Article Type : Opinion Article
Authors : Agarwal KN, Agarwal DK
Keywords : Malnutrition; Sequel; Anthropometric indices; Leucocyte F?AN; Erythrocyte glutamic acid; Salivary ferritin; Dahi; Berseem leaves
Malnutrition
in India has been rampant; in women and children this affects growth,
development and skilled work. In 1973-74, decided to study on:
Develop diagnostic tools
Anthropometric indices: Growth Standards To diagnose malnutrition, growth data from affluent Indian children were collected during 1989-1991 from birth to 5 yr (7 states), only full term with birth weight ?2500 g (boys 433 and girls 346) were followed during first yr of life at 3, 6, 9 and 12 mo of age with minimum of 3 reading for every infant (cohort-I). In cohort-II, from 12 mo to 5 yr + children of cohort-I also continued, 1011 boys and 874 girls were followed on their birthday and 6 monthly with minimum of 3 measurements for each child up to 72 mo of age. Children had received exclusive breast milk for 3-4 mo of life in cohort I. In a cross-sectional multicentric data for physical growth and sexual development for 5- 17.5 yr in girls and 5 to 18 yr in boys (cohort II- from 9 states- 23 schools; 12893 boys and 10,941 girls) on affluent Indian children were collected during 1989-1991 [1-4].
Development of biochemical tests to diagnose malnutrition
Blood -Leucocytes (life span 13- 20 days) F?AN
decreased in hypoproteinemia [5]. Erythrocytes
(life span 100 days) showed significant increase in glutamic acid [6]. The
serum and salivary arginase activity and levels of salivary protein and
ferritin decreased with severity of PEM. The salivary ferritin showed very
significant fall even in PEM grade I, in grade III the mean ferritin was 3.28
+/- 0.75ug/L as compared to 169.3 +/- 21.9ug/L for normal children. The changes
in salivary protein, arginase activity, and ferritin in PEM may be used in
recognizing severity as well as early stage of the disease [7-10].
> 3000 g. Polygraphic sleep cycle studies-EEG, ECG, ECOG, phasic
body activity and respiration performed on term
newborn babies of severely undernourished mothers showed disorganization during
active rapid eye movement (REM) sleep and quiet nonrapid eye movement (NREM)
sleep, babies clinically had
hypotonia 72% and hypo excitability 56%, with incomplete Moro’s [12,13].
National Family Health Survey of India- data
(2021-2022 showed stunting in 35.5%, wasting 19.3% and underweight
32.1% in <5 yr children (14). Studies in Varanasi
had shown that Stunted- wasted develop: soft neurological signs (SNS), their
EEG had slow & sharp waves, in frontal, parietal and temporal lobes,
with motor deficit
[15]. There was - persistence
of impaired repetitive speed movements with overflow & dysrhythmia. Wasted and underweight had deficit in
higher mental abilities WISC IQ was low, poor social competence
[16,17]. Examined at age 17 yr for biochemical
and 31- phosphorus magnetic resonance spectroscopy (31-P MRS) showed that for vital functions, body
mobilized amino acids from muscles: i) serum enzyme activities increased i.e.
LDH, ALP, AST, ALT, CK, CK-MB and CK-mm and ii) b-ATP and Pi in muscles was increased at the cost of Pcr (Phosphocreatinine)
[18]. In brain MRI and cognitive evoked potential studies- Frontal lobes- size
was reduced and asymmetry of anterior as well as posterior lobes was lost [19].
These children with I Q > 90 had impaired perceptual maturity and conceptual
grasp- Learning disability [20]. Reaction
time was affected
for perceptual abilities, information processing and
analytical capabilities, irreversibly [21].
Long term physical and neuromotor sequalae, possible pathology in intrauterine and early life malnutrition
Summarized from the research article [11]. A
prospective epidemiological study was conducted in rural Varanasi, India to
study effects of maternal nutrition/anemia on 3700 pregnant women and their
offspring’s- 34.6% <2500g (lbw) and only 8.2% > 3000 g. Polygraphic sleep
cycle studies-EEG, ECG, ECOG, phasic body activity and respiration performed
on term newborn babies of severely
undernourished mothers showed disorganization during active rapid eye movement
(REM) sleep and quiet nonrapid eye movement (NREM) sleep, babies clinically had
hypotonia 72% and hypo excitability 56%, with incomplete Moro’s [12,13].
National Family Health Survey of India- data (2021-2022 showed stunting in
35.5%, wasting 19.3% and underweight 32.1% in <5 yr children (14). Studies
in Varanasi had shown that Stunted- wasted develop: soft neurological signs
(SNS), their EEG had slow & sharp waves, in frontal, parietal and temporal
lobes, with motor deficit [15]. There was - persistence of impaired repetitive
speed movements with overflow & dysrhythmia. Wasted and underweight had deficit in higher
mental abilities WISC IQ was low, poor social competence [16,17]. Examined at
age 17 yr for biochemical and
31-phosphorus magnetic resonance spectroscopy (31-P MRS) showed that for vital functions, body
mobilized amino acids from muscles: i) serum enzyme activities increased i.e.
LDH, ALP, AST, ALT, CK, CK-MB and CK-mm and ii) b-ATP and Pi in muscles was
increased at the cost of Pcr (Phosphocreatinine) [18]. In brain MRI and
cognitive evoked potential studies- Frontal lobes- size was reduced and
asymmetry of anterior as well as posterior lobes was lost [19]. These children
with I Q > 90 had impaired perceptual maturity and conceptual grasp-
Learning disability [20]. Reaction time was affected for perceptual abilities,
information processing and analytical capabilities, irreversibly [21].
Identifying vegetarian immunonutrient foods to eradicate malnutrition
Children with PEM (severe) were treated as per WHO
protocol (milk in diet). Studied 2 protein and micronutrients rich foods in WHO
regime to develop better alternative to milk. i) Dahi (with lactobacillus bulgaricus
and streptococcus thermophilus) and ii) Berseem leaf protein (LPC) was fed and
compared for their efficacy; milk diet taken as control. All patients of PEM
had infections. On WHO dahi diet improved in wt, Hb and CD2/CD4 cell ratio,
high serum ferritin decreased and CRP got activated. The cytokine levels (TNF?,
IFN?, IL-10 and IL-4) were raised in PEM, on feeding dahi in WHO diet or LPC
serum proinflammatory (TNF?, IFN?), and anti-inflammatory (IL-10) cytokine
levels increased. The increase in IL-10 was higher on dahi diet. IL-1, IL-6
levels increase on day 15th and at 6 wk, on both the diets. The mean initial
absolute lymphocyte counts were 3707±1551 and 4553±1776/µl on dahi and milk
diets, after 6wk of treatment to 6312±1937 and 3493±1418 µl, respectively
(p=0.004). Similar, trend was observed for CD3+, CD4+, CD8+, CD19+ and CD56+
cells in both the groups. These observations demonstrate that dahi has
immunonutrient properties i.e. lymphocyte counts increased and there was higher
rise of IL10 and IL6 than on WHO milk diet. Dahi is an immunonutrient
vegetarian food to treat & eradicate malnutrition and WHO diet should use
dahi, instead of milk. While LPC may be mixed in cereals to raise protein and
micronutrient content [22-28].