Abstract
Twenty-four children with kwashiorkor and nine with marasmus were investigated at the Medical Research Council Infantile Malnutrition Unit, Kampala. Blood-glucose and plasma-levels of insulin and free fatty acids (F.F.A.) were measured at intervals of 4 days during the first 2 weeks of treatment on suitable dietary regimens, and intravenous glucose-tolerance tests were done before and after this period. In marasmus, blood-glucose levels were low but the intravenous glucose-tolerance tests were normal; low or normal plasma-F.F.A. levels may reflect body-fat wastage; in kwashiorkor the blood-glucose levels were also lower than normal, but plasma-F.F.A. were elevated, and correlated with impairment of glucose tolerance. Plasma-insulin was low in marasmus, and normal or high in kwashiorkor. Plasma-growth-hormone concentration was high in untreated kwashiorkor. The metabolic findings in children with kwashiorkor suggest a " block " at the point of entry of short-chain fatty-acyl-coenzyme-A into the citric-acid cycle. Three children with kwashiorkor died during the first 4 days of treatment. Sudden hypoglycæmia has been suggested elsewhere as a cause but in only one of these children was the blood-glucose below 40 mg. per 100 ml. post mortem.
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