Nutrition Programme, International Centre for Diarrhoeal Disease Research, Bangladesh, ICDDR, B, Dhaka, Bangladesh.
Indian J Med Res. 2009 Nov;130(5):651-4.
Oedematous malnutrition, represented by its most severe form kwashiorkor, is rampant in many parts of the world and is associated with a high case fatality rate. Despite being first described more than a century ago, the pathogenesis of kwashiorkor is still not clear. The traditional thinking is that it results from a deficiency of dietary protein and is usually associated with an infection. This has now been challenged by the finding that there is no difference in diets of children developing marasmus or kwashiorkor. Nutritional oedema is associated with an increased secretion of anti-diuretic substance (probably antidiuretic hormone) which prevents the normal excretory response to water administration. Experimental studies have shown that feeding low-protein, low-calorie diets results in delayed and incomplete response to a water load, and that the livers of the animals show a reduced capacity for inactivating anti-diuretic hormone. There is now evidence that links generation of free radicals and depletion of anti-oxidants with the development of oedema in kwashiorkor.
浮肿性营养不良，以其最严重的形式夸希奥科（Kwashiorkor）为代表，在世界许多地方普遍存在，并且与高病死率相关。尽管这种疾病在一个多世纪以前就已被首次描述，但它的发病机制仍不清楚。传统观点认为，它是由饮食中蛋白质缺乏引起的，通常与感染有关。但现在的发现对此提出了挑战，即患消瘦症或夸希奥科的儿童的饮食并无差异。营养性水肿与抗利尿物质（可能是抗利尿激素）的分泌增加有关，这会阻止正常的水排泄反应。实验研究表明，喂食低蛋白、低热量饮食会导致对水负荷的反应延迟和不完全，并且动物的肝脏表现出降低的抗利尿激素失活能力。现在有证据表明，自由基的产生和抗氧化剂的消耗与夸希奥科水肿的发展有关。
