Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
Feinstein International Center, Tufts University, Boston, MA, USA.
Am J Clin Nutr. 2021 Sep 1;114(3):925-933. doi: 10.1093/ajcn/nqab136.
Kwashiorkor is an often-fatal type of severe acute malnutrition affecting hundreds of thousands of children annually, but whose etiology is still unknown. Evidence suggests inadequate sulfur amino acid (SAA) status may explain many signs of the condition but studies evaluating dietary protein intake in relation to the genesis of kwashiorkor have been conflicting. We know of no studies of kwashiorkor that have measured dietary SAAs.
We aimed to determine whether children in a population previously determined to have high prevalence of kwashiorkor [high-prevalence population (HPP)] have lower dietary intakes of SAAs than children in a low-prevalence population (LPP).
A cross-sectional census survey design of 358 children compared 2 previously identified adjacent populations of children 36-59 mo old in North Kivu Province of the Democratic Republic of the Congo. Data collected included urinary thiocyanate (SCN), cyanogens in cassava-based food products, recent history of illness, and a 24-h quantitative diet recall for the child.
The HPP and LPP had kwashiorkor prevalence of 4.5% and 1.7%, respectively. A total of 170 children from 141 households in the LPP and 169 children from 138 households in the HPP completed the study. A higher proportion of HPP children had measurable urinary SCN (44.8% compared with 29.4%, P < 0.01). LPP children were less likely to have been ill recently (26.8% compared with 13.6%, P < 0.01). Median [IQR] intake of SAAs was 32.4 [22.9-49.3] mg/kg for the LPP and 29.6 [18.1-44.3] mg/kg for the HPP (P < 0.05). Methionine was the first limiting amino acid in both populations, with the highest risk of inadequate intake found among HPP children (35.1% compared with 23.6%, P < 0.05).
Children in a population with a higher prevalence of kwashiorkor have lower dietary intake of SAAs than children in a population with a lower prevalence. Trial interventions to reduce incidence of kwashiorkor should consider increasing SAA intake, paying particular attention to methionine.
夸希奥科病是一种常见的致命性严重急性营养不良症，每年影响数十万儿童，但病因仍不清楚。有证据表明，硫氨基酸（SAA）状态不足可能解释许多该病的症状，但评估与夸希奥科病发病相关的饮食蛋白质摄入的研究结果存在矛盾。我们不知道有研究测量过夸希奥科病患者的饮食 SAA。
我们旨在确定先前确定高患病率夸希奥科病（高患病率人群[HPP]）的人群中儿童的饮食 SAA 摄入量是否低于低患病率人群（LPP）的儿童。
采用横断面普查设计，比较刚果民主共和国北基伍省的 2 个先前确定的相邻儿童人群（36-59 月龄）。收集的数据包括尿硫氰酸盐（SCN）、木薯基食品中的生氰糖苷、近期患病史和儿童 24 小时定量饮食回忆。
HPP 和 LPP 的夸希奥科病患病率分别为 4.5%和 1.7%。在 LPP 中，有 141 户家庭的 170 名儿童和 HPP 中 138 户家庭的 169 名儿童完成了研究。HPP 儿童中可测量尿 SCN 的比例较高（44.8%比 29.4%，P<0.01）。LPP 儿童近期患病的可能性较低（26.8%比 13.6%，P<0.01）。LPP 儿童的 SAA 摄入量中位数[IQR]为 32.4[22.9-49.3]mg/kg，HPP 儿童为 29.6[18.1-44.3]mg/kg（P<0.05）。蛋氨酸是这两个人群中的第一限制氨基酸，HPP 儿童的摄入不足风险最高（35.1%比 23.6%，P<0.05）。
高患病率人群的儿童饮食 SAA 摄入量低于低患病率人群的儿童。降低夸希奥科病发病率的试验干预措施应考虑增加 SAA 摄入量，尤其要注意蛋氨酸。
