioninaemia.

Dietary treatment of malnutrition. Balance-sheets of the main nutrients. Part II.

Results of a balance study of nitrogen, fat, electrolytes and trace-elements (Fe, Cu, Zn, Mn) with 3 1/i to 9 years old malnourished children in the Kwilu region (Zaïre) are given. The main components of the diets were fish, lactose free milk, caseinate, partial hydrolasate of albumin, fermented corn and soya (Soy-Ogi), medium-chain triglycerides, rice and the local foods manioc, peanuts and caterpillars. The lactose free milk and the Soy-Ogi were well tolerated since we found only a small quantity of non absorbed sugar in the faeces.