CO₂ production during acute infection in malnourished Malawian children

Objective: This study tested the hypotheses that the rate of CO₂ production is less in marasmic children with acute infection when compared to well-nourished children, but greater when compared to uninfected marasmic children. Design: A descriptive comparison of children aged 12-60 months who had their rates Of CO₂ production measured using a stable isotope tracer dilution method while receiving feedings. Body mass index (BMI) was the best measure of lean body mass available in this study. Setting: Queen Elizabeth Central Hospital, Blantyre, Malawi. Subjects: A total of 56 children were studied, 28 with marasmus and acute infection, 16 with marasmus, and 12 well nourished with acute infection. Those with acute infection had malaria, pneumonia, or sepsis. Results: Well-nourished children with acute infection produced more CO₂ than marasmic children (344 ± 60 vs 225 ± 65 mmol CO₂/h, mean ± s.d., P < 0.001; 24.2 ± 4.6 vs 18.4 ± 5.4 mmol CO₂/BMI h, P = 0.001). However, the rate of CO₂ production in marasmic children with acute infection was not greater than in uninfected marasmic children (225 ± 65 vs 228 ± 61 mmol CO₂/h). The observed rate of CO₂ production was greater than that which could be produced from the dietary intake alone (29.6 vs. 25.8 mmol CO₂/kg h). Conclusions: Marasmic children do not increase energy expenditure in response to acute infection, as well-nourished children do. Dietary energy provided to marasmic children should be at least 420 kJ/kg day.