Marginal Malnutrition Research Articles

Doris Howes Calloway

Throughout her career, Doris Howes Calloway sought to understand what influences human protein and energy requirements and metabolism in controlled and field settings. Much of her research became the basis for national and international dietary recommendations, many of which are in use today. She served on many committees of the US Food and Nutrition Board/National Research Council/Institute of Medicine and the Food and Agriculture Organization/World Health Organization of the United Nations. Concerned about populations where marginal malnutrition is often overlooked, Dr Calloway led a major United States Agency for International Development–funded multiuniversity research project in low-income countries to better understand the effects of moderate malnutrition on growth and health. She led this extensive multinational study while serving as provost, the first woman in the senior administration at the University of California, Berkeley campus. Toward the end of her professional career, she was appointed chair of the 1995 Dietary Guidelines for Americans Advisory Committee. Her interest in food and nutrition policy helped reorient dietary guidance both in the United States and internationally. Dr Calloway's scientific and humanitarian accomplishments were extended further through the subsequent research and leadership activities of her colleagues, graduate students, and others whom she mentored.

Thiamine and magnesium deficiencies: Keys to disease

Thiamine deficiency (TD) is accepted as the cause of beriberi because of its action in the metabolism of simple carbohydrates, mainly as the rate limiting cofactor for the dehydrogenases of pyruvate and alpha-ketoglutarate, both being critical to the action of the citric acid cycle. Transketolase, dependent on thiamine and magnesium, occurs twice in the oxidative pentose pathway, important in production of reducing equivalents. Thiamine is also a cofactor in the dehydrogenase complex in the degradation of the branched chain amino acids, leucine, isoleucine and valine. In spite of these well accepted facts, the overall clinical effects of TD are still poorly understood. Because of the discovery of 2-hydroxyacyl-CoA lyase (HACL1) as the first peroxisomal enzyme in mammals found to be dependent on thiamine pyrophosphate (TPP) and the ability of thiamine to bind with prion protein, these factors should improve our clinical approach to TD. HACL1 has two important roles in alpha oxidation, the degradation of phytanic acid and shortening of 2-hydroxy long-chain fatty acids so that they can be degraded further by beta oxidation. The downstream effects of a lack of efficiency in this enzyme would be expected to be critical in normal brain metabolism. Although TD has been shown experimentally to produce reversible damage to mitochondria and there are many other causes of mitochondrial dysfunction, finding TD as the potential biochemical lesion would help in differential diagnosis. Stresses imposed by infection, head injury or inoculation can initiate intermittent cerebellar ataxia in thiamine deficiency/dependency. Medication or vaccine reactions appear to be more easily initiated in the more intelligent individuals when asymptomatic marginal malnutrition exists. Erythrocyte transketolase testing has shown that thiamine deficiency is widespread. It is hypothesized that the massive consumption of empty calories, particularly those derived from carbohydrate and fat, results in a high calorie/thiamine ratio as a major cause of disease. Because mild to moderate TD results in pseudo hypoxia in the limbic system and brainstem, emotional and stress reflexes of the autonomic nervous system are stimulated and exaggerated, producing symptoms often diagnosed as psychosomatic disease. If the biochemical lesion is recognized at this stage, the symptoms are easily reversible. If not, and the malnutrition continues, neurodegeneration follows and results in a variety of chronic brain diseases. Results from acceptance of the hypothesis could be tested by performing erythrocyte transketolase tests to pick out those with TD and supplementing the affected individuals with the appropriate dietary supplements.

A Study on the Relationship between Nutritional Status and Prevalence of Pneumonia and Diarrhoea among Preschool Children in Kushtia

The prevalence of diarrhoea and pneumonia is quite alarming amongst children under 5 years of age who belong to low socioeconomic status. This study was carried out from January to December (2012) in Kushtia, and the total sample were boys (209) and girls (191). Anthropometric measurements were performed by standard methods National Centre for Health Statistics (NCHS). The prevalence of severe underweight, stunting and wasting (≤ -3 SD) were found in the sample data about 11%, 22% and 17% respectively; whereas the prevalence of pneumonia, diarrhea and both pneumonia & diarrhea was found 53%, 44.50% and 38.75% respectively. The high prevalence of pneumonia (62.72%) and frequency (1.85) were found in under 12 months age group, while diarrhea (48.86%) and both pneumonia & diarrhea (45.45%) were found in 13-24 months age group. A greatest relationship was found between mother and child health status. About 89.26% mothers with poor health status have a sick child. Among the mothers with good health, the percentage of sick children was 45.73%. In this study, 34.25% of children were found to be severe anemic, 40.25% of children were found to be moderately anemic and 25.50% were nonanemic. Our findings underscore the fact that even poor nutrition or marginal malnutrition can predispose children to pneumonia. Anemia also significantly increased the risk of pneumonia in children. Our study revealed that anemia might be a risk factor for lower respiratory tract infections including pneumonia; however further studies with statistical model is needed to confirm. This study also indicated that children with diarrhea were at increased risk of pneumonia.

La Pauvreté - Déterminant Majeur Et Conséquence De L’Épidémie Du Vih/Sida Dans Une Contrée Frontalière En Afrique Australe Cas De La Frontière De Kasumbalesa (République Démocratique Du Congo – Zambie) (Poverty - Major Determinant and Consequence of the HIV/AIDS at a Border in Southern Africa - Case of Kasumbalesa Border Post (Democratic Republic of Congo - Zambia))

This thesis aims to evaluate the interaction between poverty and the HIV/AIDS in the border city of Kasumbalesa. Cross-sectional surveys were conducted among households, truckers from Southern Africa, the population in general, people living with HIV/AIDS from October 2008 to April 2009 for the collection of different information that has been analyzed depending on the specific objectives described in this work. We found that the poverty threshold for a household per year is 213,747.2 FC equivalents to 3776 U.S dollars. 77.73% of households live in poverty, 37.05% of households living in deep poverty and 21.66% living in severe poverty. Also, 88% of girls aged 11 to 24 years old live in poverty with a coefficient of variation of inequality of poverty by area of residence of 49.98%. The depth of poverty among girls aged 11 to 24 years is around 42.23% and the severity of poverty among girls aged 11 to 24 years is around 25.03%. These situations of poverty in this population get this people in open and hidden prostitution throughout the border of Kasumbalesa with a very high risk of being contaminated with HIV. In the fight against the spread of HIV/AIDS, it is recommended to start from the state of knowledge of people to adapt the messages for information, education and communication (IEC). Broadly speaking, as regards the results of our study, knowledge on HIV/AIDS improved slightly compared to other studies done in specific areas, such as Kapolowe. The main modes of transmission remain largely known by the population. But some beliefs, such as the transmission of the virus in public toilets by a mosquito bite or due to touch a PLWIH remained at a significant level suggesting that the mechanisms underlying the transmission of the virus remain poorly controlled by some. The belief of the HIV/AIDS transmission through particular supernatural means such as witchcraft is widespread, about 44% (from 37.12% to 50.88% : C.I 95%) of people still believe that HIV/AIDS can be transmitted by supernatural means and a significant 6.5% (from 3.08 to 9.92%: C.I 95%) people do not know whether the virus can be transmitted through supernatural means. Furthermore, we found that the border city of Kasumbalesa is one of the great doors of the HIV/AIDS epidemic by truckers from southern Africa. Indeed, the prevalence of HIV infection among truckers who reported having had at least one sexual intercourse during their stay at the border of Kasumbalesa is 37.07%. Considering poverty as a result of the HIV/AIDS, we have been interested to people living with HIV/AIDS. In this regard, we found that 85.45% of households of persons living with HIV live in poverty. 42.18% of PLWIH experiencing a deep or intense poverty and the index of severity of poverty among people living with HIV/AIDS is about 25.8%. Also 86% of AIDS orphans live in poor households, 43.57% of AIDS orphans live in a state of deep poverty and 27.04% of AIDS orphans live in severe poverty. Concerning the nutritional status of people living with HIV using the Body Mass Index criteria and the ideal weight method we have found: 18.18% of PWLIH have severe malnutrition, 3.64% had moderate malnutrition and 27.27% have a marginal malnutrition. These results suggest that poverty is the major determinant of the HIV/AIDS and its consequences in gathering the others. Indeed, the socio-economic conditions of sexual relations are important determinants of the dynamics of HIV infection. The low ability of women to negotiate sex relation with less risk is a key element of this dynamic. The vulnerability of women is also in economic terms (sex workers or occasional sex relations against retribution, sex between young girls and mature men, women seeking to cover the basic needs with paid sex relation).

The nutrition CRSP: what is marginal malnutrition, and does it affect human function?

This review of the Nutrition Collaborative Research Support Program (Nutrition CRSP) describes the results of a longitudinal study of the effects of marginal malnutrition on human function in Egypt, Kenya, and Mexico. Growth-stunting occurred soon after birth and was associated with cognitive and behavioral deficits in infancy and childhood. Maternal nutritional status was implicated in this phenomenon. All three population groups had poor dietary quality and multiple micronutrient deficiencies, which were associated with poor function. Energy deficiency was a problem only in Kenya.

The functional assessment of nutritional status: principles, practice and potential.

The relatively high prevalence of biochemically diagnosed marginal malnutrition has raised the issue of health significance of the so-called “deficient” and “low” values for certain biochemical parameters on which such diagnoses are usually made. In fact, it Is well known that many cut-off points suggested as the borderline of adequate intake for a given nutrient are rather arbitrary. They have usually been obtained by studying the distribution of an individual biochemical parameter in the populations with different degrees of clinical appearance of malnutrition, and are meant to represent only the guidelines for expressing the levels of nutrients, not to quantify deficiency status. There seems to be little justification for accepting those cut-off points as diagnostic criteria for the impairment of health status due to the deficiency of a respective nutrient.

Skeletal muscle expression of LDH and monocarboxylate transporters in growing rats submitted to protein malnutrition

In different circumstances such as infant malnutrition, old age or chronic disease, decline of muscular strength, particularly anaerobic power, is shown. In this context, our laboratory, has demonstrated a decrease in anaerobic glycolytic power in pre-pubertal Bolivian children living at low and high altitude and suffering from marginal protein malnutrition. To bring molecular support to the relationship between protein malnutrition and anaerobic glycolytic metabolism, we studied the impact of prolonged protein malnutrition on lactate metabolism in different muscles of growing rats. Lactate dehydrogenase (LDH), monocarboxylate transporters (MCT1, MCT4) and membrane protein CD147 were chosen as specific markers of anaerobic glycolytic metabolism. Two groups of 10 weaning male rats were fed for 10 weeks either ad libitum with a well-balanced diet containing 18% protein or an isocaloric-diet containing 8% protein. LDH activity and mRNA amounts of LDH isoforms, MCT, CD147 were measured. Protein deprivation during rat growth induced a decrease of LDH specific activity in skeletal muscles (mean value of -41%), accompanied by isoform distribution modifications in soleus, but not in glycolytic muscles (extensor digitorum longus (EDL) or plantaris). A reduction in mRNA amounts encoding the LDH A and B subunits was observed in EDL. A decrease in LDH B mRNA amounts was monitored in plantaris, whereas no modification in both LDH isoform mRNA quantities was observed in soleus. MCT1 mRNA quantities were decreased in EDL but MCT4 mRNA quantities remained stable. CD147 mRNA amounts were unchanged except for EDL with a 42% increase. The global decreases of LDH activity, LDH and MCT gene expressions in growing rat skeletal muscles support the observed alterations of lactate metabolism associated with lowered muscular anaerobic performances in protein malnutrition.

Application of radiochemical neutron activation and atomic absorption spectrometry methods for the study of nutrition-pollution interactions in children

The application of radiochemical neutron activation analysis (RNAA) and atomic absorption spectrometry (AAS) is expected to aid in understanding and evaluating the effects of environmental pollution on the nutritional status of children already exposed to marginal malnutrition. Samples of placenta, of low-weight and control newborns groups, were collected for determination of nutritional elements and pollutants. The mean ratios of pollutants and nutrients such as Cd/Zn, Hg/Se and Pb/Ca were evaluated for both groups. All these ratios in the placenta of the low-weight newborns are higher than that of the healthy group. The degree of the nutrient-pollutant interaction is evaluated by quantity R, with mercury considered as the most active pollutant while calcium the most active nutrient among the involved elements in process of the interaction.

Activité physique habituelle, influence du sexe et des facteurs environnementaux

Aim. – This paper reviews the effect of gender and life conditions on physical activity during growth. Topics. – Physical activity is reduced during puberty and decreases from 60 min/day at 10 years to 20 min/day at 20 years. During teenage, girls are the less active and their participation to intense activity (>6 Mets) is lower. Socio-economical conditions, marginal malnutrition, cold and hot climates, altitude and ethnic origins have no major influences on the quantity of daily physical activity (average daily heart rate close to 100 bpm). The need of physical activity is similar during growth whatever ethnic origins and live conditions. However these factors may influence the type of habitual physical activities. The time devoted to video activities (on average 1 à 3 h/day) is negatively correlated to physical activity score. Futures prospects. – A main objective in the next 10 years is to deal with the interactions between biological, psychological and sociological factors affecting physical activity. Conclusion. – Physical activity depends mainly on age and sex.

Sudden infant death syndrome requires genetic predisposition, some form of stress and marginal malnutrition

Over the past 30 years or more, the problem of sudden, unexplained death in infants (SIDS) has made little headway. Many hypotheses have been offered but the basic cause remains elusive. The only successful prevention has been made by the supine sleeping posture. There is still, however, a hard core of unexplained incidents. There is evidence that certain stress factors are involved, and there is good evidence that the tragedy has a familial or genetic tendency. The third factor necessary for the event is inefficient oxidation in brain cells induced most commonly by marginal malnutrition in pregnancy or after birth. The absence of any one or more of these three factors decreases risk to the point of extinction. Anything that impedes healthy oxidation, or accelerates energy utilization through responding to stress, increases the risk greatly. Improving the biochemical mechanisms through appropriate nutrition is by far the best defense.

Dietary intake and nutritional status of women and pre-school children in the Republic of the Maldives.

Malnutrition and poor nutritional status among children are common problems in the Republic of Maldives, a small island nation in the Indian Ocean. The aim of this study was to determine possible macro- and micronutrient deficiencies in the traditional Maldivian diet. In five atolls, 333 women with children aged between 1 and 4 years who were no longer breast-fed were interviewed, using a 24-hour recall. Additionally, the weights and heights of both the women and children were measured, and blood samples from 15 women were collected for measurements of vitamins A and E, beta-carotene, homocysteine, cholesterol and haemoglobin. Of the women, 22% had a body mass index (BMI) below 18.5. Of the children, 41% were stunted, 14% were wasted and 51% were underweight. The women's and children's diets were sufficient in protein (14%) and carbohydrates (67%) but deficient in fat, which contributed only 19% to the total energy intake. Consumption of dietary substances that depend on vegetable and fruit intake (e.g. beta-carotene, vitamin C, dietary fibre and folic acid) was low. The low intake of beta-carotene was underlined by low plasma concentration. The estimated iron intake was low, although blood haemoglobin levels were normal. Marginal nutritional status and marginal malnutrition are due to low fat intake and selected micronutrient deficiency. Higher intakes of locally available vegetables and fruits and fat (especially for children) on a regular basis might reverse the deficits documented on the atolls.

Serum insulin-like growth factor I and physical performance in prepubertal Bolivian girls of a high and low socio-economic status.

The aim of the study was to determine if a decrease in serum insulin-like growth factor I (Igf-I) levels under marginal malnutrition is responsible for the lower physical performance of girls of a low socio-economic status (LSES). Girls were selected after physical examination (Tanner's stage 1) and anthropometric measurements (height, body mass or mb, body mass index or BMI = mb height2). Lean body mass mb,1 was measured after skinfold thickness determination; serum IGE-I, by radioimmunoassay; maximal O2 consumption, (VO2max), directly during incremental exercise up to exhaustion; and maximal aerobic power (Wmax), using the force-velocity test. LSES girls (n = 31) had been malnourished in the past and, currently, were suffering from marginal malnutrition: they were smaller (135.2 +/- 5.5 vs 146.1 +/- 4.3 cm), lighter (31.7 +/- 3.9 vs 37.6 +/- 5.0 kg), exhibited a lower mb,1 (24.2 +/- 2.5 vs 27.5 +/- 3.0 kg) but same BMI compared with HSES (high socio-economic status) girls (n = 32). Igf-I levels (27.7 +/- 7.9 vs 34.1 +/- 6.5 nmol.1(-1), VO2max (45.26 +/- 4.72 vs 50.74 +/- 6.02 ml. min-1.kg-1 LBM) and Wmax (6.00 +/- 1.15 vs 8.70 +/- 1.53 W.kg-1 mb,1 were lower in LSES girls. Moreover, the differences in every parameter were not the consequence of the younger age (10.8 +/- 0.9 vs 11.2 +/- 0.6 years) of the LSES girls. Our results provide evidence that the lower Wmax of undernourished prepubertal girls was partly the consequence of alterations in muscle function at the qualitative level, as a result of a decrease in Igf-I levels. Conversely, under normal nutritional conditions, anthropometric characteristics only are explicatory factors for physical performances.

Effect of anthropometric characteristics and socio-economic status on physical performances of pre-pubertal children living in Bolivia at low altitude

We have previously observed that 11-year-old children of low socio-economic status (LSES) showed a delayed physical growth of approximately 2 years and developed lower normalized short-term power output than children of high socio-economic status (HSES) of the same age. In contrast, maximal oxygen uptake (VO2max) per unit of fat free mass was no different in either group. The aim of this study was to evaluate the effect of anthropometric characteristics between HSES and LSES prepubertal children in aerobic and anaerobic performance. To compare children of the same body dimensions, 11-year-old boys (n = 30) and girls (n = 31) of LSES and 9-year-old boys (n = 21) and girls (n = 27) of HSES were studied. Anthropometric measurements, VO2max (direct test), maximal anaerobic power (Pmax, force-velocity test) and mean anaerobic power (P, Wingate test) were determined. In these children having the same body dimensions: mean VO2max were the same in LSES and HSES children [1.2 (SD 0.2) l.min-1]; Pmax and P were lower in LSES subjects [154.0 (SD 33.2) vs 174.6 (SD 38.4) W and 116.3 (SD 23.3) vs 128.2 (SD 28.0) W, respectively]; the linear relationships between VO2max and fat free mass were the same in LSES and HSES boys but, in the girls, the LSES group had lower values. For anaerobic performance, the relationships were significantly different: the slopes were the same but LSES values for the both sexes were lower. These results would suggest that factors other than differences in body dimensions alone were responsible for the lower performance of LSES girls and boys. Cultural factors and motor learning, structural and functional alterations of muscle induced by marginal malnutrition have been discussed.

Sister chromatid exchange frequency is elevated and cell proliferation is delayed in bone marrow cells of starved and marginally malnourished rats

The frequency of sister chromatid exchanges (SCE) and the cell proliferation kinetic were analyzed in bone marrow (BM) cells of Wistar rats subjected to starvation and marginal malnutrition (MN) after 24h of 5-bromodeoxyuridine (BdUr) implantation. SCE were analyzed in a minimum of 18 consecutive second division metaphases and for cell proliferation, 100 consecutive metaphases were analyzed and classified into the first, second and third or subsequent replication cycles. Rats subjected to starvation and MN exhibited significantly higher mean SCE per lymphocyte in bone marrow than the well nourished rats. Further, they also showed a longer proliferation kinetic in BM cells. These observations indicate that starvation and MN per se resulted in greater SCE and prolongation of the cell cycle in experimental animals. On rehabilitation, the cells with high SCE frequency and prolonged cell cycle in both starved and MN rats were comparable to control groups.

Chromosomal abnormalities in starved and marginally malnourished rats and in utero upon rehabilitation.

The effects of starvation and marginal malnutrition (MN) on the lymphocytes of rats were evaluated by chromosomal analysis before and after rehabilitation. The effect of parental starvation or malnutrition on chromosomal aberrations in the foetus was also studied. Wistar rats, 30-35 days old, were starved for 5 days or fed a minimally restricted or a severely restricted diet for three weeks. At the end of the period of starvation or malnutrition, lymphocytes were isolated and chromosomal analysis was performed. Starved and severely restricted rats showed significantly higher mean chromosomal aberrations than the controls. These aberrations returned to a normal level when the experimental groups were rehabilitated for a month, indicating that the damage was transient. A chromosomal aberration study done on foetal cells from rehabilitated rats which had previously been starved or fed a severely restricted diet showed significantly increased values, indicating that some damage was permanent. A low number of implantations was also recorded in these experimental groups. These observations clearly indicate that young animals exposed to conditions like starvation or chronic malnutrition are prone to permanent damage of the genetic system.

Marginal malnutrition in school-aged Colombian boys: metabolic rate and estimated daily energy expenditure

Total daily energy expenditure (TDEE) and energy expenditure in activity (EAc) were estimated in 114 free-ranging, nutritionally normal, and undernourished boys 6–16 yr of age by measuring basal and resting metabolic rates, average daily heart rate while awake, and oxygen consumption and heart rate during exercise on a treadmill. Mean daily heart rates were in the range of exercising heart rates and gave reasonable estimates of TDEE and EAc. TDEE increased with age (p < 0.001) and was reduced in undernourished boys (p = 0.011). Results indicate that nutritional group differences in TDEE were due to differences in body size. EAc increased with age but did not show significant differences between nutritional groups, indicating that in the marginal malnutrition of school-aged children, reduced growth and associated economy of energy expenditure in locomotion is sufficient physiological adaptation. Peer pressure in school and play activities may interfere with the protective mechanism of reduced activity.

Marginal malnutrition and reduced physical work capacity of migrant adolescent boys in Southern Brazil

We measured the effect of marginal malnutrition on physical work capacity of adolescent children of agricultural migrant workers in Southern Brazil. Nutritional status was evaluated using 24-h dietary recall. Body size was evaluated anthropometrically. Biochemical assessments were also made. Physical work capacity (PWC170) was assessed by measuring heart rate, blood lactic acid levels, and oxygen consumption during submaximal bicycle ergometer work. The same tests were also carried out on a comparable group of local well-to-do boys of the same age in the same community who served as controls. The dietary results suggest that adolescent boys of migrant families were marginally malnourished. Their physical growth and development were retarded by at least 1 yr. They had significantly lower reserves of body fat and less muscle mass when compared with controls.Their Hb levels were normal. At the submaximal work loads measured (0, 25, 50, 75 W) the migrant children exhibited similar oxygen consumption and gross exercise efficiency as the control children, but achieved this work at a higher percentage of their maximum work capacity as shown by significantly higher heart rates for the same oxygen consumption. Higher blood lactic acid levels in the migrant children suggest that the available muscle mass was under greater stress to accomplish the same task. PWC170 was reduced one-third in the migrant children (migrant 643 ± 162 kpm/min, control 905 ± 345 kpm/min; p < 0.005). These differences were largely associated with weight (migrant 20.6 ± 5.9 kpm/kg/min; control 18.8 ± 4.3 kpm/kg/min; p > 0.1). These observations suggest that marginal as well as severe malnutrition affect physical work capacity at levels low enough to affect growth and development.

Marginal malnutrition in school-aged Colombian boys: body composition and maximal O2 consumption

Do changes in body composition account for the changes in O2 consumption during maximal exercise (VO2max) in nutritionally deprived boys? School age urban and rural boys with no deficits (N) or with significant deficits (W-H) in weight for age and for height were studied. Percentage lean body mass was higher in W-H than in N boys. By contrast percentage intracellular water, the creatinine excretion coefficient and percentage arm muscle mass were not higher in W-H boys. Thus nutritional compromise decreased more the cellular than the support tissues of the body. VO2max per unit body weight was higher in W-H than in N boys. In the rural group, this was accounted for by the higher percentage lean body mass in W-H boys. In the urban group, VO2max/lean body mass was also higher in most W-H boys. Thus W-H urban boys had higher levels of aerobic training than N urban boys, reflecting perhaps a relative increase in daily physical activity as the same tasks have to be performed with less muscle by W-H boys.

Marginal malnutrition in school-aged Colombian boys: efficiency of treadmill walking in submaximal exercise

Measurements of oxygen consumption (V̇O2) were made during submaximal treadmill exercise (3.5 mph) in 658 boys 6 to 16 yr of age classified as nutritionally normal, low weight for age, and low weight for height. Gross efficiency (at 15% grade) increased with age and was significantly lower in low weight for age and height boys than in normal children but A efficiency showed no statistically significant differences between nutritional groups. It is concluded that marginal malnutrition has no effect on the efficiency of submaximal work during treadmill walking.

Functional Consequences of Marginal Malnutrition among Agricultural Workers in Guatemala

Functional Consequences of Marginal Malnutrition among Agricultural Workers in Guatemala