Angel Cordano

Malnutrition in Infancy: Changes in Muscle and Adipose Tissue Before and After Rehabilitation

Extract: In nine infants suffering from protein-calorie malnutrition, significantly low values for muscle mass and cell mass which were proportional were observed. These were 1.02±0.44 kg and 2,295±693 pg, respectively (P < 0.001). The extracellular volume was disproportionally high relative to creatinine excretion before and after rehabilitation. The extracellular volume was disproportionally high relative to creatinine excretion before and after rehabilitation. The major loss of muscle mass was due to loss of cell size rather than cell number.The protein/DNA ratio was 78±18.7 (P<0.001) prior to rehabilitation and 109.6±45.1 (P<0.001) following rehabilitation. The RNA/DNA ratio was low at 0.96±0.26 (P0.001) prior to rehabilitation while after rehabilitation the value increased to 1.24±0.14 but was still less than normal (P<0.01).The levels of Mg and Zn per unit DNA were reduced in muscle prior to rehabilitation. These values were 6.6±0.7 and 35.6±15.8, respectively (P<0.001).The significantly reduced protein/DNA and RNA/DNA ratios after rehabilitation suggest either persistent alteration in mechanisms responsible for protein synthesis or a prolonged period necessary for recovery. Muscle mass of 1.67±0.64 kg was not significantly different from the normal for body length after rehabilitation.The concerntrations of water (39.96±16.99) and collagen (3.86±2.24) in adipose tissue were elevated (P<0.01), while that of fat (50.36±21.87) was low prior to rehabilitation. The noncollagen protein was constant per gram of tissue in marasmus and following rehabilitation.Speculation: Because insulin is intimately related to protein synthesis and the attainment of normall cytoplasmic growth, the persistently poor secretion of insulin during rehabilitation from malnutrition may be responsible for inadequate cytoplasmic growth.Inaulin administered judiciously during the recovery phase may accelerate recovery and insure a return to normal.

Infantile malnutrition: changes in body composition during rehabilitation.

Extract: Total body water (TBW), intracellular (ICW) and extracellular (ECW) spaces, muscle mass and supporting tissue were measured in nine malnourished infants, 5–30 months of age, shortly after hospitalization, and then following 4–9 months of rehabilation. Initially all infants had server growth deficits, heights age being 4–64% (average 40%) and weight age 0–40% (average 15.6%) of chronologic age TBW ranged from 63.5 to 89.3% of body weight and ECW ranged from 38.6 to 50.6% of TBW, suggesting marked losses of cell mass and body fat with conservation of supporting tissues. Excretory levels of creatinine and hydroxproline ranged from 31 to 86 mg/24 h and from 10.3 to 28.5 mg/24 h, respectively. During rehabilitation all patients exhibited accelerated growth, height age becoming 28.6–69.1% (averange 58.8%) of chronologic age; most of the children become moderately obese. With the exception of one infant, who did not gain weight well hydroxyproline increased 45–360% over the intial values. TBW became 54.7–65% of body weight and ECW 41.8–55.9% of TBW. Proportionally smaller increase in metabolically active protoplasm, respresented by ICW, were exprienced in four infants under 11 months (average 25%, than in four of five infants over 11 months of age (average 67.5%); however; these four infants demonstrated proportionately greater gains in ECW (77 versus 36%).Determinations of blood sugar, growth hormone and insulin responses to arginine were made in five of these patients and in three additional infants. On admission, the levels of growth hormone in these infants were found to be elevated (11.5–18 ng/ml) and did not respond, to arginine injection; determination of blood sugar also showed elevated levels (119–182 mg/100 ml). One to three months later the response was usually normal. Insulin responses, initially and after partial rehabilitaion, were almost invariably blunted, with only one child, at 50 days, showing a rise to 45 ng/ml.It is apparent that growth during, recovery from malnutrition is neither a uniform process nor is it simply reinitiation of normal growth.Speculation: The apparently normal production of growth hormone and the impaired insulin, which was persistently demonstrated by these infants, along wiht the poor growth in cell mass of those under 11 months of age, suggest that gains in cell mass in the younger infant may be primarily dependent on insulin and not on growth hormone. Cartilage and other supporting tissues may continue to respond to growth hormone, despite fairly severe malnutririon.

Acceptability, tolerance, and nutritional value of a rice-based infant formula.

Summary: An infant formula based on high protein rice flour, with added lysine and threonine, was evaluated in recovering malnourished infants. Acceptability, tolerance, and the digestibility of most major nutrients (energy 93.9 ± 0.7%, fat 96.9 ± 0.3%, carbohydrate 96.8 ± 0.6% of intake) were excellent. Digestibility of protein, as with all rice products, was moderately low (80.1 ± 3.3%), but its high biological value made N retention equal to that from casein. Plasma-free amino acids were consistent with the low essential/total amino acids ratio found in cereals, with slower absorption, and with the possibility that leucine was the first-limiting amino acid. Absorptions of Ca, Mg, PO4, and Zn were considered satisfactory. Energy costs of weight gain and the estimated percentage N in the weight gained during 14 days were comparable to those attained with the highest quality cows milk-derived formulas in children of similar ages and nutritional status.

Nutritional supplementation of pregnant adolescents

Disadvantaged pregnant black teenagers have a higher proportion of low-birth-weight infants and their offspring have a lower mean birth weight. One hundred and fifty-seven pregnant adolescents enrolled in a Baltimore public school for pregnant teenagers were studied to determine the impact of a nutritional supplement on pregnancy outcome. Seventy-eight students voluntarily agreed to receive a nutritional supplement; 79 comparably matched students did not receive the supplement. The supplement Sustacal provided a mean intake of 8691 cal with 530 g of protein and additional vitamins and minerals over an average period of 15.1 weeks. This supplement was associated with a significant increase of 157 g in the mean infant birth weight (P less than 0.05). A significant increase in infant birth weight of 269 g was noted in the offspring of supplemented girls below 16 years of age compared with the nonsupplemented girls below this age (P less than 0.05). Significant differences in infant birth weight were also noted in the offspring of nonsmoking supplemented adolescents (P less than 0.05). The proportion of low-birth-weight infants was decreased in the supplemented subjects, but the difference was not significant.

Absorption and retention from an iso-osmolal casein hydrolysate infant formula

Abstract Pregestimil ® , the control formula, and Nutramigen ® , a casein hydrolysate formula, further modified to reduce osmolality from 443 to 300 m0sm/kg water, were well accepted and tolerated while supporting adequate growth and maintaining normal serum albumin levels in six recovering malnourished infants. Stool characteristics were similar in both groups. An apparent nitrogen absorption of 88±4% of intake was observed for both products with apparent nitrogen retention rates of 39±8 and 43±6% for the control and test products, respectively. Mean fat absorptions exceeded 93% of intake for both products and carbohydrate absorption was practically complete as confirmed by the absence of significant peaks in the breath hydrogen determinations. Dry stool weights and fecal excretions of energy, fat and carbohydrate were modestly but significantly higher with reformulated Nutramigen ® than with Pregestimil ® , however, no clinical effects were noted in this infant population.