Abstract
The case mortality for severe malnutrition
in childhood remains high, but established best approaches to treatment
are not
used in practice. The energy and protein content of
the diet at different stages of treatment appears important, but
remains
controversial. The effect on growth, urea kinetics
and the urinary excretion of 5-L-oxoproline was compared
between a standard infant formula (HP group) provided in different
quantities at each stage of treatment
and a recommended dietary regimen, which
differentiates the requirements of protein and energy during the acute
phase of resuscitation
(maintenance intake of energy and protein,
relatively low protein to energy ratio, LP group) from those during the
restoration
of a weight deficit (energy and nutrient dense).
The energy required to maintain weight was less in the HP than the LP
group,
but the HP group was not able to achieve as high an
energy intake during repletion of wasting because of the high volume
which
would have had to be consumed. Compared to the LP
group, in the HP group during catch-up growth there was significantly
greater
deposition of lean tissue and higher rates of urea
production, hydrolysis and salvage of urea-nitrogen. These, together
with
higher rates of 5-L-oxoprolinuria, suggest
a greater constraint of the formation of adequate amounts of
nonessential amino acids, especially
glycine, in the face of enhanced demands. Although
more effective rehabilitation might be achieved using a standard
formula,
there is the need to determine the extent to which
it might impose metabolic stress compared with the modified formulation.
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