The Role of Sulfur Amino Acids in Risk of Kwashiorkor

Study Overview
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Brief Summary
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This observational cross-sectional study is investigating if young children in populations with higher prevalence of kwashiorkor malnutrition have lower dietary sulfur amino acid intake than populations with lower prevalence of kwashiorkor, controlling for multiple potential confounding factors. Intake is estimated through diet recalls during interviews with a child's caregiver, analysis of urine samples and analysis of food samples for their amino acid profiles.

Detailed Description
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Kwashiorkor is one of two categorizations of severe acute malnutrition, but its etiology remains unclear. Although kwashiorkor is found only where diets are low in quality protein, comparisons of total dietary protein of individual children with and without kwashiorkor has been inconclusive. This study aims to compare amino acid profiles of the diets, not just total protein. Evidence has shown that children with kwashiorkor consistently have very low circulating levels of sulfur amino acids (cysteine and methionine). Typical staple foods in regions with endemic kwashiorkor are generally poor in sulfur amino acids and the signs characterizing kwashiorkor can plausibly be explained by a shortage of sulfur amino acids. In eastern Democratic Republic of the Congo, certain populations have chronically higher prevalence of kwashiorkor than neighboring populations with similar livelihoods, religion, environment, language and ethnicity. This study will compare these two populations to understand what differences between them may explain the difference in prevalence.

Official Title
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The Role of Sulfur Amino Acids in Risk of Kwashiorkor

Conditions
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Kwashiorkor

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: resident of the selected population in the appropriate age range Exclusion Criteria: caregiver reports the child has an illness that has required treatment for at least 6 months

Ages Eligible for Study
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Minimum Age: 36 Months
Maximum Age: 59 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| High Prevalence Population<br>Prevalence of kwashiorkor (as diagnosed by bipedal pitting edema) is >2% among children 36 to 59 months old in the population, in Murambi/Malehe Health Area of eastern Democratic Republic of the Congo | Other: No intervention<br>* no intervention<br>|
| Low Prevalence Population<br>Prevalence of kwashiorkor (as diagnosed by bipedal pitting edema) is <2% among children 36 to 59 months old in the population, in Murambi/Malehe Health Area of eastern Democratic Republic of the Congo | Other: No intervention<br>* no intervention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dietary sulfur amino acid | mg of sulfur amino acid in the diet per kg of body weight | one measure at one time point within three weeks of registration | 
| dietary sulfur amino acid above or below WHO estimated average requirement (EAR) | the total sulfur amino acid in the diet will be calculated from a diet recall this will be a bivariate measure, 1 if the SAA in the diet is above or 0 if below the WHO/FAO requirement for sulfur amino acid intake of 17mg of sulfur amino acids per kg of body weight per day | one measure at one time point within three weeks of registration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| calories and protein in diet per kg of body weight | intake of calories (kcal/kg body weight), digestibility adjusted protein - sum of (grams of protein per food item x digestibility of food item) per kg of body weight quality adjusted protein = digestibility adjusted protein in the diet x proportion of requirement of the limiting amino acid | one measure at one time point within three weeks of registration | 
| urinary sulfate | sulfate excreted in the urine, normalized to creatinine | one measure at one time point within three weeks of registration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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sulfur amino acid