Dietary protein, growth and urea kinetics in severely malnourished children and during recovery

The case mortality for severe malnutrition in childhood remains high, but e stablished best approaches to treatment are not used in practice. The energ y and protein content of the diet at different stages of treatment appears important, but remains controversial. The effect on growth, urea kinetics a nd 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 requ irements of protein and energy during the acute phase of resuscitation (mai ntenance intake of energy and protein, relatively low protein to energy rat io, LP group) from those during the restoration of a weight deficit (energy and nutrient dense). The energy required to maintain weight was less in th e 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 d uring catch-up growth there was significantly greater deposition of lean ti ssue and higher rates of urea production, hydrolysis and salvage of urea-ni trogen. These, together with higher rates of 5-L-oxoprolinuria, suggest a g reater constraint of the formation of adequate amounts of nonessential amin o 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 str ess compared with the modified formulation.