Lipid kinetic differences between children with kwashiorkor and those with marasmus.
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.


METHODS
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.
Badaloo
Asha V
AV
Tropical Metabolism Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica. asha.baldaloo@uwimona.edu.jm
Forrester
Terrence
T
Reid
Marvin
M
Jahoor
Farook
F
D005260:Female; D005990:Glycerol / Q000378:metabolism*; D006801:Humans; D007223:Infant; D007732:Kwashiorkor / Q000178:diet therapy / Q000378:metabolism*; D008066:Lipolysis; D008297:Male; D010168:Palmitates / Q000378:metabolism; D011502:Protein-Energy Malnutrition / Q000178:diet therapy / Q000378:metabolism*
D010168:Palmitates; D005990:Glycerol