Abstract
Objective: This study tested the hypotheses that the rate of CO2 production is less in marasmic children with acute infection when compared to well-nourished children, but greater when compared to uninfected marasmic children.
Design: A descriptive comparison of children aged 12–60 months who had their rates of CO2 production measured using a stable isotope tracer dilution method while receiving feedings. Body mass index (BMI) was the best measure of lean body mass available in this study.
Setting: Queen Elizabeth Central Hospital, Blantyre, Malawi.
Subjects: A total of 56 children were studied, 28 with marasmus and acute infection, 16 with marasmus, and 12 well nourished with acute infection. Those with acute infection had malaria, pneumonia, or sepsis.
Results: Well-nourished children with acute infection produced more CO2 than marasmic children (344±60 vs 225±65 mmol CO2/h, mean±s.d., P<0.001; 24.2±4.6 vs 18.4±5.4 mmol CO2/BMI h, P=0.001). However, the rate of CO2 production in marasmic children with acute infection was not greater than in uninfected marasmic children (225±65 vs 228±61 mmol CO2/h). The observed rate of CO2 production was greater than that which could be produced from the dietary intake alone (29.6 vs. 25.8 mmol CO2/kg h).
Conclusions: Marasmic children do not increase energy expenditure in response to acute infection, as well-nourished children do. Dietary energy provided to marasmic children should be at least 420 kJ/kg day.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Ahokas RA, Seydoux J, Llanos QJ, Mashburn TA & Blatteir CM (1985): Hypothalamic opoids and the acute phase glycoprotein response in guinea pigs. Brain Res. Bull. 15, 603–608.
Brandts CH, Ndjave M, Graninger W & Kremsner PG (1997): Effect of paracetamol on parasite clearance time in Plasmodium falciparum malaria. Lancet 350, 704–709.
Bresson JL, Mariotti A, Narcy P, Ricour C, Sachs C & Rey J (1990): Recovery of [13C] bicarbonate as respiratory 13CO2 in parenterally fed infants. Eur. J. Clin. Nutr. 44, 3–9.
Butte NF, Moon JK, Wong WW, Hopkinson JM & Smith EOB (1995): Energy requirements from infancy to adulthood. Am. J. Clin. Nutr. 62(Suppl), 1047S–1052S.
Butte NF, Wong WW, Hopkinson JM, Heinz CJ, Mehta NR & Smith EOB (2000): Energy requirements derived from total energy expenditure and energy deposition during the first 2 y of life. Am. J. Clin. Nutr. 72, 1558–1569.
Elia M (1991): Energy equivalents of CO and their importance in assessing energy expenditure when using tracer techniques. Am. J. Physiol. 260, E75–E88.
El-Radhi AS & Al-Kafaji A (1980): Neonatal hypothermia in a developing country. Neonatology 19, 401–404.
Hamberger L & Lundgren C (1965): Basal metabolic rate in a group of young medical students with a note on body surface area formulas. Scand. J. Clin. Lab. Invest. 17, 221–228.
Hoerr RA, Yu YM, Wagner DA, Burke JF & Young VR (1989): Recovery of 13C in breath from NaH13CO3 infused by gut and vein: effect of feeding. Am. J. Physiol. 257, E426–E438.
Hoffman DJ, Sawaya AL, Coward WA, Wright A, Martins PA, de Nascimento C, Tucker KL & Roberts SB (2000): Energy expenditure of stunted and nonstunted boys and girls living in the shantytowns of Sao Paulo, Brazil. Am. J. Clin. Nutr. 72, 1025–1031.
James WPT, Garlick PJ, Sender PM & Waterlow JC (1976): Studies of amino acid and protein metabolism in normal man with L-[U-14C]tyrosine. Clin Sci. Mol. Med. 50, 525–532.
Kien CL & McClead RE (1996): Estimation of CO2 production in enterally fed preterm infants using an isotope dilution stable tracer technique. J. Parenter. Enteral Nutr. 20, 389–393.
Kinney JM (1995): Metabolic responses of the critically ill patient. Crit. Care Med. 11, 569–586.
Kluger MJ & Rothenburg BA (1979): Fever and reduced iron: their interaction as a host defense response to bacterial infection. Science 203, 374–376.
Kreger BE, Craven DE & McCabe WR (1980): Gram-negative bacteremia: IV. Re-evaluation of clinical features and treatment in 612 patients. Am. J. Med. 68, 344–355.
Manary MJ, Yarasheski KE & Broadhead RL (2002): Urea production and leucine oxidation in malnourished children with and without infection. Metabolism 51, 1418–1422.
Matthews DE, Motil KJ, Rohrbaugh DK, Burke JF, Young VR & Bier DM (1980): Measurement of leucine metabolism in man from a primed, continuous infusion of L-[1-13C]leucine. Am. J. Physiol. 238, E474–E479.
Salas JS, Moukarzel E, Dozio E, Goulet OJ, Putet G & Ricour C (1990): Estimating resting energy expenditure by simple lean-body-mass indicators in children on total parenteral nutrition. Am. J. Clin. Nutr. 51, 958–962.
Schofield WN (1985): Predicting basal metabolic rate, new standards and review of previous work. Hum. Nutr. Clin. Nutr. 39C, 5–41.
Scrimshaw NS & SanGiovanni J (1997): Synergism of nutrition, infection and immunity: an overview. Am. J. Clin. Nutr. 66, 464S–477S.
Shetty PS (1984): Adaptive changes in basal metabolic rate and lean body mass in chronic undernutrition. Hum. Nutr. Clin. Nutr. 38C, 443–451.
Shetty PS, Soares MJ & James WPT (1994): Body mass index: its relationship to basal metabolic rates and energy requirements. Eur. J. Clin. Nutr. 48(Suppl 3), S28–S38.
Soares MJ, Piers LS, Shetty PS, Robinson S, Jackson AA & Waterlow JC (1991): Basal metabolic rate, body composition and whole-body protein turnover in Indian men with differing nutritional status. Clin. Sci. 81, 419–425.
Soares-Wynter SY & Walker SP (1996): Resting metabolic rate and body composition in stunted and nonstunted children. Am. J. Clin. Nutr. 64, 137–141.
Spear ML, Darmaun D, Sager BK, Parsons WR & Haymond MW (1995): Use of [13C]bicarbonate for measurement of CO2 production. Am. J. Physiol. 268, E1123–E1127.
Stettler N, Schutz Y, Whitehead R & Jequier E (1992): Effect of malaria and fever on energy metabolism in Gambian children. Pediatr. Res. 31, 102–106.
Tissot S, Delafosse B, Normand S, Bouffard Y, Annat G, Viale JP, Pachiaudi C, Riou JP & Motin J (1993): Recovery of [13C] bicarbonate as respiratory 13CO2 in mechanically ventilated patients. Am. J. Clin. Nutr. 57, 202–206.
Waterlow JC (1992): Protein-energy Malnutrition. London: Edward Arnold.
Wellcome Trust Working Party (1970): Classification of infantile malnutrition. Lancet 2: 302–303.
World Health Organization (1999): Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: WHO.
Yarasheski KE, Zachwieja JJ, Gischler J, Crowley J, Horgan MM & Powderly WG (1998): Increased plasma Gln and Leu Ra and inappropriately low muscle protein synthesis rate in AIDS wasting. Am. J. Physiol. 275, E577–E583.
Zemel BS, Riley EM & Stallings VA (1997): Evaluation of methodology for nutritional assessment in children: anthropometry, body composition and energy expenditure. Annu. Rev. Nutr. 17, 211–235.
Author information
Authors and Affiliations
Contributions
Guarantor: MJ Manary
Contributors: MJM designed the study, enrolled and followed the children, analyzed the data and wrote the manuscript. KEY designed the study, performed the laboratory analyses, analyzed the data and wrote the manuscript. RB performed the laboratory analyses and wrote the manuscript. RLB enrolled and followed the children and wrote the manuscript. None of the authors have any potential conflicts of interest.
Sponsorship: Supported by National Institutes of Health (RO1HD38422), the Washington University Biomedical Mass Spectrometry Facility (NIH RR00954), and Clinical Nutrition Research Unit (NIH P30 DK56341).
Corresponding author
Rights and permissions
About this article
Cite this article
Manary, M., Yarasheski, K., Berger, R. et al. CO2 production during acute infection in malnourished Malawian children. Eur J Clin Nutr 58, 116–120 (2004). https://doi.org/10.1038/sj.ejcn.1601757
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.ejcn.1601757