Infantile malnutrition. Changes in body composition during rehabilitation.

Abstract

Extract: Total body water (TBW), intracellular (ICW) and extracellular (ECW) spaces, muscle mass and supporting tissue were measured in nine malnourished infants, 5–30 months of age, shortly after hospitalization, and then following 4–9 months of rehabilation. Initially all infants had server growth deficits, heights age being 4–64% (average 40%) and weight age 0–40% (average 15.6%) of chronologic age TBW ranged from 63.5 to 89.3% of body weight and ECW ranged from 38.6 to 50.6% of TBW, suggesting marked losses of cell mass and body fat with conservation of supporting tissues. Excretory levels of creatinine and hydroxproline ranged from 31 to 86 mg/24 h and from 10.3 to 28.5 mg/24 h, respectively. During rehabilitation all patients exhibited accelerated growth, height age becoming 28.6–69.1% (averange 58.8%) of chronologic age; most of the children become moderately obese. With the exception of one infant, who did not gain weight well hydroxyproline increased 45–360% over the intial values. TBW became 54.7–65% of body weight and ECW 41.8–55.9% of TBW. Proportionally smaller increase in metabolically active protoplasm, respresented by ICW, were exprienced in four infants under 11 months (average 25%, than in four of five infants over 11 months of age (average 67.5%); however; these four infants demonstrated proportionately greater gains in ECW (77 versus 36%). Determinations of blood sugar, growth hormone and insulin responses to arginine were made in five of these patients and in three additional infants. On admission, the levels of growth hormone in these infants were found to be elevated (11.5–18 ng/ml) and did not respond, to arginine injection; determination of blood sugar also showed elevated levels (119–182 mg/100 ml). One to three months later the response was usually normal. Insulin responses, initially and after partial rehabilitaion, were almost invariably blunted, with only one child, at 50 days, showing a rise to 45 ng/ml. It is apparent that growth during, recovery from malnutrition is neither a uniform process nor is it simply reinitiation of normal growth. Speculation: The apparently normal production of growth hormone and the impaired insulin, which was persistently demonstrated by these infants, along wiht the poor growth in cell mass of those under 11 months of age, suggest that gains in cell mass in the younger infant may be primarily dependent on insulin and not on growth hormone. Cartilage and other supporting tissues may continue to respond to growth hormone, despite fairly severe malnutririon.