The influence of renutrition on biochemical and hematological parameters and morbidity in severely malnourished children

Forty-three severely malnourished Colombian children were studied for a 4-6 week period of nutritional recuperation in the hospital, and for one year after discharge. Kwashiorkor, marasmus and combined malnutrition were characterized by biochemical and clinical parameters. Children with kwashiorkor required significantly longer periods of renutrition and suffered more frequent infections. Serum levels of total proteins, albumin, iron, transferrin and cholesterol rapidly attained normal levels within 2-3 weeks of treatment, and remained within normal ranges up to one year post-discharge. Infections were rarely diagnosed in the first 4 months after hospitalization but 60% of the children developed infection during the succeeding 8 months. One year after recuperation, 29 of the children were still normal or mildly malnourished (Grade I), 9 had dropped to Grade II, and three had reverted to Grade III malnourished based upon anthropometric criteria. Two of the children died during the study as a result of infectious disease. Factors contributing to the long-term beneficial effects of renutrition may have included nutrition education of the mothers and reduction of infectious disease burden accompanied by increased immune responsiveness.