Av. Badaloo et al., THE EFFECT OF SPLENECTOMY FOR HYPERSPLENISM ON WHOLE-BODY PROTEIN-TURNOVER, RESTING METABOLIC-RATE AND GROWTH IN SICKLE-CELL DISEASE, European journal of clinical nutrition, 50(10), 1996, pp. 672-675
Objective: To determine whether, in the same individual, an observed f
all in whole body protein turnover following splenectomy in children w
ith hypersplenism and homozygous sickle cell (SS) disease is associate
d with a measurable fall in resting metabolic rate (RMR) and an increa
se in rate of growth. Subjects: Six children (5 SS disease, 1 S beta d
egrees thalassaemia), aged 68 to 126 months, were studied before and a
fter splenectomy for hypersplenism. Design: Protein turnover was measu
red by the end product method using prime/intermittent oral doses of N
-15-glycine and RMR by indirect calorimetry before preoperative transf
usion and repeated at least eight weeks after splenectomy. Height and
weight velocities were measured over six month periods before and afte
r splenectomy. Setting: University Hospital of the West Indies in Jama
ica and the Medical Research Laboratories (Jamaica). Results: After sp
lenectomy protein turnover fell significantly by 30% and RMR by 34 kJ/
kg/d. Mean weight velocity which was below normal before surgery, z=-2
.3, improved significantly after surgery, z=0.7, (P=0.03). Height velo
city increased in two children but the mean height velocity did not ch
ange following splenectomy. The reduction in protein turnover was esti
mated to account for 62% of the fall in RMR. Conclusion: This study co
nfirms that there is a significant reduction in energy expenditure fol
lowing splenectomy for hypersplenism in SS disease. A reduction in pro
tein turnover was a major contributor to the saving in energy, althoug
h it is not clear whether it accounted for all. In the present group o
f children the energy saved was associated with an improvement in the
wasting present before splenectomy.