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Cryptosporidium infections have been associated with growth stunting, even in the absence of diarrhea. Having previously detailed the effects of protein deficiency on both microbiome and metabolome in this model, we now describe the specific gut microbial and biochemical effects of Cryptosporidium infection. Protein-deficient mice were infected with Cryptosporidium parvum oocysts for 6-13 days and compared with uninfected controls. Following infection, there was an increase in the urinary excretion of choline- and amino-acid-derived metabolites. Conversely, infection reduced the excretion of the microbial-host cometabolite (3-hydroxyphenyl)propionate-sulfate and disrupted metabolites involved in the tricarboxylic acid (TCA) cycle. Correlation analysis of microbial and biochemical profiles resulted in associations between various microbiota members and TCA cycle metabolites, as well as some microbial-specific degradation products. However, no correlation was observed between the majority of the infection-associated metabolites and the fecal bacteria, suggesting that these biochemical perturbations are independent of concurrent changes in the relative abundance of members of the microbiota. We conclude that cryptosporidial infection in protein-deficient mice can mimic some metabolic changes seen in malnourished children and may help elucidate our understanding of long-term metabolic consequences of early childhood enteric infections., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

The objective of this study is to report the effects of cysteine on the pharmacokinetics of intravenous and oral docetaxel in rats with protein-calorie malnutrition (PCM). The in vivo pharmacokinetics and in vitro hepatic/intestinal metabolism of docetaxel were assessed using control, CC (control with cysteine), PCM and PCMC (PCM with cysteine) rats. The effects of cysteine on the intestinal absorption of docetaxel were further investigated through in vitro transport studies using rat intestine and Caco-2 cell monolayers. The AUCs (the areas under the plasma concentration-time curve from time zero to time infinity) of intravenous docetaxel in PCM rats were significantly greater than in the control rats because of the significant decrease in the hepatic CYP3A. In PCMC rats, the elevated AUCs in PCM rats returned to control levels. The AUC(0-6 h)s of oral docetaxel in PCM rats were significantly smaller than that in the control rats, mainly due to the decrease in gastrointestinal absorption. In CC and PCMC rats, oral cysteine supplement enhanced the gastrointestinal absorption of docetaxel probably via intestinal P-gp inhibition. If the present rat data could be expressed to humans, the alterations in docetaxel absorption and metabolism should be considered in designing a dosage regimen for cancer patients with PCM state after cysteine supplement.

Malnutrition leads to adverse effects and may worsen clinical outcome. Surgery as a stress factor activates pathological reactions changing metabolism structure. The aim of this study was to evaluate changes of protein metabolism in patients after elective neurosurgical operation. 24 patients were prepared for elective surgery and were enrolled in this study. Evaluation of each patient included: measurement of anthropometric indices--height, weight, arm circumference and the triceps skinfold thickness, the definition of protein loss by determining the loss of nitrogen in the urine, assessment of protein catabolism, determining the violations of nutritional status upon the base of laboratory parameters. During the course of the conducted investigation significant (p < 0.05) decrease in the indices of total protein, albumin, transferrin and the absolute numbers of lymphocytes in the postoperative period was revealed. All the patients developed severe protein catabolism. It became clear that uncomplicated elective surgical intervention, together with the adopted scheme of the nutritional therapy leads to severe protein catabolism in all patients.

Systematic studies were performed on the biological perturbations in metabolic phenotype responding to protein-energy malnutrition through global metabolic profiling analysis, in combination with pattern recognition. The malnutrition rat model was established through five weeks of strict diet restriction, and the metabonome data obtained from gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) were integrated to approximate the comprehensive metabolic signature. Principal component analysis and orthogonal projection to latent structure analysis were used for the classification of metabolic phenotypes and discovery of differentiating metabolites. The perturbations in the urine profiles of malnourished rats were marked by higher levels of creatine, threitol, pyroglutamic acid, gluconic acid and kynurenic acid, as well as decreased levels of succinic acid, cis-aconitic acid, citric acid, isocitric acid, threonic acid, trimethylglycine, N-methylnicotinic acid and uric acid. The alterations in these metabolites were associated with perturbations in energy metabolism, carbohydrate, amino acid, and fatty acid metabolism, purine metabolism, cofactor and vitamin metabolism, in response to protein and energy malnutrition. Our findings show the integration of GC-MS and LC-MS techniques for untargeted metabolic profiling analysis was promising for nutriology.

Nitrogenous metabolism, vitamin provision and anthroponietric indices were inventigated in 1560 Uzbek youths (18-21 years old) with diverse alimentary status. Changes cheatinine in urine, insufficient vitamines content and violations of authropometric indices were revald in patients with protein-calorie deficiency.

The aim of the present work was to study the presence of aflatoxins in blood and urine of infants with protein-energy malnutrition (PEM). The study was conducted on 60 infants, 30 with kwashiorkor and 30 with marasmus, with 10 age-matched healthy infants studied as a control group. Complete blood count, liver function tests, and determination of the level of aflatoxins (B1, B2, G1, G2, M1, M2, G2a, B3, GM1, P, and aflatoxicol R0) in blood and urine were carried out in all studied infants. Serum aflatoxins were detected in more infants with kwashiorkor (80%) than in those with marasmus (46.7%). The mean serum levels of total aflatoxins, AFB1, AFG1, and AFB2a, were significantly higher in infants with kwashiorkor (p <.001). Aflatoxin B1 (AFB1) was the most commonly detected type. The prevalence of aflatoxin excretion in the urine of infants with kwashiorkor was 80%, a higher value than that in infants with marasmus (46.7%). The mean urinary concentration of total aflatoxins followed the same pattern of distribution (p < .052). There were no significant differences between groups in the mean urinary concentrations of AFB1, AFG1, AFB2a, AFM1, and AFG2a. Aflatoxins were not detected in any of the serum or urine samples of the control group. Aflatoxins are highly prevalent in this study population and show a high degree of correlation with severe PEM.

Protein-calorie malnutrition is associated with poor prognosis in chronic liver disease, but reliable assessment is hampered by changes in body water. We prospectively evaluated the effect of fluid retention on bioelectrical impedance analysis (BIA) as a simple method for the estimation of body cell mass (BCM(BIA)) in 41 patients with cirrhosis (n = 20 with ascites; n = 21 without ascites) using total body potassium counting (BCM(TBP)) as a reference method. Arm muscle area and creatinine-derived lean body mass were compared with total body potassium data. In patients total body potassium was 24.4% lower than in controls and this loss was more severe in patients with ascites (-34.1%; P<.01). BCM(BIA) and BCM(TBP) were closely correlated in controls (r(2) =.87, P<.0001), patients without ascites (r(2) =.94, P <.0001) and patients with ascites (r(2) =.56, P<.0001). Removal of 6.2 +/- 3 L of ascites had only minor effects on BCM(BIA) (deviation of -0.18 kg/L ascites). Limits of agreement between both methods were wider in patients with ascites than in patients without (6.2 vs. 4.2 kg). In patients without ascites arm muscle area (r(2) =.64; P<.001) and lean body mass (r(2) =.55; P<.001) correlated significantly with total body potassium, but not in patients with ascites. For assessment of protein malnutrition in patients with cirrhosis, body cell mass determination by use of BIA offers a considerable advantage over other widely available but less accurate methods like anthropometry or the creatinine approach. Despite some limitations in patients with ascites, BIA is a reliable bedside tool for the determination of body cell mass in cirrhotic patients with and without ascites.

Protein energy malnutrition (PEM) is common in underprivileged populations in many parts of the world and results from diets deficient in protein (kwashiorkor) or protein and calories (marasmus). The literature documents renal tubular abnormalities in children with PEM. In PEM the reabsorption of amino acids and phosphate is defective. In many kidney disorders in which renal tubular function is impaired (e.g., diabetes, preeclampsia, nephrotic syndrome, sickle cell anemia), lysosomal enzymuria ensues. We compared the urinary excretion of the following five lysosomal enzymes in 31 Nigerian children with marasmus, kwashiorkor, or marasmic-kwashiorkor: beta-hexosaminidase, alpha-galactosidase, beta-galactosidase, beta-glucuronidase, and alpha-mannosidase. All of the protein energy malnourished children and the 18 age- and gender-matched controls were from the city of Jos, located in central Nigeria. In the severely malnourished children, the urine levels of all five lysosomal enzymes (expressed as units of enzyme activity per mg creatinine) were markedly increased. The greatest increases were seen with beta-hexosaminidase (16-fold) and beta-glucuronidase (14-fold). Routine clinical analyses also revealed that, relative to the control population, the sera of the 14 most severely malnourished patients contained 2- to 5-fold more vitamin B12 and markedly reduced levels (15%, p < 0.00001) of calcium. These data are significant in that they document lysosomal enzymuria in Nigerian children with severe PEM and point to the potential diagnostic utility of the urinary beta-galactosidase determination for assessing renal function in children with this disorder.

Forty-two elderly patients were subjected to a nutritional assessment and an intravenous magnesium load (0.5 mmol/kg). After 48 h, patients with protein-calorie malnutrition (PCM) showed magnesium retentions (MgR) above 20 per cent, thus indicating magnesium deficit, and greater (P < 0.001) than those from well-nourished patients. The discriminating cross-point for undernourished patients was at 28 per cent with 95 per cent sensibility and specificity. There were significant correlations between MgR and most nutritional parameters. An increase of the RMg constitutes a PCM indicator which may be useful to quantify it.

Pyridinoline (PYD) and deoxypyridinoline (DPD) are cross-linking aminoacids of collagen that are located mainly in bone and cartilage. When bone matrix is resorbed these cross-links are quantitatively excreted in the urine and therefore represent specific markers. We have measured the urinary excretion rate of PYD and DPD in 46 severely malnourished boys to assess their skeletal turnover and to relate this to their subsequent rate of growth. The children were aged 13 months (SD 6), and height-for-age was -3.6 (1.6) Z-score, and weight-for-height was -2.4 (0.8) Z-score. PYD excretion when malnourished and after "recovery" was 11.2 (4.6) nmol h-1m-2 and 32.2 (10.8) nmol h-1m-2 and DPD excretion was 2.6 (1.3) nmol h-1m-2 and 7.5 (3.0) nmol h-1m-2, respectively. The ratio of the two cross-links did not change with recovery. These data show that cartilage and bone turnover is much lower in the malnourished than in the recovered child. There was no difference in the degree of depression of turnover between the children with marasmus, marasmic-kwashiorkor, or kwashiorkor. The rate of height gain during recovery was significantly related to cross-link excretion, age, and weight-for-height on admission. These three factors accounted for 44% of the variance in the height velocity of the children. PYD and DPD excretion rate could be used to assess therapeutic interventions designed to alleviate stunting.

The effect of caloreen (glucose polymer) supplementation on indicators of iron status during protein-energy malnutrition was studied. Sixty-four children with moderate protein energy malnutrition (PEM) were fed diets supplemented with caloreen or starch (control) for 14 days, following which iron status as packed cell volume (PCV), haemoglobin (Hb), serum iron, total iron binding capacity (TIBC), serum ferritin, and urinary iron levels were determined. Caloreen supplementation significantly increased (P less than 0.05). PCV, serum iron and serum ferritin and decreased (P less than 0.05) TIBC. Also, there was a tendency for Hb to increase and urinary iron to decrease in this group, but these changes were not statistically significant. Such changes were not observed in the starch-placebo-supplemented group. It is concluded that caloreen supplementation to PEM children increases body iron status. These increases in the indices of iron status may contribute to an early recovery of anaemia associated with PEM. Prolonged supplementation of a regular diet with glucose early in the development of PEM may retard the development and severity of anaemia in children.

Renal tubular handling of sodium, potassium, calcium, magnesium, phosphate and aminoacids in children suffering from marasmus and kwashiorkor revealed wastage of phosphate and aminoacids. In the malnourished children aminoaciduria could contribute significantly to the negative nitrogen balance. Exact cause of this tubular functional defect is not known.

A group of five children with kwashiorkor, seven with marasmic kwashiorkor and one underweight child were given an aflatoxin-free diet consisting of maize meal and milk powder. Blood specimens were collected on admission; on day 4 and 10, 24 hour urine and stool samples were collected for the first ten days. Serum, urine and stool samples were analysed for aflatoxins using high performance liquid chromatography with fluorescent detection, after various extraction and clean-up procedures. The children with kwashiorkor and marasmic kwashiorkor excreted aflatoxins in stools for up to 9 and 6 days after admission respectively. No aflatoxins were detected in the stools or urine of the underweight child. In kwashiorkor, urinary excretion ceased after 2 days, while in marasmic kwashiorkor urinary excretion persisted for 4 days. In stools, B1 was the type of aflatoxin detected most frequently in kwashiorkor and least frequently in marasmic kwashiorkor. Aflatoxin M2 was frequently detected in the stools of both groups of children. Estimates of the total amount of aflatoxin excreted by kwashiorkor and marasmic kwashiorkor indicate that these children were harbouring up to 4 micrograms/kg body weight at the time of admission. These findings establish that aflatoxins accumulate in body fluids and tissues in kwashiorkor and marasmic kwashiorkor which is only slowly eliminated.

Objectives: To research if the improvement in psychomotor development observed during the treatment of malnutrition, is related to favorable changes in the speed of nerve conduction and in the excretion of hydroxy-indole acetic acid (indole). DESIGNED OF THE STUDY: Prospective, of a descriptive type, includes the follow-up of children during the first month of treatment., Application: To better know the impact which malnutrition has on mental development., Patients: Nine children, ranging from three to 15 months of age, gravely undernourished., Intervention: The neurological development, the speed of nerve conduction and the excretion of indole were evaluated at 10 day intervals., Measurements and Results: Using the Gesell technique in order to evaluate the development, the measurement of conduction through the medial and external popliteal sciatic nerves and indole excreted in 24 hours, a quantitative increase of all of these variables was seen in 24 hours. At the beginning the conduction speed was slow (less than 30 m/s) and the excretion of indole was very low (0.28 mg/24 h). After the tenth day these measurements returned to normal, although the development coefficient was found to still below at the end of the study (63.9 +/- 21.0)., Conclusions: Simultaneous to the neurological deficit, there is a reduced speed of conduction, which returns to normal after the tenth day without a positive correlation with motor functions and development. Neither does the disponibility of serotonin (judged by the excretion of indole) correlate with the speed of conduction.

A creatinine height index, which compares the creatinine excretion of a patient with that of an idealized normal adult of the same height, was used to assess protein status in 30 young males serving as controls and 11 malnourished male surgical patients, eight on a metabolic ward and three on a general surgical ward. The mean creatinine height index was 1.09 in the normal males and 0.50 in the 11 who were malnourished, a difference which is highly significant, p less than 0.005. The creatinine height index was more sensitive than other measures of nutritional status in this study, which included weight for height, nitrogen balance and serum albumin levels. These results suggest a role for this technique in the nutritional assessment of the surgical patient, which must play an increasing role in the critical care of this patient population.

So far, most studies on renal function in children with advanced protein-energy malnutrition have shown an impairment of glomerular filtration rate and renal plasma flow, as well as diminished ability to excrete an acid load and a concentrated urine. Investigation of these functions in eight marasmic infants and eight children with kwashiorkor once they were free of obvious infections and acute electrolyte disturbances has shown a practically normal renal performance.

The calcium/creatinine ratio (Ca/Creat.) as an indicator of calcium nutritional status was evaluated in "basal urine" from 24 children comprised within the ages of three to 36 months during a 60-day period. The children were divided in normal or undernourished, according to Waterlow's classification. Children under 12 months of age were fed ad libitum with one of two commercial milk formulas, assigned according exclusively to the pediatric criterium. Children older than 12 months received milk besides the habitual hospital diet. In all cases the food intake was controlled and the calcium intake calculated. At the end of the study, basal urine was collected and calcium and creatinine determined. The results revealed that: a) In the normal children the Ca/Creat. ratio gradually decreased with age tending to a low value of 0.2 at the age of 36 months. The relationship between the Ca/Creat. ratio and the calcium intake showed a change in the slope when the requirements were met according to RNC (60 mg/kg/day); b) In undernourished children, the Ca/Creat. ratio was nearly constant whatever their age or calcium intake. The trend to approach the value of 0.2 for calcium intake (about 250 mg/kg/day), however, and the absence of the inflexion point, would suggest that the requirements of these children are far higher than the NRC recommendation, and that the change of the slope would be found for intakes over those obtained in our study. According to these findings, we conclude that the Ca/Creat. ratio in basal urine does not reflect calcium intake, but would depend on the bone calcium turnover. Consequently, it would be a simple and useful indicator of calcium nutritional status.

The erythropoietin (ESF) content of plasma and urine has been studied in children with protein-energy-malnutrition (PEM) living in the Kivu province at an altitude of 1467--2000 m. On admission, packed cell volume (PCV) was moderately reduced; after 2 months of refeeding PCV had increased but was still lower than in the controls. Plasma ESF was increased on admission and in patients refed for 2 months. The expected positive correlation between serum and urine ESF levels was found after refeeding but not on admission; the last finding could not be explained by the presence of erythropoiesis inhibiting factor(s) in the urine. In spite of the normal 2,3-DPG and P50 previously described in PEM in Kivu, the anaemia associated with this disease is not merely an adaptation to lowered oxygen consumption and there must be some disturbances in the responsiveness of bone marrow to ESF. The high ESF values observed after 2 months of refeeding confirm that the restoration of the red cell volume proceeds slowly.

Free catecholamine (epinephrine + norepinephrine) excretions of normal male infants 2.1-3.2, 4.5-10.6, and 12.5-18.5 months of age, respectively, and of infants and children with marasmus or marasmic kwashiorkor were measured on three consecutive days after admission and after partial rehabilitation. In normal infants, particularly the older ones, the first day's excretion was higher than that of the next two days, probably in response to the stress of the procedures. There was an increase with age, but on a surface area basis, the differences were not significant, the three age groups excreting 15.1 plus or minus 10.2, 23.8 plus or minus 20.9, and 24.7 plus or minus 14.3 mug/m-2/day, respectively. Excretions of marasmic infants on admission were not significantly different from those of the control children. Higher mean values were due to elevated excretions of infants with severe infection. After partial rehabilitation, excretions were similar to those of control subjects. In children with marasmic kwashiorkor excretions were no different from those of control infants, except in severely infected children. Admission values revealed more day-to-day variation than recovery values or than those of normal and marasmic infants, in whom subject to subject variation was more marked.

The urinary free amino acid pattern in a morning urine sample of Sudanese children suffering from Kwashiorkor and marasmus were determined before and during the course of treatment up to the 2nd week. The urinary amino acid/total urinary N (3.62) was found to be almost constant for Kwashiorkor patients, while the mean for marasmic patients was found to be 27. The concentration of leucine, valine, phenylalanine, methylhistidine, lysine, hydroxylysine and beta-amino-isobutyric acid was elevated in marasmic children, while the concentration of most of these amino acids was at a lower level in Kwashiorkor patients. The significance of these differences was discussed in relation to the biochemical detection of these deficiencies in field nutrition surveys.

Several biochemical and anthropometric tests were used to define the states of mild or moderate protein-energy malnutrition among 810 children aged under five years in the forest region of Southern Cameroon. The results show that the percentage and the identity of children classified as undernourished may be different according to the anthropometric test employed. The mean values of most of the biochemical variables assayed decrease in the groups affected with moderate weight and arm deficiencies. A system is proposed for the evaluation of the nutritional status based on the simultaneous use of four anthropometric tests. Some biochemical parameters may be useful for establishing a diagnosis.

The urinary excretion of 3-methylhistidine (3 MEH) has been shown to be a reliable index of muscle protein breakdown. It is decreased in protein-calorie malnutrition and increased during the hypercatabolic phase of sepsis and thermal trauma. Losses of 3 MEH after moderate to severe skeletal trauma in man and animals are reported as increased or unchanged. To clarify this response, 24 male and 6 female skeletal trauma patients were evaluated for 24 hr urinary losses of 3 MEH, nitrogen and creatinine. Eight of the 24 males also received a catabolic steroid for treatment of a head injury. In addition, 3 male and 1 female septic patients were similarly evaluated. Controls consisted of 10 volunteers on a meat free diet for 4 days and of 8 volunteers who were given only intravenous 5% dextrose in water for 3 days. The 3 MEH excretion for all control males was 3.6 mumole/Kg/day and for females was 2.8 Skeletal trauma produced a 280% increase for the males and a 225% increase for the females. Trauma with steroids caused a 325% increase. Sepsis induced a 227% increase in 3 MEH losses for males and 292% for females during the febrile episode. Creatinine excretion also increased significantly in response to trauma and sepsis but the magnitude of the increase was less than for 3 MEH. This was reflected in the 3 MEH to creatinine molar ratio increase from 0.018 for controls to 0.030-0.040 in sepsis and trauma. Patients with extensive body weight loss showed decreases in 3 MEH and creatinine excretion and a molar ratio similar to controls. The calculated contribution of muscle protein to whole body protein breakdown in the trauma and septic groups showed a twofold increase compared to the control group. The data indicate that the increased muscle protein catabolic response following stress of skeletal trauma and sepsis provides an insight on the origin of the large urinary nitrogen losses following such insults.

Since urine is the main excretory pathway for chromium, this study was conducted to compare in normal individuals the daily urinary chromium excretion with a 4 hr sample, to investigate diurnal fluctuations of urinary chromium and age-dependent relationship between urinary chromium and creatinine excretion. The results can be summarized as 1) there was no significant difference between the observed 24 hr chromium excretion and 24 hr excretion calculated from the one 4 hr samples, 2) a diurnal variation was observed when urinary excretion was expressed as chromium per minute, but no time-related variation could be established when chromium/creatinine (Cr/Cre) ratios in samples from three different periods of the same day were compared, although a significant positive correlation existed between urinary chromium and creatinine concentration, 3) the Cr/Cre ratio was found to be age-dependent, 4) in malnourished children the Cr/Cre ratio was very high and significantly different from that of normal infants, 5) This ratio for the eight diabetics was found to be significantly higher when compared with normal adults. On the basis of these results, it is suggested that morning 4 hr urinary chromium reflects the daily chromium excretion and that the Cr/Cre ratio of single urine samples obtained during this period is a reliable criterion in the evaluation of chromium nutrition of individuals in different conditions, provided that the influence of age is taken into consideration.

Because protein-calorie undernutrition is common in patients with neoplastic disease, nutritional support is often recommended. It is uncertain, however, that methods of supplemental alimentation successful in noncancerous subjects are suitable in cancer patients. We measured elemental balances, serum proteins, anthropometrics (triceps skinfold and mid-arm muscle area), and creatinine/height ratio in 15 undernourished patients with advanced cancer and in 10 noncancer undernourished controls during central venous or enteral hyperalimentation and found the following. (a) During central venous hyperalimentation, cancer patients showed significantly less improvement than the noncancerous controls in body weight (median increment, 5 kg in cancer patients and 8.5 kg in noncancerous), albumin (0.1 g/dl in cancer patients and 0.5 g/dl in noncancerous patients), creatinine/height ratio (4% of standard in cancer and 10% of standard in noncancer), and mid-arm muscle area (4% of standard in cancer and 11% of standard in noncancer). During enteral hyperalimentation, gains in body weight and albumin by cancer patients were significantly inferior to those in noncancerous subjects. Triceps skinfold increments, in contrast, were similar during both central venous and enteral hyperalimentation for cancer and noncancerous patients. (b) While nitrogen retention was similar in cancer and noncancer patients, the cancer group retained significantly less magnesium and phosphorus (delta Mg in cancer patients, 3.2 mEq/day central, -2.7 mEq/day enteral; delta Mg in noncancer patients, 11.9 mEq/day central, 10.1 mEq/day enteral; delta P in cancer patients, 0.13 g/day central, 0.07 g/day enteral; delta P in noncancer patients, 0.27 g/day central, 0.33 g/day enteral). The poorer balances of cancer patients were caused by increased urinary, not fecal, loss. These findings indicate a partial block in repletion of lean body mass or abnormal composition of newly deposited lean body mass when undernourished patients with advanced cancer receive hyperalimentation.

A simple procedure to estimate stress has been developed based upon 24 hour urine urea nitrogen excretion. This catabolic index partitions total urea excretion into that resulting from dietary protein intake and obligatory urea excretion and that due to an increase in endogenous protein catabolism: catabolic index equals 24 hour urine urea nitrogen excretion - (0.5 dietary nitrogen intake + 3 grams) where an index of less than zero represents no significant stress; an index of zero to 5, moderate stress, and an index greater than 5, severe stress. In 111 persons, significant differences were noted in the catabolic index, reflecting varying degrees of stress, nutrient intake and nutritional status. The catabolic index may have useful diagnostic and treatment applications.

Total urinary nitrogen (TUN) and urinary urea nitrogen (UUN) in a 24-hour urine collection were measured under a variety of clinical and nutritional conditions in 81 patients for 564 study days. The difference between TUN and UUN averaged 1.8 +/- 0.9 g/day (range 0.0-5.8 g/day) and was independent of the absolute value for UUN. Since UUN was found to correlate linearly with TUN (R = 0.98) over a wide range of values, it is possible to estimate an approximate TUN excretion by adding a constant to the nitrogen excreted as urea. On the basis of the measured mean difference, we suggest using an estimate of 2 g of nitrogen per day. We feel this will not seriously under- or overestimate urinary nitrogen excretion in the calculation of nitrogen balance for the clinical management of nutritional support therapies. Since all hospitals can perform this routine test, it provides an effective, simple, and rapid method to follow accurately the protein catabolic response during disease and response to nutritional therapy. This method, without the supporting data presented here, has previously been recommended [Blackburn et al, 1977, JPEN 1:11-22] and has become a widely used technique for nutritional assessment.

Aflatoxin analyses were undertaken on sera and urines of 41 children admitted to a rural hospital in Kenya with kwashiorkor, marasmus, marasmic kwashiorkor or normal nutrition (Wellcome Classification). Aflatoxins were detected most frequently and at highest concentrations in the sera of kwashiorkors who, conversely, showed aflatoxins least frequently in their urine and in concentrations that were disproportionately low compared with serum/urine aflatoxin levels in other groups. These findings indicate altered aflatoxin metabolism in kwashiorkor and support the hypothesis that there are special relationships between aflatoxins and kwashiorkor.