Albumin Metabolism in Children With Protein Malnutrition1

Of the biochemical disturbances associated with protein malnutrition in man, hypoalbuminemia is undoubtedly one of those most consistently found (1, 2). The metabolic mechanisms operating to produce this hypoalbuminemia are not known. However, analysis of diets of children with se-vere protein malnutrition (kwashiorkor) has re-vealed that the protein intake of such children is less than half of the minimal protein requirement for age, even discounting the fact that the pro-teins ingested are primarily of vegetable origin and that caloric intake is indaequate as well (3, 4). While it is not possible to decide a priori that the hypoalbuminemia in this condition is at-tributable to decreased synthesis secondary to diminished amino acid intake, this possibility would seem the most likely; diminished albumin synthesis has been shown to occur in animals on comparable diets (5). However, since the plasma concentration of albumin represents a balance be-tween synthesis, distribution in the body, and degradation, any or all of these factors could play a role. Consequently, this study was undertaken to evaluate the relative influence of each of these on the production of hypoalbuminemia in children with protein malnutrition. METHODS Patients. Fourteen children, admitted to the Hospital Infantil; Mexico City, with severe protein malnutrition, were selected for study (Table I). All of the children had a history of prolonged inadequate protein intake and repeated episodes of diarrhea during which total food intake was greatly reduced as well. Although extremely malnourished, 3 children had no edema upon admission