Biochemical tests in differential diagnosis of protein and calorie deficiencies.

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Abstract
Studies were made on 16 children with nutritional marasmus and 36 with kwashiorkor. The children with kwashiorkor were subdivided into those with dark hair and those with pale hair. The clinical state of the dark-haired children was complicated by malaria and intestinal worm infestations. The amino acid ratio was raised in both groups with kwashiorkor, but only slightly so in the marasmic children. The serum proteins were low in the kwashiorkor, but almost normal in the marasmic cases. The hydroxyproline index was low in the marasmic children and in those with kwashiorkor and pale hair, but it was not so low in those with dark hair. The dark-haired cases of kwashiorkor had very low levels of Hb [hemoglobin] and serum protein, but the glucose in their blood was higher and more nearly normal than in that of the pale-haired children. It is suggested that by using the serum protein, the amino acid ratio, and the hydroxyproline index, it is possible to differentiate between calorie deficiency and 2 types of protein malnutrition. With successful treatment the hydroxyproline index rose, but if recovery was delayed by intercurrent infections the index fell to levels similar to those found initially. The rate at which the index increased was proportional to the rate of growth.