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Mark J Manary - One of the best experts on this subject based on the ideXlab platform.
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Kwashiorkor: more hypothesis testing is needed to understand the aetiology of oedema
Malawi medical journal : the journal of Medical Association of Malawi, 2009Co-Authors: Mark J Manary, Geert Tom Heikens, Michael H. N. GoldenAbstract:Kwashiorkor is severe childhood malnutrition characterised by oedema, often showing as swelling in the hands and feet. (1) In the last 20 years the WHO nomenclature has referred to Kwashiorkor as oedematous malnutrition.
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the quality of the diet in malawian children with Kwashiorkor and marasmus
Maternal and Child Nutrition, 2006Co-Authors: Jesse Sullivan, Macdonald Ndekha, Dawn Maker, Christine Hotz, Mark J ManaryAbstract:Nutritionists have suggested that Kwashiorkor is related to low dietary protein and/or antioxidant intake. This study explored the hypothesis that among Malawian children with severe malnutrition, those with Kwashiorkor consume a diet with less micronutrient- and antioxidant-rich foods, such as fish, eggs, tomatoes and orange fruits (mango, pumpkin and papaya), than those with marasmus. A case-control method with a food frequency questionnaire was used to assess the habitual diet. Children with severe childhood malnutrition presenting to the central hospital in Blantyre, Malawi during a 3-month period in 2001 were eligible to participate. The food frequency questionnaire collected data about foods consumed by siblings <60 months of age in the home. It was assumed that the habitual diet of all siblings 1-5 years old in the same home was similar. Dietary diversity was assessed using a validated method, with scores that ranged from 0 to 7. Regression modelling was used to control for demographic and disease covariates. A total of 145 children with Kwashiorkor and 46 with marasmus were enrolled. Children with Kwashiorkor consumed less egg and tomato than those with marasmus: 17 (15) vs. 24 (31) servings per month for egg, mean (SD), P < 0.01 and 27 (17) vs. 32 (19) servings per month for tomato, P < 0.05. Children with Kwashiorkor had a similar dietary diversity score as those with marasmus, 5.06 (0.99) vs. 5.02 (1.10), mean (SD). Further research is needed to determine what role consumption of egg and tomato may play in the development of Kwashiorkor.
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antioxidant supplementation for the prevention of Kwashiorkor in malawian children randomised double blind placebo controlled trial
BMJ, 2005Co-Authors: Heather M Ciliberto, Michael A Ciliberto, Andree Briend, Per Ashorn, Dennis Bier, Mark J ManaryAbstract:Objective To evaluate the efficacy of antioxidant supplementation in preventing Kwashiorkor in a population of Malawian children at high risk of developing Kwashiorkor. Design Prospective, double blind, placebo controlled trial randomised by household. Setting 8 villages in rural southern Malawi. Participants 2372 children in 2156 households aged 1-4 years were enrolled; 2332 completed the trial. Intervention Daily supplementation with an antioxidant powder containing riboflavin, vitamin E, selenium, and N-acetylcysteine in a dose that provided about three times the recommended dietary allowance of each nutrient or placebo for 20 weeks. Main outcome measures The primary outcome was the incidence of oedema. Secondary outcomes were the rates of change for weight and length and the number of days of infectious symptoms. Results 62 children developed Kwashiorkor (defined by the presence of oedema); 39/1184 (3.3%) were in the antioxidant group and 23/1188 (1.9%) were in the placebo group (relative risk 1.70, 95% confidence interval 0.98 to 2.42). The two groups did not differ in rates of weight or height gain. Children who received antioxidant supplementation did not experience less fever, cough, or diarrhoea. Conclusions Antioxidant supplementation at the dose provided did not prevent the onset of Kwashiorkor. This finding does not support the hypothesis that depletion of vitamin E, selenium, cysteine, or riboflavin has a role in the development of Kwashiorkor.
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selenium status Kwashiorkor and congestive heart failure
Acta Paediatrica, 2001Co-Authors: Mark J Manary, G D Macpherson, Francis Mcardle, Malcolm J Jackson, C A HartAbstract:UNLABELLED: Selenium deficiency is associated with congestive heart failure (CHF) in geographic areas where dietary selenium intake is low and in individuals receiving total parenteral nutrition. Among 66 children with Kwashiorkor (including marasmic-Kwashiorkor), those who developed CHF had lower serum selenium concentrations than those who did not (32.9 +/- 8.3 vs 41.1 +/- 11.9 microg/L, mean +/- SD, p = 0.03). This association was independent of serum albumin and selenium status was not associated with severity of symptoms, anthropometric indices or HIV infection. CONCLUSION: This association raises the possibility that selenium may contribute to CHF in washiorkor.
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Increased oxidative stress in Kwashiorkor
The Journal of pediatrics, 2000Co-Authors: Mark J Manary, Christiaan Leeuwenburgh, Jay W. HeineckeAbstract:Abstract To test the hypothesis that Kwashiorkor is associated with increased oxidative stress, urinary concentrations of 2 oxidized amino acids, o,o ’-dityrosine and ortho -tyrosine, were measured by gas chromatography–mass spectrometry. Children with Kwashiorkor, with or without infection, had a 3- to 7-fold increase in urinary o,o ’-dityrosine and a 1.5- to 2-fold increase in ortho -tyrosine when compared with well-nourished children. This observation raises the possibility that oxidative damage to proteins and other biologic targets plays a role in the clinical manifestations of Kwashiorkor. (J Pediatr 2000;137:421-4)
Torleif Markussen Lunde - One of the best experts on this subject based on the ideXlab platform.
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diet and Kwashiorkor a prospective study from rural dr congo
PeerJ, 2014Co-Authors: Hallgeir Kismul, Jan Van Den Broeck, Torleif Markussen LundeAbstract:The etiology of Kwashiorkor remains enigmatic and longitudinal studies examining potential causes of Kwashiorkor are scarce. Using historical, longitudinal study data from the rural area of Bwamanda, Democratic Republic of Congo, we investigated the potential causal association between diet and the development of Kwashiorkor in 5 657 preschool children followed 3-monthly during 15 months. We compared dietary risk factors for Kwashiorkor with those of marasmus. Kwashiorkor was diagnosed as pitting oedema of the ankles; marasmus as abnormal visibility of skeletal structures and palpable wasting of the gluteus muscle. A 24-h recall was administered 3-monthly to record the consumption of the 41 locally most frequent food items. We specified Hanley-Miettinen smooth-in-time risk models containing potential causal factors, including food items, special meals prepared for the child, breastfeeding, disease status, nutritional status, birth rank, age, season and number of meals. Bayesian Information Criteria identified the most plausible causal model of why some children developed Kwashiorkor. In a descriptive analysis of the diet at the last dietary assessment prior to development of Kwashiorkor, the diet of children who developed Kwashiorkor was characterized by low consumption of sweet potatoes, papaya and "other vegetables" [0.0% , 2.3% (95% CI [0.4, 12.1]) and 2.3% (95% CI [0.4, 12.1])] in comparison with children who did not develop Kwashiorkor [6.8% (95% CI [6.4, 7.2]), 15.5% (95% CI [15, 16.1]) and 15.1% (95% CI [14.6, 15.7])] or children who developed marasmus [4.5% (95% CI [2.6, 7.5]) 11.8% (95% CI [8.5, 16.0]) and 17.6% (95% CI [13.7, 22.5])]. Sweet potatoes and papayas have high β-carotene content and so may some of "the other vegetables". We found that a risk model containing an age function, length/height-for age Z-score, consumption of sweet potatoes, papaya or other vegetables, duration of this consumption and its interaction term, was the most plausible model. Among children aged 10-42 months, the risk of developing Kwashiorkor increased with longer non-consumption of these foods. The analysis was repeated with only children who developed marasmus as the reference series, yielding similar results. Our study supports that β-carotene may play an important role in the protection against Kwashiorkor development.
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Diet and Kwashiorkor: a prospective study from rural DR Congo
2013Co-Authors: Hallgeir Kismul, Jan Van Den Broeck, Torleif Markussen LundeAbstract:The etiology of Kwashiorkor remains enigmatic and longitudinal studies examining potential causes of Kwashiorkor are scarce. Using historical, longitudinal study data from the rural area of Bwamanda, Democratic Republic of Congo, we investigated the potential causal association between diet and the development of Kwashiorkor in 5 657 preschool children followed 3-monthly during 15 months.We compared dietary risk factors for Kwashiorkor with those of marasmus. Kwashiorkor was diagnosed as pitting oedema of the ankles; marasmus as abnormal visibility of skeletal structures and palpable wasting of the gluteus muscle. A food frequency questionnaire was administered 3-monthly to record the consumption of the 41 locally most frequent food items. We specified Hanley-Miettinen smooth-in-time risk models containing potential causal factors, including food items, specialmeals prepared for the child, breastfeeding, disease status, nutritional status, birth rank, age, season and number of meals. Bayesian Information Criteria identified the most plausible causal model of why some children developed Kwashiorkor.In a descriptive analysis of the diet at the last dietary assessment prior to development of Kwashiorkor, the diet of children who developed Kwashiorkor was characterized by a low intake of sweet potatoes, papaya and “other vegetables” [0.0% , 2.3% (95%CI: 0.4, 12.1) and 2.3% (95%CI: 0.4, 12.1)] in comparison with children who did not develop Kwashiorkor [6.8% (95%CI: 6.4, 7.2), 15.5% (95%CI: 15, 16.1) and 15.1% (95%CI: 14.6, 15.7)] or children who developed marasmus [4.5% (95%CI 2.6, 7.5) 11.8% (95%CI: 8.5, 16.0) and 17.6% (95%CI: 13.7, 22.5)]. Sweet potatoes and papaya have high β-Carotene content and so may some of “the other vegetables”. We found that a risk model containing an age function, length/height-for age Z-score, consumption of sweet potatoes, papaya or other vegetables , duration of this consumption and its interaction term, was the most plausible model. Among children aged aged 10-42 months, the risk of developing Kwashiorkor increased with longer non-consumption of theses foods.The analysis was repeated with only children who developed marasmus as the reference series, yielding similar results. Our study supports that β-Carotene may play an important role in the protection against Kwashiorkor development.
J E Iputo - One of the best experts on this subject based on the ideXlab platform.
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serum free carnitine levels in children with Kwashiorkor
East African Medical Journal, 1999Co-Authors: I Aseo, G Tindimwebwa, E Agu, J E IputoAbstract:Objective: To determine the serum free carnitine concentration in normally nourished children and in children with Kwashiorkor and to relate the carnitine concentration to the ability to oxidise exogenous long chain fatty acids in the body. Study design: A cross-sectional comparative study of two age-matched groups. Subjects: Forty seven children with Kwashiorkor and 47 age-matched normally nourished children. Main outcome measures: Fasting blood samples were enzymatically analysed for free carnitine levels. 13 C labelled hiolein was administered orally and the recovery of 13 C from the breath air was monitored after administration of the feed. The cumulative per cent dose (CUMPD) recovery of 13 C 16 hours after the ingestion of labelled hiolein was determined. Results: Normal children had significantly higher free carnitine concentrations (mean = 60.7 μmol/l; 95% confidence interval of the mean = 42.7 - 77.8) than the Kwashiorkor children (mean = 16.5 μmol/l; 95% confidence interval of the mean = 11.3 - 19.8)(p<0.001). There was no correlation between serum free carnitine concentration and serum albumin in Kwashiorkor subjects, but there was a significant correlation between serum free carnitine concentration and the degree of weight loss as indicated by the weight: weight for age and sex ratio. The greater the weight loss, the lower the serum carnitine concentration amongst the Kwashiorkor children (r=0.46; p<0.01). There was a linear relationship between serum free carnitine and hiolein oxidation (r=0.89; p<0.001). Conclusion: There is carnitine deficiency in Kwashiorkor, and that the impaired lipid oxidation in Kwashiorkor is related to this deficiency.
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Impaired dietary lipid oxidation in Kwashiorkor
Nutrition Research, 1998Co-Authors: J E Iputo, Ww Wong, Pd KleinAbstract:Abstract Energy substrate oxidation studies were performed on 12 Kwashiorkor children and five well-nourished children fed on a standard recovery diet for Kwashiorkor. 13 C labeled leucine, Glucose, and hiolein were administered orally on three consecutive days. The recovery of 13 C from the breath air was monitored after administration of each feed. The mean cumulative percent dose (CUMPD) recovery of 13 C seven hours after the ingestion of labeled leucine was 22.0 ± 1.7% (mean ± SEM) for the Kwashiorkor children as compared to 32.7 ± 3.7% for the well-nourished children (p 13 C 12 hours after ingestion of labeled glucose was 58.3 ± 4.7% as compared to 70.2 ± 6.0% in the well-nourished children (p 13 C 16 hours after the ingestion of labeled hiolein was 4.8 ± 1.1% for the Kwashiorkor children as compared to 19.0 ± 2.1% for the well-nourished children (p 13 C recovery following hiolein ingestion was inversely correlated to the weight/expected weight for age and sex ratio (r = −0.93; p
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Protein-losing enteropathy in Transkeian children with morbid protein-energy malnutrition
South African Medical Journal, 1993Co-Authors: J E IputoAbstract:A cOmnlercially available radial inununodiffusion assay was used to Illeasure seruIll and faecal 0.1 antitrypsin concentrations as well as ai-antitrypsin clearance in 17 children with Kwashiorkor 11 children with Illarastnic Kwashiorkor 10 children with IllaraSIllUS, and 16 nonnal children. Serutn ai-antitrypsin concentrations were significantly higher than nonnal in the IllaraSIllUS and Illaras tnic Kwashiorkor groups, and significantly lower than norIllal in th'e Kwashiorkor group. The intestinal clearance of ai-antitrypsin was signifi cantly higher than nonnal in the IllaraSIllUS and Illarastnic Kwashiorkor grQUPS, and significantly lower than norIllal in the Kwashiorkor group. There was a significant inverse correlation between the ai-antitrypsin clearance and serUIll albuIllin concentration in the IllaraSIllUS and Illarastnic Kwashiorkor groups. No such correla tion was evident in the Kwashiorkor group. It is concluded that protein-losing enteropathy is likely to play a significant role in the deVe)OpIllent and perpetuation of hypo-albUIllinaetnia in children with IllaraSIllUS and Illarastnic Kwashiorkor but not in those with Kwashiorkor. S Air Med J 1993; 83: 588·589. M orbid protein-energy malnutrition (PEM), defined as PEM severe enough to warrant hos . pital admission, is a common clinical problem among children in the Transkei and is responsible for up to 9% of admissions to the children's wards in Umtata General Hospital. Kwashiorkor, the oedematous variant of PEM, is the most common form of morbid PEM seen in this hospital, and accounts for 60% of PEM admissions. It has a particularly poor short-term prog nosis with a mortality rate of 40%.I Protein-losing enteropathy (PLE) has been shown to exist in PEM in conjunction with measles' and diar rhoea.' It is believed that PLE plays the major role in the pathogenesis of the hypo-albuminaemia and subsequent oedema of the Kwashiorkor that may complicate measles.' Children with PEM often present with pro tracted episodes of chronic or intermittent diarrhoea. The intestinal mucosa of such children has been shown to be leaky! The cause of this loss of integrity is not clear. It has been suggested that the chronic diarrhoea seen in children with PEM, rather than being the cause ofthe intestinal damage, is the result of that damage.' If It IS accepted that the leakiness of the intestinal mucosa in PEM precedes the diarrhoea, what then is responsible for the loss of integrity of the mucosa? Could it be that PEM per se can lead to PLE? It is known that PEM is associated with the histological picture of villus atrophy and inflammatory cell infilrration of the lamina propria ~ the llltestmal mucosa.·" This clinical and histological picture has been associated with the maldigestion and malabsorption of nutrients, as well as diarrhoea,8 but there is a paucity of data on whether this clinical and histological picture is associated with PLE as well! It is, therefore, not clear whether the PLE seen in the chronic
Richard L. Henry - One of the best experts on this subject based on the ideXlab platform.
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Intestinal permeability in Kwashiorkor
Archives of disease in childhood, 1997Co-Authors: Mark J Manary, I. S. Menzies, E. V. O'loughlin, Richard L. HenryAbstract:Accepted 16 September 1996 Intestinal permeability can be assessed non-invasively using the lactulose-rhamnose (L-R) test, which is a reliable measure of small intestinal integrity. AIMS—To determine risk factors for abnormal intestinal permeability in Kwashiorkor, and to measure changes in L-R ratios with inpatient rehabilitation. DESIGN—A case-control study of 149 Kwashiorkor cases and 45 hospital controls. The L-R test was adapted to study Kwashiorkor in Malawi, with testing at weekly intervals during nutritional rehabilitation. Urine sugars were measured by thin layer chromatography in London. RESULTS—The initial geometric mean L-R ratios (×100) (with 95% confidence interval) in Kwashiorkor were 17.3 (15.0 to 19.8) compared with 7.0 (5.6 to 8.7) for controls. Normal ratios are
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intestinal permeability in Kwashiorkor
Archives of Disease in Childhood, 1997Co-Authors: D R Brewster, Mark J Manary, I. S. Menzies, E V Oloughlin, Richard L. HenryAbstract:Accepted 16 September 1996 Intestinal permeability can be assessed non-invasively using the lactulose-rhamnose (L-R) test, which is a reliable measure of small intestinal integrity. AIMS—To determine risk factors for abnormal intestinal permeability in Kwashiorkor, and to measure changes in L-R ratios with inpatient rehabilitation. DESIGN—A case-control study of 149 Kwashiorkor cases and 45 hospital controls. The L-R test was adapted to study Kwashiorkor in Malawi, with testing at weekly intervals during nutritional rehabilitation. Urine sugars were measured by thin layer chromatography in London. RESULTS—The initial geometric mean L-R ratios (×100) (with 95% confidence interval) in Kwashiorkor were 17.3 (15.0 to 19.8) compared with 7.0 (5.6 to 8.7) for controls. Normal ratios are <5, so the high ratios in controls indicate tropical enteropathy syndrome. Abnormal permeability in Kwashiorkor was associated with death, oliguria, sepsis, diarrhoea, wasting and young age. Diarrhoea and death were associated with both decreased L-rhamnose absorption (diminished absorptive surface area) and increased lactulose permeation (impaired barrier function) whereas nutritional wasting affected only L-rhamnose absorption. Despite clinical recovery, mean L-R ratios improved little on treatment, with mean weekly ratios of 16.3 (14.0 to 19.0), 13.3 (11.1 to 15.9) and 14.4 (11.0 to 18.8). CONCLUSION—Abnormal intestinal permeability in Kwashiorkor correlates with disease severity, and improves only slowly with nutritional rehabilitation.
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Comparison of milk and maize based diets in Kwashiorkor
Archives of disease in childhood, 1997Co-Authors: Mark J Manary, I. S. Menzies, Richard L. Henry, E. V. O'loughlinAbstract:The dual sugar test of intestinal permeability is a reliable non-invasive way of assessing the response of the small intestinal mucosa to nutritional rehabilitation. AIM To compare a local mix of maize-soya-egg to the standard milk diet in the treatment of Kwashiorkor. DESIGN The diets were alternated three monthly in the sequence milk-maize-milk. There were a total of 533 Kwashiorkor admissions of at least five days during the study who received either milk or maize. Intestinal permeability was assessed at weekly intervals by the lactulose-rhamnose test in 100 Kwashiorkor cases, including 55 on milk and 45 on the maize diet. RESULTS Permeability ratios (95% confidence interval) on the milk diet improved by a mean of 6.4 (1.7 to 11.1) compared with −6.8 (−16.8 to 5.0) in the maize group. The improved permeability on milk occurred despite more diarrhoea, which constituted 34.8% of hospital days (29.8 to 39.8) compared with 24.3% (17.8 to 30.8) in the maize group. Case fatality rates for all 533 Kwashiorkor admissions were 13.6% v 20.9%, respectively, giving a relative risk of death in the maize group of 1.54 (1.04 to 2.28). The maize group also had more clinical sepsis (60% v 31%) and less weight gain (2.9 v 4.4 g/kg/day) than the milk group. IMPLICATIONS Milk is superior to a local maize based diet in the treatment of Kwashiorkor in terms of mortality, weight gain, clinical sepsis, and improvement in intestinal permeability. Key messages Children with Kwashiorkor had a lower mortality and better weight gain on the standard milk diet compared with a maize-soya-egg diet Diets were similar in protein and energy densities, were supplemented with zinc, and the maize was germinated to increase palatability Intestinal permeability improved with nutritional rehabilitation on the milk diet but worsened on the maize diet The milk group experienced more initial diarrhoea in hospital, which was due to lactose intolerance rather than cows’ milk allergy We recommend a low lactose milk based diet in the treatment of Kwashiorkor, rather than a local staple diet
Hallgeir Kismul - One of the best experts on this subject based on the ideXlab platform.
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diet and Kwashiorkor a prospective study from rural dr congo
PeerJ, 2014Co-Authors: Hallgeir Kismul, Jan Van Den Broeck, Torleif Markussen LundeAbstract:The etiology of Kwashiorkor remains enigmatic and longitudinal studies examining potential causes of Kwashiorkor are scarce. Using historical, longitudinal study data from the rural area of Bwamanda, Democratic Republic of Congo, we investigated the potential causal association between diet and the development of Kwashiorkor in 5 657 preschool children followed 3-monthly during 15 months. We compared dietary risk factors for Kwashiorkor with those of marasmus. Kwashiorkor was diagnosed as pitting oedema of the ankles; marasmus as abnormal visibility of skeletal structures and palpable wasting of the gluteus muscle. A 24-h recall was administered 3-monthly to record the consumption of the 41 locally most frequent food items. We specified Hanley-Miettinen smooth-in-time risk models containing potential causal factors, including food items, special meals prepared for the child, breastfeeding, disease status, nutritional status, birth rank, age, season and number of meals. Bayesian Information Criteria identified the most plausible causal model of why some children developed Kwashiorkor. In a descriptive analysis of the diet at the last dietary assessment prior to development of Kwashiorkor, the diet of children who developed Kwashiorkor was characterized by low consumption of sweet potatoes, papaya and "other vegetables" [0.0% , 2.3% (95% CI [0.4, 12.1]) and 2.3% (95% CI [0.4, 12.1])] in comparison with children who did not develop Kwashiorkor [6.8% (95% CI [6.4, 7.2]), 15.5% (95% CI [15, 16.1]) and 15.1% (95% CI [14.6, 15.7])] or children who developed marasmus [4.5% (95% CI [2.6, 7.5]) 11.8% (95% CI [8.5, 16.0]) and 17.6% (95% CI [13.7, 22.5])]. Sweet potatoes and papayas have high β-carotene content and so may some of "the other vegetables". We found that a risk model containing an age function, length/height-for age Z-score, consumption of sweet potatoes, papaya or other vegetables, duration of this consumption and its interaction term, was the most plausible model. Among children aged 10-42 months, the risk of developing Kwashiorkor increased with longer non-consumption of these foods. The analysis was repeated with only children who developed marasmus as the reference series, yielding similar results. Our study supports that β-carotene may play an important role in the protection against Kwashiorkor development.
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Diet and Kwashiorkor: a prospective study from rural DR Congo
2013Co-Authors: Hallgeir Kismul, Jan Van Den Broeck, Torleif Markussen LundeAbstract:The etiology of Kwashiorkor remains enigmatic and longitudinal studies examining potential causes of Kwashiorkor are scarce. Using historical, longitudinal study data from the rural area of Bwamanda, Democratic Republic of Congo, we investigated the potential causal association between diet and the development of Kwashiorkor in 5 657 preschool children followed 3-monthly during 15 months.We compared dietary risk factors for Kwashiorkor with those of marasmus. Kwashiorkor was diagnosed as pitting oedema of the ankles; marasmus as abnormal visibility of skeletal structures and palpable wasting of the gluteus muscle. A food frequency questionnaire was administered 3-monthly to record the consumption of the 41 locally most frequent food items. We specified Hanley-Miettinen smooth-in-time risk models containing potential causal factors, including food items, specialmeals prepared for the child, breastfeeding, disease status, nutritional status, birth rank, age, season and number of meals. Bayesian Information Criteria identified the most plausible causal model of why some children developed Kwashiorkor.In a descriptive analysis of the diet at the last dietary assessment prior to development of Kwashiorkor, the diet of children who developed Kwashiorkor was characterized by a low intake of sweet potatoes, papaya and “other vegetables” [0.0% , 2.3% (95%CI: 0.4, 12.1) and 2.3% (95%CI: 0.4, 12.1)] in comparison with children who did not develop Kwashiorkor [6.8% (95%CI: 6.4, 7.2), 15.5% (95%CI: 15, 16.1) and 15.1% (95%CI: 14.6, 15.7)] or children who developed marasmus [4.5% (95%CI 2.6, 7.5) 11.8% (95%CI: 8.5, 16.0) and 17.6% (95%CI: 13.7, 22.5)]. Sweet potatoes and papaya have high β-Carotene content and so may some of “the other vegetables”. We found that a risk model containing an age function, length/height-for age Z-score, consumption of sweet potatoes, papaya or other vegetables , duration of this consumption and its interaction term, was the most plausible model. Among children aged aged 10-42 months, the risk of developing Kwashiorkor increased with longer non-consumption of theses foods.The analysis was repeated with only children who developed marasmus as the reference series, yielding similar results. Our study supports that β-Carotene may play an important role in the protection against Kwashiorkor development.
