All issues > Volume 5(4); 1962

Original Article

J Korean Pediatr Soc. 1962;5(4):227-243. Published online December 31, 1962.

Clinical Studies on Malnutrition in Korean Children

Keun Soo Lee¹

¹Department of Pediatrics, The National Medical Center, Seoul, Korea

Abstract

Malnutrition, especially protein deficiency malnutrition, is one of the gravest medical and social problems of Korea at the present time. The etiology of malnutrition in Korean children is predominantly chronic underfeeding of protein containing nutreints. A number of studies on severe malnutrion outside of Korea were made by many investigators. Nervertheless, not until now have systematic, scientific studies on severe malnutrition in Korean children been carried out. In these studies, the author has investigated clinical features and biochemical characteristics especially for electrophoretic serum protein pattern of severe malnutrition in Korean children. Severe malnutrition with low serum protein cases were only chosen in this study. Total number was 51 cases. Majority of the cases were orphans. The dietary history indicated a very low protein intake without exception. A Clinical features 70% of the children suffering from malnutrition were between the ages of 6 months and 5 years. No sex predilection was apparent. The weight was from 37% to 65% of the average normal weight. Malaise was present in all cases, muscle wasting was observed in 92%, subcutan fat tissue was very poor in all cases, facial pallor was seen in 72%. Clinical edema was present in 50% of the cases. Edema was often absent in the younger age group despite the very low serum albumin, and there was only one infant with edema below the age of one year. Diarrhea was observed in 68%, hepatomegaly was present in 44% on admission, concurrent infection was present in 70% and pneumonia was most frequent concurrent infection among them. Hair changes were observed in 18%, skin lesion were present in 90% of the group. Some mental and behavior disturbances were seen in 88%. B. Biochemical characteristics. 1.Electrophoretic serum-protein pattern. The serum protein and its electrophoresis were determined with 7-10 days interval in all cases. a)Total serum protein values were decreased in all and serum protein values were lower in edematous children than in those without edema b)Serum albumin values were very low in all Cases. Clinical edema was manifested in most of the patients when the serum albumin values were less than 2 g%, but no strict correlation between the presence of edema and the decrease of serum albumin was seen. c)Alfai-globulin values were varied from patient to patient. d)Alfa2-globulin values were not decreased during acute stage even in a single case, the majority of the cases showed significant increase in alfa2-globulin values. It seemed to be closely correlated with concurrent infection. All cases whic had concurrent infection showed a be significant increase in alfa2-globulin fraction in electrophoretic serum protein pattern. e) Beta globulin values were decreased in many cases during the acute stage. f)Gamma globulin values were often increased in many cases. No significant correlation between concurrent infection and gamma globulin values was seen. 2.Liver function tests. a)The results of thymol turbidity test were normal during the acute stage of malnutrition and the abnormal results of thymol turbidity tests obtained during recovery frequently. b)Cholesterol values were significantly decreased in all cases and returned to normal during recovery. c)Prothrombin indexes were normal in all regardless presence of purpura.d)Alkaline phosphatase values were normal in all cases. e)Glucose tolerance tests: were vaired from patient to patient. 3)Electrolytes: Electrolyte imbalances were seen in more than 50% of the cases. 4)Anemia was only seen in 50%, most probably due to hemoconcentration? Generally, the anemia was normochromic and normocytic. 5)Circulating eosinophils were decreased during acute stage and gradually returned to normal during recovery. 6)Most outstanding urine findings were transient proteinuria and it was observed in 43% during the acute stage. Proteinuria quickly disappeared as recovery took place. 7) The mortality rate was 15% in the author's series.

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