Abstract
Birthweight differences between kwashiorkor and marasmus suggest that intrauterine factors influence the development of these syndromes of malnutrition and may modulate risk of obesity through dietary intake. We tested the hypotheses that the target protein intake in adulthood is associated with birthweight, and that protein leveraging to maintain this target protein intake would influence energy intake (EI) and body weight in adult survivors of malnutrition. Sixty-three adult survivors of marasmus and kwashiorkor could freely compose a diet from foods containing 10, 15 and 25 percentage energy from protein (percentage of energy derived from protein (PEP); Phase 1) for 3 days. Participants were then randomized in Phase 2 (5 days) to diets with PEP fixed at 10%, 15% or 25%. Self-selected PEP was similar in both groups. In the groups combined, selected PEP was 14.7, which differed significantly (P < 0.0001) from the null expectation (16.7%) of no selection. Self-selected PEP was inversely related to birthweight, the effect disappearing after adjusting for sex and current body weight. In Phase 2, PEP correlated inversely with EI (P = 0.002) and weight change from Phase 1 to 2 (P = 0.002). Protein intake increased with increasing PEP, but to a lesser extent than energy increased with decreasing PEP. Macronutrient intakes were not independently related to birthweight or diagnosis. In a free-choice situation (Phase 1), subjects selected a dietary PEP significantly lower than random. Lower PEP diets induce increased energy and decreased protein intake, and are associated with weight gain.
Highlights
There is epidemiological and experimental evidence that developmental influences may modify appetite control and the risk of obesity later in life [1, 2]
There was no significant difference in height, weight or body mass index (BMI) between the adult survivors of kwashiorkor and marasmus (P > 0.1)
Low birthweight was associated with higher protein targeting, the effect of birthweight may be mediated through body weight
Summary
There is epidemiological and experimental evidence that developmental influences (maternal nutrition, fetal growth, birth size and postnatal nutrition) may modify appetite control and the risk of obesity later in life [1, 2]. Children with a developmental history of adequate intrauterine nutrition and normal birthweight develop kwashiorkor when exposed to undernutrition in childhood When acutely malnourished such children fail to sustain amino acid and lipid supply to their metabolic machinery and suffer impaired synthesis of protein and peptides and an energy shortage [15,16,17]. This metabolic pattern may confer a lower risk of obesity later in life in a high energy environment than the marasmic phenotype.
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