Golden M H
Lancet. 1982 Jun 5;1(8284):1261-5. doi: 10.1016/s0140-6736(82)92839-2.
The role of dietary protein deficiency in kwashiorkor is uncertain, although it has been shown not to be involved in the famine oedema of adults. A study of six different diets given to 103 children with oedematous malnutrition showed that the rate of loss of oedema was strongly correlated with the dietary energy intake (r = 0.75) but not with the protein intake (r = 0.03). 66 patients given a very-low protein diet (2.5% protein energy) lost oedema as fast as those given five times as much protein. The energy intake above which oedema resolved and below which oedema accumulated was 245-270 KJ/kg/day. Because energy deficiency is not invariably associated with oedema it cannot be the only factor involved, and the necessary dietary component(s) must therefore have been present in surfeit in all the therapeutic diets. This could be potassium together with factors necessary for its retention. The accessory ingredients must be low in foods associated with human and experimental nutritional oedema. It is suggested that protein deficiency is not the cause of the oedema of kwashiorkor and that there is no need to postulate a different pathogenesis for this oedema from starvation oedema of adults.
蛋白质缺乏在夸休可尔症中的作用尚不确定，尽管已有研究表明它与成人饥荒性水肿无关。一项针对103名水肿型营养不良儿童的六种不同饮食的研究表明，水肿消退率与饮食能量摄入量密切相关（r = 0.75），但与蛋白质摄入量无关（r = 0.03）。66名接受极低蛋白饮食（蛋白质能量占2.5%）的患者水肿消退速度与蛋白质摄入量为其五倍的患者一样快。水肿消退时的能量摄入量以及水肿开始累积时的能量摄入量分别为245 - 270千焦/千克/天。由于能量缺乏并非总是与水肿相关，所以它不可能是唯一的相关因素，因此所有治疗性饮食中必然都过量存在某种必需的饮食成分。这可能是钾以及使其潴留所需的因素。在与人类和实验性营养性水肿相关的食物中，辅助成分含量必定较低。有人提出，蛋白质缺乏并非夸休可尔症水肿的病因，而且无需假定这种水肿的发病机制与成人饥饿性水肿不同。
