WHOLE-BODY PROTEIN KINETICS IN MARASMUS AND KWASHIORKOR DURING ACUTE INFECTION

Marasmus and kwashiorkor are clinically distinct manifestations of sev ere malnutrition. This study tested the hypothesis that rates of whole -body protein synthesis and breakdown are higher in marasmus than in k washiorkor during acute infection. We measured whole-body protein kine tics using stable isotope tracers in eight children with marasmus and acute infection (pneumonia or malaria) to determine the rate of appear ance of urea and leucine in plasma. Serum concentrations of total prot ein, albumin, and C-reactive protein were also measured. These finding s were compared with those reported previously for 13 children with kw ashiorkor (including marasmic kwashiorkor) and acute infection who wer e studied with the same methods. HIV infection was present in 10 of 21 children. Rates of protein breakdown and synthesis were higher in mar asmus than in kwashiorkor (227 +/- 59 compared with 103 +/- 30 mu mol leucine.kg(-1).h(-1) and 216 +/- 60 compared with 97 +/- 30 mu mol leu cine.kg(-1).h(-1), P < 0.001). The concentration of globulin (total pr otein minus albumin) was higher in marasmus than kwashiorkor (40 +/- 1 7 compared with 25 +/- 7 g/L, P less than or equal to 0.01), but C-rea ctive protein was not different (73 +/- 79 compared with 83 +/- 89 mg/ L). HIV infection and body composition did not explain the differences between marasmus and kwashiorkor. The accelerated rate of protein tur nover in children with marasmus and acute infection requires further i nvestigation.