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Treatment
Vinodini
Reddy
of kwashiorkor
and
Children
200
kcal/kg.
opaque-2
maize
weeks.
The
They
results
Both
the
were
comparable
clinical
opaque-2
maize
122-124,
1974.
divided
twelve
and
indicate
and
kwashiorkor
with
were
other
that
because
of
appears
to
its
low
be
with
as
content
of
The
milk
of
milk
received
diet
in the
in children
Thus,
providing
the
composition
of
the
of
consumed
quality
Am.
protein.
a period
treatment
who
nutritive
for
4 g/kg
a diet
diets
protein
based
of
on
5
4 to
kwashiorkor.
the
maize
of the
.1. Clin.
is given
diet
protein
Nutr.
in
of
27:
Table
1.
Opaque-2
maize
was
analyzed
for
the
protein
and
lysine
content.
Protein
was
determined
by
the
macro-Kjeldahl
procedure
and
lysine
by a microbiological
technique
described
earlier
(3).
The
protein
content
was 9.2%
and the concentration
of lysine
was
4.25
g/100
g protein.
Maize
was given
in the form
of
chapati
(unleavened
bread)
or porridge.
In addition,
all
the children
received
one multivitamin
tablet
(vitamin
A, 2,000
IU;
vitamin
D, 200
IU;
thiamin,
1 mg;
riboflavin,
1.2 mg; ascorbic
acid,
30 mg)
and
one
fersolate
tablet
(60 mg iron)
per day.
A daily
record
of clinical
progress
and body
weight
was maintained.
Blood
samples
were
obtained
at the
time
of admission
and
again
on the
10th and 30th
days
of treatment.
Hemoglobin
was determined
as
oxyhemoglobin
and
serum
albumin
was estimated
by
the
micro-Kjeldahl
method
after
fractionating
with
28% sodium
sulfite.
Criteria employed
in the assessment of response are
1) time taken
for the disappearance
of edema,
2) gain
in
weight
after
the
minimum
body
weight
was
reached, and 3) serum
albumin
regeneration.
and methods
the
diet
completely
because
cases
were
excluded
from
the
Ten
children
who
consumed
others
who
consumed
the
followed
for
a period
of 4
groups
were
comparable
with
and severity
that
a diet
children
is effective
milk.
as
with
Ten
a skim
observed
skim
good
Twenty-two
children
with
kwashiorkor
were
investigated.
They
were
grossly
underweight
with
varying
levels
of edema
and
hypoalbuminemia.
In addition,
some
of
them
showed
mental
changes
and
skin
changes.
Their
ages ranged
from
1 to 5 years
and their
weights
from
5 to
10
kg.
The
children
were
hospitalized
for 4 to 5 weeks
and were
given
diets
which
provided
4 g/kg
of protein
and
200
kcal/kg
body
wt.
They
were
divided
into
two
groups.
One
group
received
a diet based
on opaque-2
maize
and the
other
group
received
a skim
milk diet.
Children
with
severe
anorexia
refused
to take
the maize
so they had
to be given
skim
milk.
Some
of them
could
not
consume
maize
responses
obtained
groups.
received
opaque-2
biochemical
to those
treated
two
children
acids,
particularly
lysine.
In
recent years,
efforts
have been made to produce
food
grains of better
nutritional
quality.
Opaque-2
maize
is a variety
of corn
which
contains
higher
amounts
of lysine
and tryptophan than ordinary corn. Studies in experimental animals have
shown
that
PER
value
for
opaque-2 maize is equal to that of milk protein
(1, 2) and it has been suggested
that this can
replace
milk
in the diets
of children
in poor
communities.
A clinical
trial
was
therefore
undertaken
to test
the efficacy
of opaque-2
maize
in the
treatment
of protein-calorie
malnutrition.
Materials
maize’
of the bulk.
Six
study
for these
reasons.
the maize
diet
and
12
skim
milk
diet
were
to S weeks.
These
two
regard
to age, weight,
Results
Acceptability
The skim milk diet was readily
accepted
by
all the children
but
some
difficulty
was
encountered
in feeding
the maize
diet.
They
could
not take the diet completely
because
of
the bulk.
Even the 10 children
who consumed
the maize diet had to be coaxed
and persuaded
to do so during
the first 4 to 5 days. Once they
recovered
from
the
acute
stage,
however,
feeding was no longer a problem.
‘From
Council
of
the National
Institute
of Nutrition,
Medical
Research,
Jamai-Osmania,
bad-500007,
of edema.
Indian
Hydera-
India.
122
The American
Journal
of Clinical
Nutrition
27:
FEBRUARY
1974,
pp.
122-124.
Printed
in U.S.A.
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
is poor
amino
were
into
Cereals
form the staple diet in many developing countries
where
protein-calorie
malnutrition is widely
prevalent.
The quality
of cereal
protein
essential
opaque-2
C. P. Gupta
ABSTRACT
and
with
TREATMENT
Clinical
OF
KWASHIORKOR
response
There was littledifference between the two
groups with regard to the
rate
of clinical
improvement
(Table 2). The time taken for the
disappearance
of edema ranged from 1 to 3
weeks in both groups. At the end of 4 weeks of
treatment,
the mean
weight
gain
after
the
minimum
body weight was reached was 0.7 kg
in the group who received the maize diet and
0.9 kg in the children
who received
the skim
milk one. Improvement
of the associated
signs
of malnutrition
such as the mental
and skin
changes
also did not differ in these two groups.
Hemoglobin
admission,
anemia,
the Hb
TABLE
1
Composition
Skim
Dry
of the
milk
skim
the children
levels ranging
moderate
7 to
11
diets’1
Maize
milk
9
Ghee
Sugar
Opaque-2
20
Ghee
8
8
Sugar
Two bananas/day.
‘1Amount
in grams
per kilogram
b Protein,
4 g/kg;
calories,
200/kg
diet’
45
5
S
maize
body
weight.
body
wt.
2
Response
to treatment
Opaque-2
Groups
Time taken
maize
fordis-
appearance
of
edema,
days
Initial
body
weight,
kg
Gain
in weight,
kg
in 30 days
15.0
±
2.6
8.4
±
0.67
0.7
±
0.12
milk
Skim
15
±
1.9
7.6
±
0.54
0.9
±
0.10
Initialalbumin level, 1.88 ± 0.168
g/l00 ml
1.63 ± 0.164
Increase
g/l00
day
Increase
g/lOO
day
in albumin,
±
0.112
0.66
±
0.115
in albumin,
ml on 30th
1.08
±
0.173
1.23
±
0.171
ml on
8.0
±
0.24
8.6
±
0.46
Hb, g/lOO
10th
Serum
admission
9.5±0.34
are means
±
g to
albumin
9.5
g/100
ml
in
the
group
regeneration
On admission,
the serum albumin
concentration was low in all the children,
the mean levels
being
1 .88 and 1 .63 g/l 00 ml in groups
1 and
2, respectively.
The albumin
level increased
by
0.66 and 1 .23 g/l 00 ml on the 10th and 30th
day after treatment
with skim milk, whereas
in
the other group,
the increase
in serum albumin
was slightly
lower,
0.53 and I .08 g/lOO ml on
the 10th
and 30th
day after
treatment
with
opaque-2
maize.
However,
these
differences
were not statistically
significant.
The results
of the present
study indicate
that
opaque-2
maize is effective
in the treatment
of
kwashiorkor.
The response
observed
in children
who consumed
the maize diet was comparable
to that
obtained
with
skim milk. The rise in
serum albumin
in these children
was nearly 90%
of that observed
in children
treated
with skim
milk.
Earlier
studies
with
different
vegetable
proteins
have
shown
that
although
they
are
effective
in controlling
the acute clinical
manifestations
of kwashiorkor,
they are inferior
to
skim milk as far as serum albumin
regeneration
is concerned
(4). In this study,
the mean rise in
albumin
level obtained
with
opaque-2
maize
was
I .08 g/ I 00 ml, which
is close to the I .04
g/100
ml observed
in the earlier
experiment
with bengal gram protein (4) and much higher
than
the values
obtained
with diets based
on
cottonseed (5), sesame, groundnut
and cerealpulse
combinations
(4). Thus, the quality
of the
protein
of
SE.
9.3±
0.39
opaque-2
maize
appears
to
be
that of several
vegetable
proteins
and close to that of milk protein.
Though
skim milk has proved
to be most
effective
in the treatment
of kwashiorkor,
this
cannot
be the practical
answer
to the problem
to
of widespead
Hb,g/loomlon
30th day
Values
8.0
there
a mean
receiving
the maize diet and from 8.6 g to 9.3
g/100
ml in the group
treated
with skim milk.
superior
0.53
ml on
of
weeks
after
treatment,
increase
in Hb from
Discussion
dietb
Bread
TABLE
had
from
g/100
ml. Four
was a significant
level
123
MAIZE
Sources
found.
foods
protein
therefore
deficiency
in the
country.
cheaper
than milk have to be
for suitable
vegetable
protein
of protein
The search
becomes
Although
several
into
consideration
important.
factors
in the
have
choice
to be taken
of a vegetable
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
On
levels
WITH
124
REDDY
AND
Both clinical
and biochemical
responses
observed
in children
who received
the maize diet
were comparable
to those
obtained
with skim
milk.
A rise in serum
albumin
levels in these
children
was approximately
90% of that
observed in children
treated
with skim milk,
Because
the nutritive
quality
of protein
of
opaque-2
maize is almost
equivalent
to that of
milk protein,
inclusion
of this millet in the diets
may be expected
to improve
the quality
of the
diet and thus improve
the nutritional
status
of
undernourished
populations.
El
References
1.
MERTZ,
E. T.,
0.
0. E. NELSON.
maize.
2.
Science
148:
BRESSANI,
with
G.
ELIAS
AND
R. A.
Protein
quality
of opaque-2
in rats. J. Nutr. 97: 173, 1969.
Y. G., AND K. C. PANT. Nutrient
L.
Indian
vegetable
J. Med.
5. SRIKANTIA,
AND
fed on opaque-2
composition
and
amino
acid pattern
of
yielding
maize
varieties.
Indian
J. Nutr.
244,
1971.
SRIKANTIA,
S. G., AND
C. GOPALAN.
trials
protein
Res.
48:
foods
637,
S. G., AND
some
high
Dietet.
8:
Clinical
in kwashiorkor.
1960.
SAHGAL.
Use
seed protein
in protein-calorie
malnutrition. Am. J. Clin. Nutr.
21: 212,
1968.
BRESSANI,
R. Protein
quality of opaque-2 maize
in children.
Proc.
High
Lysine
Corn
Coni.
Corn
Refiners
Assoc.,
Inc.
Washington,
D.C.,
1966,
p.
of
6.
L. S. BATES
of rats
1965.
1741,
R.,
GOMEZ-BRENES.
corn, evaluation
3. DEOSTHALE,
4.
A. VERON,
Growth
SHANTI
cotton
34.
7. YOUNG,
V.
R.,
I. OZALP,
B. B. CHOLAKOS
N. S. SCRIMSHAW.
Protein value of Colombian opaque-2
corn
for young
adult
men.
J. Nutr.
101:
1475,
1971.
CLARK,
H. E., P. E. ALLEN,
S. M. MEYERS,
S.
AND
Summary
Twenty-two
treated
with
children with kwashiorkor were
a diet providing
4 g/kg of protein
and
200
divided
into
two groups.
One group
received
a
based
on opaque-2
maize
and
the other
received
a skim
milk diet for a period
of
diet
group
kcal/kg
4 to 5 weeks.
body
wt.
The
children
8.
E.
were
9.
TUCKETf
AND
Y.
YAMAMURA.
Nitrogen
balances
of adults
consuming
opaque-2
maize
protein.
Am. J. Clin. Nutr.
20: 825,
1967.
Indian
Agricultural
Research
Institute.
Recent
research
on
the improvement
of protein
and
nutritional
properties
of food and feed plants,
IARI.
1971.
Res.
Bull.
(New
Series
No.
6),
New
Delhi,
Downloaded from ajcn.nutrition.org by guest on September 9, 2014
protein
food,
one of the most important
is its
nutritive
value, Studies
in experimental
animals
have shown
that the PER value for opaque-2
maize is equivalent
to that of casein (1, 2). The
results
of the present
study
as well as the
balance
studies
reported
in normal
subjects
(6-8)
confirm
the fact that the nutritive
value
of opaque-2
maize
protein
is indeed
high and is
well utilized
by humans.
Recipes
containing
opaque-2
maize
as an ingredient
can therefore
be
recommended
as food
supplements
to
prevent
protein-calorie
malnutrition
in children.
Though
children
with kwashiorkor
who
were acutely
ill could
not consume
the maize
diet completely,
acceptability
was found
to be
good
after
recovery
and
also among
those
children who were suffering from a mild or
moderate degree of malnutrition.
Maize is an important
food crop in India and
is well accepted
by many people.
Hybrid
com
has
already
gained
popularity
among
our
farmers. Recently, high-lysine maize composites,shakti and rattan, containing the opaque-2
gene
have
been
developed
at
the
Indian
Agriculture Research Institute (9) and are now
available
for cultivation.
Food
grains of high
nutritive
quality
have tremendous
significance
in the nutrition
of people
in many
developing
countries. Inclusion of such grains in the diets
appears to be a practical approach to improve
the protein
nutritional
status of the population.
GUPTA