title: Whole-body leucine kinetics and the acute phase response during acute infection in marasmic Malawian children.
abstract: This study compared leucine kinetics and acute-phase protein and cytokine concentrations in three groups of Malawian children who were fed an isoenergetic, isonitrogenous diet: children with marasmus with (n = 25) and without (n = 17) infection and well-nourished children with infection (n =13). The hypotheses tested were that whole-body leucine kinetics will be less in marasmic acutely infected children than in well-nourished acutely infected children but greater than in marasmic uninfected children. Children were studied after 24 h of therapy using standard (13)C-leucine stable isotope tracer techniques. Well-nourished children with acute infection had greater leucine kinetic rates than did marasmic children with acute infection; nonoxidative leucine disposal was 153 +/- 31 versus 118 +/- 43 micromol leucine. kg(-1). h(-1), leucine derived from whole-body proteolysis was 196 +/- 34 versus 121 +/- 47, and leucine oxidation was 85 +/- 31 versus 45 +/- 13 (p < 0.01 for all comparisons). Leucine kinetic rates were similar in marasmic children with and without acute infection. Well-nourished children with acute infection increased their serum concentration of five of six acute-phase proteins during the first 24 h, whereas marasmic children with infection did not have any increases. The serum concentrations of IL-6 were elevated in well-nourished and marasmic children with infection. These data suggest that the cytokine stimulus for the acute-phase protein kinetic response to acute infection is present in marasmic children but that the acute-phase protein metabolic response is blunted by malnutrition.
authors.affiliation: Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, One Children's Place, St. Louis, MO 63110, USA. manary@kids.wustl.edu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Manary
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Yarasheski
authors.forename: Richard
authors.initials: R
authors.lastname: Berger
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Abrams
authors.forename: Charles Anthony
authors.initials: CA
authors.lastname: Hart
authors.forename: Robin L
authors.initials: RL
authors.lastname: Broadhead
mesh_terms: D000208:Acute Disease; D000209:Acute-Phase Proteins / Q000378:metabolism; D000210:Acute-Phase Reaction / Q000150:complications* / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D002247:Carbon Isotopes; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D007239:Infections / Q000150:complications* / Q000378:metabolism*; D015850:Interleukin-6 / Q000097:blood; D007930:Leucine / Q000493:pharmacokinetics*; D008295:Malawi; D008297:Male; D011502:Protein-Energy Malnutrition / Q000150:complications* / Q000378:metabolism*
chemical_list: D000209:Acute-Phase Proteins; D002247:Carbon Isotopes; D016207:Cytokines; D015850:Interleukin-6; D002097:C-Reactive Protein; D007930:Leucine