WHOLE-BODY PROTEIN KINETICS IN CHILDREN WITH KWASHIORKOR AND INFECTION - A COMPARISON OF EGG-WHITE AND MILK AS DIETARY SOURCES OF PROTEIN

This study tested the hypothesis that during treatment of kwashiorkor (including marasmic kwashiorkor) with infection there is a lower rate of amino acid oxidation when the dietary intake of amino acids resembl es the amino acid composition of acute phase proteins (APPs). Twenty-t wo children in Blantyre, Malawi, with kwashiorkor and acute infection were fed an isoenergetic, isonitrogenous diet with either egg white or milk as a protein source. The whole-body amino acid oxidation rate wa s measured after 24 h by determining the plasma urea rate of appearanc e, and whole-body protein breakdown and synthesis rates were determine d from the plasma leucine rate of appearance. Plasma concentrations of C-reactive protein, alpha(1)-antitrypsin, tumor necrosis factor alpha (TNF-alpha), and interleukin 6 (IL-6) were determined on admission an d at 24 and 48 h. The II children who received milk had a lower rate o f amino acid oxidation than the children who received egg white ((x) o ver bar +/- SD: 137 +/- 65 compared with 195 +/- 66 mu mol urea.kg bod y wt(-1).h(-1), P < 0.05). No significant differences were found betwe en the two groups in the rate of whole-body protein breakdown or prote in synthesis. The TNF-alpha concentration correlated inversely with wh ole-body protein breakdown and synthesis rates, and the IL-6 concentra tion correlated directly with C-reactive protein. We conclude that by making the amino acid composition of the diet resemble that of APPs in the treatment of acute kwashiorkor, the rate of amino acid oxidation can be decreased.