Is the adult protein-energy malnutrition syndrome the same as that described in the infant?

Protein-energy malnutrition, a multi-factorial disease, has been described predominantly in the infant. It was the aim of this research to give a biochemical assessment of the adult form and to compare it to the infantile syndrome within the same socio-cultural context of central Zaïre (Kwilu region). Thirty-four children, 22 women and 2 men suffering from marasmic kwashiorkor at the hospital of Yasa-Bonga (Kwilu) were submitted to a complete set of 7 anthropometric and 60 biochemical tests. The control values were taken from healthy well-fed children and adults from Yasa-Bonga; for certain parameters, rural adult control values were also obtained. Dyspigmentation was found in all patients, children and adults alike. The other symptoms were, in decreasing order of importance : oedema, dermatitis, apathy and liver enlargement, often accompanied by associated secondary pathology. In the children, all anthropometric indices were well below normal. In serum, total protein, albumin, prealbumin, ceruloplasmin and haemoglobin were reduced; the alpha 1, alpha 2 and beta-globulins were slightly reduced in infants but not much modified in adults, whereas gamma-globulins were slightly increased in adults only. IgG and IgM were increased in both infants and adults, the enhancement was less pronounced for IgA. Essential amino acids in serum were reduced in the patients and most non-essential amino acids raised, with the exception of tyrosine and arginine which were reduced like the essential amino acids. Some ratios (phenylalanine/tyrosine, serine/threonine, and non-essential/essential amino acids) proved to be very sensitive parameters for this type of protein-energy malnutrition. No differences were found in the amino acid levels between adult and infant patients, with the exception of alanine which was higher in the adults. Alanine levels were also high in the rural adult controls as compared to the European controls, probably due to the extremely high carbohydrate (manioc) diet. Serum electrolytes were normal in adult patients, with the exception of low Ca, whereas in children P and Mg were also low. Total lipids and cholesterol were reduced in adult and infant patients. The urinary excretion of all parameters measured (N, urea, creatinine, hydroxyproline, electrolytes, trace elements and some vitamins) was reduced in the patients with only small differences between adults and infants.(ABSTRACT TRUNCATED AT 400 WORDS)