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A Study on Protein-Calorir Malnutrition
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KMID : 0353019680050020077
Abstract
A study was conducted by the author in September 1968 towards the infants and young children in some underprivileged rural villages of Korea by employing such methods as clinical assessment, nutritional biometry, and biochemical tests, in an attempt to evaluate their nutritional status with possible reference to protein calorie malnutrition (PCM).
The infants and young children examined totaled 232 of whom 111 were boys and 121 were girls.
The results are as follows:
¥°. Clinical Assessment
The prevalence rates of the signs suggestive of PCM turned out to be as below :
1) Cases with dyspigmented hair were observed with 4.5% of the 45 infants examined. and 18.8% of the 187 young children examined.
Cases with thin and sparse hair were seen with 22.8% of the infants, 14.0% of the young children, and l5.2% of both the infants and young children.
2) Prevalence of the pale conjunctiva rated 28.6% of the infants. 32.3% of the young children, and 30.4% of both the infants and young children.
3) Keratomalacia cases were found in 0.5% of the young children only and they corresponded, in turn, to 0.4% of the whole examined.
4) Cases with angulostomatitis rated 14.0% of the young children only, who constituted 10.0% of the total examined.
5) Those with moon-face were observed only with 2.3% of the infants, rating 0.4% of the total.
6) Cases with flaky-paint dermatosis were observed with 2.3% of the infants, 0.5% of the young children, and 0.9% of both the infants and young children.
7) Those who were found to have such skin lesions as fissure of the ear lobe, tender sores, or moist groin rash rated 15.9% of the infants, 20.4% of the young children, and 19.6% of both the infants and children.
8) Rate of those with muscles wasted was 11.4% of the infants, 25.8% of the young children, and 23.0% of both the infants and young children.
9) Those with edema were observed only with 0.5% of the young children. rating 0.4% of the total.
10) Psychomotor changes (apathetic, miserable, inert, withdrawn, or anorexic) rated 7.0% of the young children only, and 5.7% of the whole examined.
11) Prevalence rate of diarrhea precipitating dehydration and such other conditioning infections as thrush was found to be 20.5% of the infants, 7.5% of the young children, and 10.0% of both the infants and young children.
12) The results of clinical assessment led the author to the following findings:
(1) Those corresponding to 29.1% of the whole examined had one or two combined signs suggestive of PCM.
(2) Those with three or more signs combined rated 1.3% of the total children examined.
(3) No clinically obvious kwashiorkor was found, but each of the component signs which, in constant combination, characterize it (edema, muscle-wasting, and psychomotor changes) was separately observed mainly with the young children as presented in table 2.
(4) Those who impressed the author with clinically obvious nutritional marasmus were 6.7% of the infants, 3.2% of the young children, and 3.9% of both the infants and young children.
¥±. Nutritional Biometry
1) The mean heights. weights, chest circumference, and head circumference obtained were as shown in table 3.
2) The mean triceps skin-fold thickness, upper mid-arm-circumference. and upper-mid-arm-muscle circumference were as presented in table 4.
3) Distribution of the heights by four levels of 10% intervals indicated underweights in the light of Korean general standard, as shown in table 10.
4) Distribution of the weights contrasted likewise with the Korean general standard were as shown in table 11.
5) The underweights demonstrated by cases of mild-moderate PCM computed at four levels of 10% intervals as against the Korean general standard, rated 42.2% of the infants, 42.8% of the young children, and 42.7% of both the infants and young children. by the criteria Dr. Jelliffe suggested ??.
The severe PCM cases were comprised 31.1% of the infants, 7.5% of the young children. and 12.1% of both groups of them.
In the light of the above rates, more than a half of the children examined were found to be affected with PCM ascribable to deficiency of both the protein and calorie.
6) The cases with "Chest circumference/Head circumference Ratio being below 1 after the first 6 months of life" suggestive of the wasting of pectoral muscles which is attributable to PCM corresponded to 57.1% of the infants, 25.1% of the young children, and 29.3% of both the infants and young children as shown in table 13.
¥². Biochemical Tests
1) Hemoglobin levels were found to be anemic (level less than 10.8gm%) with 13.8% of the 80 children examined as presented in table 5.
2) Serum total protein and serum albumin levels were as shown in tables 6 and 7, respectively.
The serum albumin levels turned out to be normal with 75.9%, and "low"(2.80gm%¡3.51gm%) with 24.1% of the examined. No deficiency level (less than 2.80gm%) was found among the 29 children.
3) Serum iron content and total serum iron-bindin capacity (TIBC) were as shown in table 8.
The deficiency levels of serum iron content less than 50 microgram % comprised 33.3% of the 21 children examined.
Those corresponding to 25% and 75% of the 16 children examined had values of TIBC within normal range (300 microgram %¡400 microgram %) and values below the normal range (less than 300 microgram %), respectively, and no case exceeded over the range of normality inspite of the low serum iron content, suggesting the possible ascription to chronic protein deficiency ??.
4) "Urinary Urea-nitrogen / Creatinie-nitrogen excretion Ratios" regarded as an approximte index of dietary adequacy related to muscle storage of protein were obtained as presented in table 9.
The cases with the ratios "30 or less" (an indication of malnutrition related to dietary adequacy of protein) rated 58.8% of the 34 children examined.
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