This study tests the hypothesis that in the treatment of edematous malnutrition (EM) with coincident acute infection there is a lower rate of amino acid oxidation when the dietary intake of amino acids is more similar to the amino acid composition of acute phase proteins (APP's). Twenty-two children with EM and acute infection were fed an isocaloric, isonitrogenous diet with either egg white or milk as a protein source. The whole-body amino acid oxidation rate was measured after 24 hours by determining the plasma urea rate of appearance, and whole-body protein breakdown and synthesis rates were determined from the plasma leucine rate of appearance. Plasma concentrations of C-reactive protein, α 1-antitrypsin, TNF-α, and interleukin-6(IL-6) were determined at admission, 24 hours, and 48 hours and correlated with the metabolic measurements. The 11 children who received milk had a lower rate of amino acid oxidation than the children who received egg white (137 vs 195 micromole urea/kg/h, p<0.05). No significant differences between the 2 groups were found in the rate of whole-body protein breakdown (255 vs 222 micromole leucine/kg/h) or protein synthesis (266 vs 243 micromole leucine/kg/h), or the concentration of APP's or cytokines, although the power of these comparisons was low. TNF-α concentration was shown to correlate negatively with whole-body protein breakdown or protein synthesis (r = 0.47, p< 0.03), and IL-6 concentration correlated positively with C-reactive protein (r = 0.76, p < 0.001).
