Kwashiorkor in western Nigeria: a study of traditional weaning foods, with particular reference to energy and linoleic acid

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Abstract
1. The fatty-acid composition of the plasma total lipids of children with kwashiorkor and of healthy infants was determined by gas–liquid chromatography. Breast milk from Yoruba mothers, and traditional weaning foods, were also analysed for fatty acids, and for protein, fat and carbohydrate.2. Evidence of essential fatty acid (EFA) deficiency was obtained in the children with kwashiorkor. The proportions of linoleic and arachidonic acids were reduced in the plasma lipids, whereas the endogenous eicosatrienoic acid showed a marked increase. The triene:tetraene ratio had the abnormally high value of 1·08. These changes were consistent with the prolonged ingestion of suboptimal amounts of linoleic acid.3. Breast milk was of good quality, with a particularly high concentration of retinol. The milk was also rich in linoleic acid, and was thus discounted as a factor in the development of EFA deficiency, but the weaning foods were found to provide substantially less than the minimum recommended intake of 1% of the total energy as linoleic acid.4. The maize pap with which the children with kwashiorkor had been fed for several months before the appearance of acute symptoms provided almost 7% of the energy as protein, but only 1·21 MJ (290 kcal)/kg. To satisfy energy requirements, it would have been necessary to consume 3–4 kg of the pap each day.5. It is concluded that the protein deficiency which leads to the development of kwashiorkor in the Yoruba community arises from a very severe restriction in energy intake rather than from the consumption of foods very low in protein at adequate or excessive levels of energy intake.