Study on malnutrition. III. Biochemical assessment of the dietary treatment and evolution of the illness.

During the course of a malnutrition study, the efficiency of two diets has been followed by clinical observations and biochemical tests. The diets were adapted to the physiological state of 25 patients (16 children, 6 young mothers, 1 adolescent and 2 men) undergoing treatment in a rural hospital at Yasa-Bonga, Zaïre. One group of patients was examined after two weeks of treatment (6 children, 2 mothers), the other group after two months (8 children, 5 adults). In order to study the evolution of the illness, 9 children and 3 young mothers were examined regularly after the return to their villages every 6 months for 2-4 years. The patients responded positively to both diets. After two months of treatment they had clinically recovered, except for the most serious cases. After two weeks of treatment a deficiency in electrolytes, low levels of prealbumin and a net increase in transferrin were noted. After 2 months of treatment the children had regained their normal growth (hydroxyproline index), and most of the biochemical parameters had reached their normal value despite a few deficiencies in electrolytes, phosphorus and magnesium. However, the prealbumin level remained low, particularly amongst children suffering from relapses. In a few cases the activities of cholinesterase (CHE) and gamma-glutamyltranspeptidase (gamma-GT) remained low, which was taken as a sign of poor response to treatment. Generally, the adults responded more slowly to treatment than the children. Regular examinations carried out on certain patients on their return to the villages permitted 2 groups to be distinguished: the first one was composed of patients recuperating well due to good social conditions; the second group of patients suffered from relapses due to lack of hygiene and of rudimentary knowledge of nutrition, and above all severe social problems. The condition of the liver of all these patients was very important; it could be estimated by the determination of the serum levels of prealbumin and the activities of CHE, gamma-GT and isoenzymes of gamma-GT.