Treatment Vinodini Reddy of kwashiorkor and Children 200 kcal/kg. opaque-2 maize weeks. The They results Both the were comparable clinical opaque-2 maize 122-124, 1974. divided twelve and indicate and kwashiorkor with were other that because of appears to its low be with as content of The milk of milk received diet in the in children Thus, providing the composition of the of consumed quality Am. protein. a period treatment who nutritive for 4 g/kg a diet diets protein based of on 5 4 to kwashiorkor. the maize of the .1. Clin. is given diet protein Nutr. in of 27: Table 1. Opaque-2 maize was analyzed for the protein and lysine content. Protein was determined by the macro-Kjeldahl procedure and lysine by a microbiological technique described earlier (3). The protein content was 9.2% and the concentration of lysine was 4.25 g/100 g protein. Maize was given in the form of chapati (unleavened bread) or porridge. In addition, all the children received one multivitamin tablet (vitamin A, 2,000 IU; vitamin D, 200 IU; thiamin, 1 mg; riboflavin, 1.2 mg; ascorbic acid, 30 mg) and one fersolate tablet (60 mg iron) per day. A daily record of clinical progress and body weight was maintained. Blood samples were obtained at the time of admission and again on the 10th and 30th days of treatment. Hemoglobin was determined as oxyhemoglobin and serum albumin was estimated by the micro-Kjeldahl method after fractionating with 28% sodium sulfite. Criteria employed in the assessment of response are 1) time taken for the disappearance of edema, 2) gain in weight after the minimum body weight was reached, and 3) serum albumin regeneration. and methods the diet completely because cases were excluded from the Ten children who consumed others who consumed the followed for a period of 4 groups were comparable with and severity that a diet children is effective milk. as with Ten a skim observed skim good Twenty-two children with kwashiorkor were investigated. They were grossly underweight with varying levels of edema and hypoalbuminemia. In addition, some of them showed mental changes and skin changes. Their ages ranged from 1 to 5 years and their weights from 5 to 10 kg. The children were hospitalized for 4 to 5 weeks and were given diets which provided 4 g/kg of protein and 200 kcal/kg body wt. They were divided into two groups. One group received a diet based on opaque-2 maize and the other group received a skim milk diet. Children with severe anorexia refused to take the maize so they had to be given skim milk. Some of them could not consume maize responses obtained groups. received opaque-2 biochemical to those treated two children acids, particularly lysine. In recent years, efforts have been made to produce food grains of better nutritional quality. Opaque-2 maize is a variety of corn which contains higher amounts of lysine and tryptophan than ordinary corn. Studies in experimental animals have shown that PER value for opaque-2 maize is equal to that of milk protein (1, 2) and it has been suggested that this can replace milk in the diets of children in poor communities. A clinical trial was therefore undertaken to test the efficacy of opaque-2 maize in the treatment of protein-calorie malnutrition. Materials maize’ of the bulk. Six study for these reasons. the maize diet and 12 skim milk diet were to S weeks. These two regard to age, weight, Results Acceptability The skim milk diet was readily accepted by all the children but some difficulty was encountered in feeding the maize diet. They could not take the diet completely because of the bulk. Even the 10 children who consumed the maize diet had to be coaxed and persuaded to do so during the first 4 to 5 days. Once they recovered from the acute stage, however, feeding was no longer a problem. ‘From Council of the National Institute of Nutrition, Medical Research, Jamai-Osmania, bad-500007, of edema. Indian Hydera- India. 122 The American Journal of Clinical Nutrition 27: FEBRUARY 1974, pp. 122-124. Printed in U.S.A. Downloaded from ajcn.nutrition.org by guest on September 9, 2014 is poor amino were into Cereals form the staple diet in many developing countries where protein-calorie malnutrition is widely prevalent. The quality of cereal protein essential opaque-2 C. P. Gupta ABSTRACT and with TREATMENT Clinical OF KWASHIORKOR response There was littledifference between the two groups with regard to the rate of clinical improvement (Table 2). The time taken for the disappearance of edema ranged from 1 to 3 weeks in both groups. At the end of 4 weeks of treatment, the mean weight gain after the minimum body weight was reached was 0.7 kg in the group who received the maize diet and 0.9 kg in the children who received the skim milk one. Improvement of the associated signs of malnutrition such as the mental and skin changes also did not differ in these two groups. Hemoglobin admission, anemia, the Hb TABLE 1 Composition Skim Dry of the milk skim the children levels ranging moderate 7 to 11 diets’1 Maize milk 9 Ghee Sugar Opaque-2 20 Ghee 8 8 Sugar Two bananas/day. ‘1Amount in grams per kilogram b Protein, 4 g/kg; calories, 200/kg diet’ 45 5 S maize body weight. body wt. 2 Response to treatment Opaque-2 Groups Time taken maize fordis- appearance of edema, days Initial body weight, kg Gain in weight, kg in 30 days 15.0 ± 2.6 8.4 ± 0.67 0.7 ± 0.12 milk Skim 15 ± 1.9 7.6 ± 0.54 0.9 ± 0.10 Initialalbumin level, 1.88 ± 0.168 g/l00 ml 1.63 ± 0.164 Increase g/l00 day Increase g/lOO day in albumin, ± 0.112 0.66 ± 0.115 in albumin, ml on 30th 1.08 ± 0.173 1.23 ± 0.171 ml on 8.0 ± 0.24 8.6 ± 0.46 Hb, g/lOO 10th Serum admission 9.5±0.34 are means ± g to albumin 9.5 g/100 ml in the group regeneration On admission, the serum albumin concentration was low in all the children, the mean levels being 1 .88 and 1 .63 g/l 00 ml in groups 1 and 2, respectively. The albumin level increased by 0.66 and 1 .23 g/l 00 ml on the 10th and 30th day after treatment with skim milk, whereas in the other group, the increase in serum albumin was slightly lower, 0.53 and I .08 g/lOO ml on the 10th and 30th day after treatment with opaque-2 maize. However, these differences were not statistically significant. The results of the present study indicate that opaque-2 maize is effective in the treatment of kwashiorkor. The response observed in children who consumed the maize diet was comparable to that obtained with skim milk. The rise in serum albumin in these children was nearly 90% of that observed in children treated with skim milk. Earlier studies with different vegetable proteins have shown that although they are effective in controlling the acute clinical manifestations of kwashiorkor, they are inferior to skim milk as far as serum albumin regeneration is concerned (4). In this study, the mean rise in albumin level obtained with opaque-2 maize was I .08 g/ I 00 ml, which is close to the I .04 g/100 ml observed in the earlier experiment with bengal gram protein (4) and much higher than the values obtained with diets based on cottonseed (5), sesame, groundnut and cerealpulse combinations (4). Thus, the quality of the protein of SE. 9.3± 0.39 opaque-2 maize appears to be that of several vegetable proteins and close to that of milk protein. Though skim milk has proved to be most effective in the treatment of kwashiorkor, this cannot be the practical answer to the problem to of widespead Hb,g/loomlon 30th day Values 8.0 there a mean receiving the maize diet and from 8.6 g to 9.3 g/100 ml in the group treated with skim milk. superior 0.53 ml on of weeks after treatment, increase in Hb from Discussion dietb Bread TABLE had from g/100 ml. Four was a significant level 123 MAIZE Sources found. foods protein therefore deficiency in the country. cheaper than milk have to be for suitable vegetable protein of protein The search becomes Although several into consideration important. factors in the have choice to be taken of a vegetable Downloaded from ajcn.nutrition.org by guest on September 9, 2014 On levels WITH 124 REDDY AND Both clinical and biochemical responses observed in children who received the maize diet were comparable to those obtained with skim milk. A rise in serum albumin levels in these children was approximately 90% of that observed in children treated with skim milk, Because the nutritive quality of protein of opaque-2 maize is almost equivalent to that of milk protein, inclusion of this millet in the diets may be expected to improve the quality of the diet and thus improve the nutritional status of undernourished populations. El References 1. MERTZ, E. T., 0. 0. E. NELSON. maize. 2. Science 148: BRESSANI, with G. ELIAS AND R. A. Protein quality of opaque-2 in rats. J. Nutr. 97: 173, 1969. Y. G., AND K. C. PANT. Nutrient L. Indian vegetable J. Med. 5. SRIKANTIA, AND fed on opaque-2 composition and amino acid pattern of yielding maize varieties. Indian J. Nutr. 244, 1971. SRIKANTIA, S. G., AND C. GOPALAN. trials protein Res. 48: foods 637, S. G., AND some high Dietet. 8: Clinical in kwashiorkor. 1960. SAHGAL. Use seed protein in protein-calorie malnutrition. Am. J. Clin. Nutr. 21: 212, 1968. BRESSANI, R. Protein quality of opaque-2 maize in children. Proc. High Lysine Corn Coni. Corn Refiners Assoc., Inc. Washington, D.C., 1966, p. of 6. L. S. BATES of rats 1965. 1741, R., GOMEZ-BRENES. corn, evaluation 3. DEOSTHALE, 4. A. VERON, Growth SHANTI cotton 34. 7. YOUNG, V. R., I. OZALP, B. B. CHOLAKOS N. S. SCRIMSHAW. Protein value of Colombian opaque-2 corn for young adult men. J. Nutr. 101: 1475, 1971. CLARK, H. E., P. E. ALLEN, S. M. MEYERS, S. AND Summary Twenty-two treated with children with kwashiorkor were a diet providing 4 g/kg of protein and 200 divided into two groups. One group received a based on opaque-2 maize and the other received a skim milk diet for a period of diet group kcal/kg 4 to 5 weeks. body wt. The children 8. E. were 9. TUCKETf AND Y. YAMAMURA. Nitrogen balances of adults consuming opaque-2 maize protein. Am. J. Clin. Nutr. 20: 825, 1967. Indian Agricultural Research Institute. Recent research on the improvement of protein and nutritional properties of food and feed plants, IARI. 1971. Res. Bull. (New Series No. 6), New Delhi, Downloaded from ajcn.nutrition.org by guest on September 9, 2014 protein food, one of the most important is its nutritive value, Studies in experimental animals have shown that the PER value for opaque-2 maize is equivalent to that of casein (1, 2). The results of the present study as well as the balance studies reported in normal subjects (6-8) confirm the fact that the nutritive value of opaque-2 maize protein is indeed high and is well utilized by humans. Recipes containing opaque-2 maize as an ingredient can therefore be recommended as food supplements to prevent protein-calorie malnutrition in children. Though children with kwashiorkor who were acutely ill could not consume the maize diet completely, acceptability was found to be good after recovery and also among those children who were suffering from a mild or moderate degree of malnutrition. Maize is an important food crop in India and is well accepted by many people. Hybrid com has already gained popularity among our farmers. Recently, high-lysine maize composites,shakti and rattan, containing the opaque-2 gene have been developed at the Indian Agriculture Research Institute (9) and are now available for cultivation. Food grains of high nutritive quality have tremendous significance in the nutrition of people in many developing countries. Inclusion of such grains in the diets appears to be a practical approach to improve the protein nutritional status of the population. GUPTA