Submitted to: American Journal of Clinical Nutrition
Publication Type: Peer reviewed journal
Publication Acceptance Date: 4/1/2006
Publication Date: 6/1/2006
Citation: Badaloo, A.V., Forrester, T., Reid, M., Jahoor, F. 2006. Lipid kinetic differences between children with kwashiorkor and those with marasmus 1-3. The American Journal of Clinical Nutrition. 83:1283-1288. Interpretive Summary: There are two types of malnutrition, one in which the patient retains water in their bodies and most of their organs fail to function well (kwashiorkor) and one in which they do not retain water (marasmus). Those with kwashiorkor are sicker and are more likely to die. The reasons why a malnourished child develops kwashiorkor instead of marasmus is not clear. It was hypothesized that inability to break down fat, which is necessary to supply energy for maintenance of cell, hence organ functions, was one factor. To test this theory we measured fat breakdown rate and the ability of cells to utilize the released fat to make energy in children with kwashiorkor and marasmus. We found that the children with kwashiorkor broke down fat at a slower rate and utilized less fat for energy production compared to children with marasmus. These findings indicate that a slower fat breakdown in response to chronic food shortage may be one reason why some children develop kwashiorkor.
Technical Abstract: BACKGROUND: It has been hypothesized that one factor associated with poor prognosis in kwashiorkor, but not in marasmus, is impaired lipid catabolism, which limits the supply of energy that is essential for survival when dietary intake is inadequate. However, this hypothesis has not been tested. OBJECTIVE: The objective was to measure lipid kinetics in malnourished children with kwashiorkor or marasmus. DESIGN: Glycerol concentration and flux (index of total lipolysis), palmitate concentration and flux (index of net lipolysis), and palmitate oxidation rate (index of fatty acid oxidation) were measured in 8 children (n = 5 boys and 3 girls) with kwashiorkor and 7 (n = 4 boys and 3 girls) with marasmus, aged 4-20 mo, in the postabsorptive state. The measurements were made approximately 3 d after admission, when the children were malnourished, and after the children attained normal weight-for-length, ie, at recovery. RESULTS: The glycerol concentration was higher in the malnourished stage than at recovery for the marasmus and kwashiorkor groups combined. Glycerol flux tended to be lower (P = 0.067) and palmitate flux significantly lower (P < 0.05) in the kwashiorkor group than in the marasmus group. Palmitate oxidation was significantly lower in the malnourished stage than at recovery in the kwashiorkor group but not in the marasmus group. In the malnourished stage, palmitate oxidation was slower in the kwashiorkor group than in the marasmus group, but no significant differences between groups were observed at recovery. CONCLUSIONS: Children with kwashiorkor break down fat and oxidize fatty acids less efficiently than do children with marasmus; this factor may explain the better survival rate in marasmus.