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American Journal of Clinical Nutrition, Vol 25, 1092-1102, Copyright © 1972 by The American Society for Clinical Nutrition, Inc.

Morphological aspects of the duodenojejunal mucosa in protein-calorie malnourished children and during recovery

Roberto E. Schneider M.D.1 and Fernando E. Viteri M.D., D.Sc.2

1 Research Associate, Biomedical Division, Institute of Nutrition of Central America and Panama; Associate Professor of Medicine, University of San Carlos School of Medicine, Guatemala, C.A., and Chief of the Research Division, Institute of Social Security of Guatemala
2 Chief, Biomedical Division, Institute of Nutrition of Central America and Panama

The characteristics and evolution of different morphological and functional alterations present in the proximal small intestine of 11 severely protein-calorie malnourished children were studied in relation to nutritional status, diarrhea, and intestinal parasitic infection. Four healthy, not previously malnourished children whose background was similar to that of the PCM subjects, were also studied. None of the morphological characteristics examined correlated with either the presence or degree of intestinal parasitic or protozoa infection.

Morphologically, the thickness of the duodenojejunal mucosa of the PCM patients as well as the heights of the epithelial cell and its brush border increased with nutritional recovery. Nevertheless, the presence of diarrhea adversely affected improvement and was associated with a decrease in the mitotic activity and an increase of the cell infiltrate in the epithelium. All other morphological characteristics, including the ridged appearance of the mucosa and the cell population of the lamina propria, remained unchanged and showed no relation to nutrition or diarrhea.

The morphological characteristics of the upper GI mucosa of normal, well-nourished children, were no different from those observed in the recovered patients.

PCM cannot be considered the only cause for the alterations found, as the presence and frequency of nonspecific diarrhea were also associated with several of those alterations; a frank interaction between PCM and diarrhea was frequently observed. It appears that the ecological situation characteristic of environments where poor hygienic conditions and diarrhea prevail plays an important role in the genesis and persistency of the GI alterations observed in children with and without clinically evident PCM.




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