Menu ENN Search

Carbon Dioxide Production in Acutely Ill Malnourished Children

Summary of published paper1

A recent study set out to test the hypothesis that the rate of carbon dioxide production is less in marasmic children with acute infection when compared to well-nourished children, but greater when compared to uninfected marasmic children. The study took place at Queen Elizabeth Central hospital, in Blantyre, Malawi. Using a stable isotope tracer dilution method, rates of carbon dioxide production were measured in children aged 12-60 months while receiving feeding. Results from 56 children were compared, 28 with marasmus and acute infection, 16 with marasmus, and 12 well nourished with acute infection. Those with acute infection had malaria, pneumonia or sepsis.

Well nourished children with acute infection produced more carbon dioxide than marasmic children. However, the rate of carbon dioxide production in marasmic children with acute infection was not greater than in uninfected children. The observed rate of carbon dioxide production was greater than that which could be produced from the dietary intake alone.

The study concluded that marasmic children do not increase energy expenditure in response to acute infection, as well nourished children do. The data suggest that children with proteinenergy malnutrition and acute infection expend less energy, largely due to a lower body temperature and the absence of fever. Although not raising body temperature in response to acute infection conserves scarce nutrients, it also determines that the immunological benefits of fever are not realised. Fever activates cellular immunity, stimulates the acute phase response, enhances iron sequestration and is associated with better survival. The clearance of the malaria parasite is also accelerated by fever.

Dietary energy intake in the 44 marasmic children studied was 350 kj/kg/day (84 kcal/kg/d), the level recommended for malnourished children from experience in treating malnourished children in Jamaica. The data from the rate of carbon dioxide production suggests that to match energy expenditure, intake should have been increased by 25% to about 440 kj/kg/day (105 kcal/kg.d), when the thermic effect of food is considered. Current standard recommendations are that during the initial phase of treatment, severely malnourished children should receive 336-420 kj/kg/day (80-100 kcal/kg/d). Further research is needed to determine whether increased dietary energy improves the response to acute infection, and whether these children might be better served by increasing their dietary intake.

Show footnotes

1Manary, M et al (2004). Carbon dioxide production during acute infection in malnourished Malawian children. European Journal of Clinical Nutrition, vol 58, pp 116-120

More like this

FEX: Comparison of the Efficacy of a Solid Ready-to-Use Food and a Liquid, Milk- Based Diet in Treating Severe Malnutrition

Kwashiorkor case, before and after management using RUTF (oedema resolved). Nutritional Rehabilitation Centre (Dispensaire Saint Martin), Senegal 2001 Summary of published...

FEX: Diet and renal function in malnutrition

Summary of presentation1 Supplementary suckling (SS) has revolutionised management of young, malnourished infants Water balance in young, malnourished infants Water is an...

FEX: Management of shigellosis in undernourished children

Tens of thousands of Rwandan refugees were believed to have died from dysentery in the Goma camps in 1994/95. Above Goma, Eastern Zaire Summary of published paper1 Acute...

en-net: Treatment of SAM in older people through outpatient

Treating older people (>=60 year old) with uncomplicated SAM with RUTF at home as out patients: which doses should we use? Some recommend 100kcal/kg/day. Should it be...

FEX: Clinical Trial of BP100 vs F100 Milk for Rehabilitation of Severe Malnutrition

Child eating BP100 in Freetown TFC. By Carlos Navarro-Colorado and Stéphanie Laquière Carlos Navarro-Colorado is a medical doctor, with a MSc Epidemiology. He has ten years...

en-net: Correlation between Maternal Nutrition and breastmilk volume

Is there any evidence based research to show the correlation between maternal nutrition and breast milk volume? As far as I am aware, no such correlation has been found. It...

FEX: Community-based Therapeutic Care (CTC)

Malnourished Child being fed with ready-touse therapeutic food (RUTF) Summary of published research1 Bedawacho Woreda is a district in Ethiopia, 350 km south of Addis Ababa,...

FEX: Antibiotics as part of the management of severe acute malnutrition

Summary of published research1 Mothers receive instruction on how to adminster antibiotics Location: Malawi What we know already: There is a high prevalence of clinically...

FEX: Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition

Summary of research Bhandari N, Mohan SB, Bose A, et al. Efficacy of three feeding regimens for home-based management of children with uncomplicated severe acute malnutrition:...

FEX: Dietary Treatment of Severe Malnutrition in Adults

Summary of a Published Paper Somalia - Standing in the mud near the edge of the Sabelle River a boy watches the arrival of the villagers from a neighbouring Bulomano which,...

FEX: Acceptability trial of a novel RUTF based on soy, lentils and rice

By Filippo Dibari, Valid International Filippo Dibari studied Food Science and Technology and more recently Public Health Nutrition at the London School of Hygiene Tropical...

FEX: Advocacy from Eritrea: working with WFP

By Hassan Taifour Hassan Taifour is the Emergency Response Nutritionist for SC(UK). He graduated from the Faculty of Agriculture, University of Khartoum in 1985 and completed...

FEX: Recovery rate of children with moderate acute malnutrition treated with ready-to-use supplementary food (RUSF) or improved corn-soya blend (CSB+)

Summary of research * Location: Cameroon. What we know: A wide range of nutritional products are currently used to treat MAM; there is no definitive consensus on the most...

en-net: Dosage of RUTF

The recommendations of RUTF are based on 200kcal per kg per day for under fives. Taking an example of a child who is, say 10.5kg, a dose of 4.2 sachets per day( 4.5 in the...

en-net: Amoxicillin first line antibiotic

Hi dear All,
1. I need the information regarding why the first line of antibiotic amoxicillin medication is needed for SAM child.
2. What will be we do with SAM...

FEX: The impact of HIV on the management of severe malnutrition in Malawi

Summary of published paper There has been remarkably little published on the implications of HIV infection for emergency nutrition interventions. HIV infection is common among...

en-net: inpatient SAM management

hi..
in Jordan, the CMAM program is integrated into primary healthcare...thus, only children with urgent complications are referred for secondary healthcare...

FEX: Postscript to: 'A pragmatic approach to managing severe malnutrition: Is F75 always beneficial?'

Michael Golden,Yvonne Grellety It is quite wrong to consider the advantage of F75 as "theoretical". However, a decreased mortality will not be seen if other aspects of faulty...

FEX: Combined protocol for SAM/MAM treatment: The ComPAS study

By Jeanette Bailey, Rachel Chase, Marko Kerac, André Briend, Mark Manary, Charles Opondo, Maureen Gallagher and Anna Kim Jeanette Bailey is the Project Director for...

FEX: Revised MSF nutrition guidelines III

By Saskia van der Kam and Sophie Baquet, MSF The summary below is based upon a near final draft of the new MSF guidelines.1 The guidelines may therefore undergo some revision...

Close

Reference this page

Carbon Dioxide Production in Acutely Ill Malnourished Children. Field Exchange 22, July 2004. p8. www.ennonline.net/fex/22/carbon

(ENN_2495)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.