Beard J L, Gomez L H, Haas J D
Am J Clin Nutr. 1986 Aug;44(2):181-7. doi: 10.1093/ajcn/44.2.181.
The effect of severe protein-energy malnutrition (PEM) on erythropoiesis in children living in the highlands of Bolivia, altitude 3700 m, was studied. Forty percent reduced hemoglobin concentrations, significantly lower arterial oxygen tensions, and a right-shifted, oxygen-dissociation curve were observed compared to high-altitude controls. Serum and erythrocyte folate concentrations were 44% and 82%, respectively, of control values. Low initial transferrin saturation decreased significantly during the 10-wk refeeding period. Thus, iron and folate deficiency contributed significantly to the poor red cell response. Results suggest that the anemia associated with severe PEM has a more significant impact on oxygen transport at high altitude than at sea level and requires an adaptive response in the oxygen-dissociation curve to satisfy tissue-oxygen demands. Furthermore, marginal iron and folate status and an inflammatory block of iron supply may limit the reestablishment of a normal tissue mass during refeeding.
研究了严重蛋白质-能量营养不良（PEM）对生活在玻利维亚高原（海拔3700米）儿童红细胞生成的影响。与高原对照组相比，观察到血红蛋白浓度降低了40%，动脉血氧张力显著降低，氧解离曲线右移。血清和红细胞叶酸浓度分别为对照值的44%和82%。在10周的再喂养期内，低初始转铁蛋白饱和度显著下降。因此，铁和叶酸缺乏是导致红细胞反应不佳的重要因素。结果表明，与严重PEM相关的贫血在高海拔地区对氧运输的影响比在海平面更为显著，并且需要氧解离曲线的适应性反应来满足组织的氧需求。此外，边缘性铁和叶酸状态以及铁供应的炎症性阻断可能会限制再喂养期间正常组织量的重建。
