Severe malnutrition is associated with decreased levels of plasma transferrin receptor

Sixty children aged 1-3 years with protein malnutrition were involved in the present study. Measurements were made of plasma transferrin receptor (TfR), haemoglobin (Hb), ferritin, transferrin and Fe in comparison with twenty apparently healthy age- and sex-matched reference children in Nigeria. Plasma TfR was measured by an immunofluorometric assay. The mean plasma concentrations of both albumin (37 g/l) and transferrin (1·88 g/l) were within reference ranges in the ‘healthy’ children. The malnourished children had severe protein deficiency as indicated by their significantly lower mean plasma albumin (24·4-28·2 g/l; P < 0·0001) and transferrin (1·24-1·53 g/l; P < 0·0001) concentrations in comparison with the reference children. In the reference children, the traditional indicators of Fe nutrition (plasma Fe, transferrin Fe saturation and Hb) were within the reference ranges, but ferritin values were raised, indicating acute or chronic infection and/or inflammation. The mean concentrations of plasma TW (4·2-5-2 mg/l) in the malnourished group were significantly lower than the mean (6·1 mgn) of the reference children (P=0·0009). In the children with severe malnutrition, none of the indicators of Fe status except Hb (81·5-86·7 g/l; P<0·0001) showed Fe deficiency, including the serum concentration of TfR and the TfR : ferritin ratio, although the Fe status was lower than in the reference children (for Fe P = 0·009; and ferritin P=0·0004). In the absence of haemodilution, the low Hb values are a clear indication that the malnourished children were Fe deficient; none of the other indices was indicative of Fe deficiency. This is the first report of TfR levels in malnourished and healthy African children.

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Observational study to define reference ranges for the 3% oxygen desaturation index during sleep in healthy children under 12 years using oximetry motion-resistant technology

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320066 ◽

2020 ◽

pp. archdischild-2020-320066 ◽

Cited By ~ 1

Author(s):

Jonathan Wen Yi Ong ◽

Daniel Williams ◽

Johanna C Gavlak ◽

Natasha Liddle ◽

Paula Lowe ◽

...

Keyword(s):

Pulse Oximetry ◽

Sleep Disordered Breathing ◽

Oxygen Desaturation ◽

Reference Ranges ◽

Healthy Children ◽

Mean Values ◽

Desaturation Index ◽

Oxygen Desaturation Index ◽

The Mean ◽

Pulse Oximeters

ObjectiveTo define reference ranges for the 3% oxygen desaturation index (DI3) in healthy children under 12 years old during sleep.DesignObservational.SettingHome.SubjectsHealthy children aged 6 months to 12 years of age.InterventionNocturnal pulse oximetry at home. Parents documented sleep times. Visi-Download software (Stowood Scientific) analysed data with artefact and wake periods removed.Main outcome measuresThe following oximetry parameters used in the assessment of sleep-disordered breathing conditions were measured: 3% (DI3) and 4% (DI4) oxygen desaturation indices—the number of times per hour where the oxygen saturation falls by at least 3% or 4% from baseline, mean saturations (SAT50), minimum saturations (SATmin), delta index 12 s (DI12s), and percentage time with saturations below 92% and 90%.ResultsSeventy-nine children underwent nocturnal home pulse oximetry, from which there were 66 studies suitable for analysis. The median values for DI3 and DI4 were 2.58 (95% CI 1.96 to 3.10) and 0.92 (95% CI 0.73 to 1.15), respectively. The 95th and 97.5th centiles for DI3 were 6.43 and 7.06, respectively, which inform our cut-off value for normality. The mean values for SAT50 and SATmin were 97.57% (95% CI 97.38% to 97.76%) and 91.09% (95% CI 90.32% to 91.86%), respectively.ConclusionIn children aged 6 months to 12 years, we define normality of the 3% oxygen desaturation index as <7 using standalone, motion-resistant pulse oximeters with short averaging times.

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How healthy are children one year after discharge from nutritional rehabilitation centres?

Tropical Doctor ◽

10.1177/0049475518786854 ◽

2018 ◽

Vol 48 (4) ◽

pp. 277-282 ◽

Cited By ~ 1

Author(s):

Pavan Pandey ◽

Sneha Jain ◽

Arushi Sharma

Keyword(s):

Nutritional Status ◽

Severe Malnutrition ◽

Nutritional Rehabilitation ◽

Malnourished Children ◽

Nutritional Recovery ◽

The Mean ◽

One Year ◽

Moderate Malnutrition

Nutritional rehabilitation centres (NRCs) have been established to ensure the nutritional recovery of severely malnourished children. The long-term nutritional outcomes in children discharged from NRCs have not been described. In this retrospective cohort study, the nutritional status of 514 children was assessed one year after discharge. Household and maternal data, as well as data regarding variables related to the children’s stay at the NRC, were collected. A total of 33.4% had moderate malnutrition and 11.7% had severe malnutrition. The mean weight for height Z-score at admission, discharge and one year after discharge were −3.61, −1.90 and −2.34, respectively. Thus, long-term monitoring and follow-up of children discharged from NRCs till they achieve normal nutritional status is mandatory.

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Serum albumin and transferrin in protein-energy malnutrition: Their use in the assessment of marginal undernutrition and the prognosis of severe undernutrition

British Journal Of Nutrition ◽

10.1017/s0007114500020249 ◽

1976 ◽

Vol 36 (2) ◽

pp. 255-263 ◽

Cited By ~ 1

Author(s):

P. J. Reeds ◽

A. A. O. Laditan

Keyword(s):

Serum Albumin ◽

Protein Energy Malnutrition ◽

Severe Malnutrition ◽

Serum Transferrin ◽

Malnourished Children ◽

Protein Energy ◽

The Mean ◽

Index Of Severity ◽

Mean Concentration ◽

Made In

1. Deficits in weight- and length-for-age, and serum albumin and transferrin concentrations were determined for children who were either marginally undernourished (twenty-five children) or suffering from either marasmus (thirty-two children) or kwashiorkor (twenty-six children) defined according to the Wellcome Classification (Waterlow, 1972). The measurements were also made in eight children with kwashiorkor after the loss of oedema, and in sixteen children who were recovering from either marasmus or kwashiorkor.2. The mean concentration of serum albumin was similar for children from the ‘under-nourished’ group and from the group with marasmus, but was significantly reduced in those with kwashiorkor.3. The concentration of serum transferrin was significantly reduced in both the group of children with marasmus and those with kwashiorkor. The serum transferrin concentration was significantly lower in children with kwashiorkor when compared with the level in those with marasmus.4. Seventeen children (seven with kwashiorkor and ten with marasmus) died. These children were neither lighter nor shorter than the severely malnourished children who survived. The concentration of serum albumin was not lower in the children who died than in those who survived.5. In contrast to the results for serum albumin concentrations, the children who died had significantly lower levels of serum transferrin than those who survived.6. There was a significant linear relationship between serum transferrin concentrations and the deficits in length-for-age (P < 0·05) and weight-for-length (P < 0·001) in the marginally undernourished children. The deficit in weight-for-length was also linearly related to the serum transferrin concentrations (P < 0·001) in children recovering from severe malnutrition.7. It is suggested that the measurement of serum transferrin concentrations provides an index of severity in severely malnourished children, and should prove useful in field assessments of nutritional status.

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New Approach to Evaluation of Proteinuric States

Clinical Chemistry ◽

10.1093/clinchem/23.4.666 ◽

1977 ◽

Vol 23 (4) ◽

pp. 666-670 ◽

Cited By ~ 50

Author(s):

Demetrius Ellis ◽

Gregory J Buffone

Keyword(s):

Excretion Rate ◽

Reference Population ◽

Healthy Children ◽

Urinary Proteins ◽

Urinary Excretion Rate ◽

New Approach ◽

Meaningful Information ◽

The Mean ◽

Range Of Values ◽

Apparently Healthy

Abstract We evaluated the use of immunonephelometric methods for measuring specific urinary proteins. Using a nephe¬lometer to detect light scattering (angle, 31'1, we mea¬sured some proteins immunonephelometrically in serum and aliquots of 24-h urines from 50 apparently healthy children, ages 2-17 years. The mean urinary excretion rate (mg/24 h) and the range of values was: for albumin 5.5 (range, 0-13.3), for transferrin 0.5 (0-1.9), for IgG 3.3 (0-12), and for a2-macroglobulin 0.6 (0-2.3). Direct comparison of the values for pathological urines with those for a reference population may offer more meaningful information concerning the integrity of the glomerular basement membrane than is provided by protein selectivity indices, and measuring a plasma protein such as albumin in urine may better define pathological proteinuria.

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Plasma concentrations of N-acetylneuraminic acid in severe malnutrition

British Journal Of Nutrition ◽

10.1079/bjn19850004 ◽

1985 ◽

Vol 53 (1) ◽

pp. 11-16 ◽

Cited By ~ 2

Author(s):

Jacqueline M. Hibbert ◽

Alan A. Jackson ◽

Sally M. Grantham-Mcgregor

Keyword(s):

Brain Function ◽

Brain Activity ◽

Protein Energy Malnutrition ◽

Plasma Concentrations ◽

Nutritional State ◽

Severe Malnutrition ◽

Acetylneuraminic Acid ◽

Malnourished Children ◽

Protein Energy ◽

Before And After

1. In rat studies, circulating concentrations of N-acetylneuraminic acid (NANA) have been shown to be an indicator of NANA concentrations in the brain and functional brain activity, in relation to nutritional state and stimulation. Abnormal behaviour can be improved with exogenous NANA. In the present study, the plasma NANA concentration has been measured in children with severe malnutrition and compared with that in controls.2. NANA was measured colorimetrically in the plasma of twenty-three severely malnourished children (mean age 11.43 (SD 6.05) months) before and after recovery, and in thirty-four controls (mean age 14.28 (SD 7.32) months). In thirteen of the malnourished children, NANA was measured after infections had been treated with a course of antibiotics.3. Mean plasma NANA concentration was significantly higher in protein-energy malnutrition (PEM)(2.89 (SD 0,58)μmol/ml; n 23) compared with controls (2.13(SD 0.37)μmol/ml; n 34, P < 0.001). The levels remained high in PEM after infections had been treated (2.87(SD 0.43) μmol/ml, n 13) but returned to control levels at recovery from PEM (2.14(SD 0.24)μmol/ml).4. In contrast to the findings in rats, in malnourished children plasma NANA concentrations were not reduced and did not relate directly to nutritional state or, by inference, brain function. These findings do not provide any support for the use of exogenous NANA supplements to improve brain function in humans.

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Albumin-dependent and independent mechanisms in the syndrome of kwashiorkor

10.1101/2021.05.31.21257914 ◽

2021 ◽

Author(s):

Gerard Bryan Gonzales ◽

James M Njunge ◽

Bonface M Gichuki ◽

Bijun Wen ◽

Moses Ngari ◽

...

Keyword(s):

Oxidative Stress ◽

Extracellular Matrix ◽

Matrix Metalloproteinase ◽

Serum Albumin ◽

Lymphatic Vessel ◽

Plasma Concentrations ◽

Severe Malnutrition ◽

Malnourished Children ◽

Related Proteins

The syndrome of kwashiorkor is a striking phenotype of childhood severe malnutrition (SM) comprising oedema, fatty liver, and skin and hair changes. Despite high fatality, the aetiology and pathophysiology of kwashiorkor remain enigmatic, including the role of serum albumin on oedema development. Here, we demonstrate that serum albumin is associated with the presence and severity of oedema among severely malnourished children. Further, in two independent cohorts of children in Malawi and Kenya, we show albumin-independent mechanisms are associated with oedema in SM, including oxidative stress and extracellular matrix (ECM) remodelling. Plasma concentrations of ECM-related proteins: lumican, podoplanin, lymphatic vessel endothelial hyaluronan receptor 1 (LYVE1) and matrix metalloproteinase (MMP)2 were associated with kwashiorkor. We therefore conclude that the pathophysiology of kwashiorkor has both albumin-dependent and independent mechanisms. We discuss the ways in which albumin-independent mechanisms may explain the clinical features observed in kwashiorkor.

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Relationship between anthropometric parameters and the location of apex beat in children

Nigerian Journal of Paediatrics ◽

10.4314/njp.v40i2.5 ◽

2013 ◽

Vol 40 (2) ◽

pp. 133-138

Author(s):

OA Oyinlade ◽

AO Olowu ◽

TA Ogunlesi

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Chest Circumference ◽

Healthy Children ◽

Strong Correlations ◽

Anthropometric Parameters ◽

Childhood Growth ◽

The Mean ◽

Apex Beat ◽

Apparently Healthy

Background: Childhood growth is characterized by changes in anthropometric parameters. The location of the apex beat may besimilarly influenced by growth.Objectives: The objective of this study was to determine any relationshipbetween the location of the apex beat and anthropometric parameters.Subjects and Methods: This crosssectional survey was carried out inSagamu, Nigeria. Apparently healthy children were randomly selected for the study. Apex beat location in the intercostal space was determined and distance from the midline was recorded. Weight and length/height were also recorded while Body Mass Index (BMI) and Body Surface Area (BSA) were calculated.Results: A total of 237 children aged 12 hours to 10 years were surveyed.The mean distance of the apex beat from the midline from birth to 10 years ranged from 2.3cm to 6.4cm. The mean distance of apex beat from the midline increased progressively with weight, height, chest circumference and BSA but not with BMI. Strong correlations were observed betweendistance of apex beat from the midline and weight (r = 0.850, p .0.001); height (r = 0.867, p .0.001); chest circumference (r = 0.833, p . 0.001); BSA (r = 0.862, p . 0.001) but not with Body Mass Index (r = 0.019, p = 0.774).Conclusion: The location of the apex beat in children was stronglyinfluenced by growth as suggested by anthropometric parameters.Key words: Anthropometry, apex beat, children, mid-clavicular line,nipple line

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Impact of Renutrition Milk on the Improvement of Clinical Profile and Gut Microbiota of Malnourished Children

Lebanese Science Journal ◽

10.22453/lsj-021.1.012-023 ◽

2020 ◽

Vol 21 (1) ◽

pp. 12-23

Author(s):

Asmaa Belgharbi ◽

◽

Aicha Meddah ◽

Boumediene Meddah ◽

Catherine Mullié ◽

...

Keyword(s):

Gut Microbiota ◽

Severe Disease ◽

Intestinal Flora ◽

Clinical Profile ◽

Severe Malnutrition ◽

Microbiological Analysis ◽

Healthy Children ◽

Fecal Matter ◽

Malnourished Children ◽

The Impact

Childhood malnutrition is a severe disease that kills 3.1 million children under the age of five worldwide yearly. Our objectives are to comparethe clinical profile and the intestinal microbiota of malnourished children and healthy ones residing in the city of Mascara (Algeria), and to specify the impact of the administration of renutrition milk on the improvement of their gut microbiota.40 children in total, aged between 2 and 36 months were chosen for this study. A clinical examination and a microbiological analysis of fecal matter were performed. The first results showed that the malnourished children included in the study suffer from severe malnutrition characterized by stunting and remarkable underweight and that their intestinal flora is quantitatively and qualitatively differentfrom that of healthy children. Moreover;the administration of the renutrition milk has a positive influence on the composition of the intestinal flora in these malnourished children.

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Vitamin A Inadequacy Observed in a Group of 2- to 6-Year-Old Children Living in Kwangju, Republic of Korea

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.77.5.311 ◽

2007 ◽

Vol 77 (5) ◽

pp. 311-319 ◽

Cited By ~ 5

Author(s):

Kim ◽

Giraud ◽

Cho ◽

Driskell

Keyword(s):

Vitamin A ◽

Plasma Concentrations ◽

Republic Of Korea ◽

Healthy Children ◽

Dietary Intakes ◽

Vitamin A Status ◽

The Mean ◽

Plasma Retinol ◽

Food Recalls ◽

Retinol Concentration

Dietary intakes and plasma concentrations of retinol and carotenoids were estimated in assessing the vitamin A status of young children in Kwangju, Republic of Korea. Three consecutive 24-hour food recalls and fasting blood samples were obtained from 123 healthy children (58 boys, 65 girls), aged 2–6 years. The daily vitamin A intake (mean ± SD) was 355.9 ± 178.1 μg retinol equivalents or 239.0 ± 111.2 μg retinol activity equivalents. Provitamin A carotenoid intakes were 1211.2 ± 840.0 μg/day β-carotene, 234.6 ± 231.7 μg/day α-carotene, and 149.1 ± 160.7 μg/day β-cryptoxanthin. Approximately 15–26% of subjects consumed < Korean Estimated Average Requirements (EAR) for vitamin A; whereas, 57–64% consumed < EAR for vitamin A for USA/Canadians. The mean plasma retinol concentration was 1.108 ± 0.244 μmol/L. There were no significant correlations between intakes and plasma concentrations of retinol and carotenoids. Only 2.4% of children were vitamin A-deficient based on having plasma retinol concentrations < 0.70 μmol/L. Plasma retinol concentrations of 42.3% of subjects were 0.70– < 1.05 μmol/L, which is considered indicative of potentially suboptimal vitamin A status. Therefore, some children may be at risk of inadequate vitamin A status in Kwangju, Republic of Korea.

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Acute-phase protein response to infection in severe malnutrition

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1998.275.1.e112 ◽

1998 ◽

Vol 275 (1) ◽

pp. E112-E117 ◽

Cited By ~ 2

Author(s):

John F. Morlese ◽

Terrence Forrester ◽

Farook Jahoor

Keyword(s):

Acute Phase ◽

Acute Phase Protein ◽

Plasma Concentrations ◽

Severe Malnutrition ◽

C Reactive Protein ◽

Reactive Protein ◽

Malnourished Children ◽

Phase Protein ◽

Recovery Study ◽

Protein Response

It is not known whether malnourished infants can mount a comprehensive acute-phase protein (APP) response and, if so, whether this is achieved by increasing APP synthesis rates. To address these issues, we measured 1) the plasma concentrations of five APPs (C-reactive protein, α1-acid glycoprotein, α1-antitrypsin, haptoglobin, and fibrinogen) and 2) the synthesis rates of three APPs (α1-antitrypsin, haptoglobin, and fibrinogen) using a constant intragastric infusion of [2H3]leucine in nine infected marasmic children at ∼2 days postadmission ( study 1), ∼9 days postadmission when infections had cleared ( study 2), and ∼59 days postadmission at recovery ( study 3). Except for fibrinogen, the plasma concentrations of all APPs were higher in study 1 than in studies 2 and 3. Although the rate of synthesis of haptoglobin was significantly greater in study 1 than study 2, the rates of fibrinogen and α1-antitrypsin synthesis were similar in all three studies. These results show that 1) severely malnourished children can mount an APP response to infection which does not include fibrinogen and 2) the APP response is accomplished through different mechanisms.

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