Protein-losing enteropathy in Transkeian children with morbid protein-energy malnutrition

A commercially available radial immunodiffusion assay was used to measure serum and faecal alpha 1-antitrypsin concentrations as well as alpha 1-antitrypsin clearance in 17 children with kwashiorkor, 11 children with marasmic kwashiorkor, 10 children with marasmus, and 16 normal children. Serum alpha 1-antitrypsin concentrations were significantly higher than normal in the marasmus and marasmic kwashiorkor groups, and significantly lower than normal in the kwashiorkor group. The intestinal clearance of alpha 1-antitrypsin was significantly higher than normal in the marasmus and marasmic kwashiorkor groups, and significantly lower than normal in the kwashiorkor group. There was a significant inverse correlation between the alpha 1-antitrypsin clearance and serum albumin concentration in the marasmus and marasmic kwashiorkor groups. No such correlation was evident in the kwashiorkor group. It is concluded that protein-losing enteropathy is likely to play a significant role in the development and perpetuation of hypo-albuminaemia in children with marasmus and marasmic kwashiorkor but not in those with kwashiorkor.