Impairment of Intestinal Absorption of Vitamin A Palmitate in Severe Protein Malnutrition (Kwashiorkor)

NEvIN S. SCRIMSHAW, PII.D., M.D.� O NE of the consequences of the severe protein malnutrition underlying kwashiorkor is a decrease in the activity of various enzymes as measured in blood serum, tissues, and duodenal contents. ‘ Thompson and Trowell’ and G#{243}mez ci a!.’ have reported that the activities of lipase, trypsin, and amylase are reduced in the duodenab secretions of kwashiorkor patients. Of the three enzymes lipase appears to be the first to be affected, followed by trypsin.’ These biochemical findings are consistent with the histologic damage observed in the pancreas and intestine when the disease is severe.4’ A decrease in pancreatic bipase and in bile salts as well as functional alterations of the small intestine, are known to impair the absorption of vitamin A. In the course of studies in children with kwashiorkor in Central America6 very low serum levels of vitamin A have been found and ocular lesions suggestive of vitamin A deficiency are observed. From the Institute of Nutrition of Central America and Panama (INCAP), Guatemala, CA. This study was assisted by funds from the Nutrition Foundation, Inc. and National Institute of Arthritis and Metabolic Diseases of the National Institutes of Health (A-981), Public Health Service. Reported in part at the Annual Meeting of the American Institute of Nutrition