Anemia in experimental protein deficiency in the rhesus monkey with special reference to iron metabolism.

NEMIA is an important manifestation of Kwashiorkor,15 a syndrome of protein malnutrition. Woodruff,5 on the basis of his studies in Africa, emphasized the difficulty of assessing the role of protein malnutrition per se in the genesis of anemia in Kwashiorkor, since the human syndrome was associated with multiple nutritional deficiencies and often complicated by intercurrent infections and parasitic infestations. This anemia responds slowly to high protein therapy alone unless the diet is supplemented with specific hematinics such as iron6 and folic acid.7 However, recently some workers have reported a good response of the anemia of Kwashiorkor to a high protein diet without other hematinics.8 The importance of dietary protein in the synthesis of hemoglobin was recognized several years ago by Whipple and Hooper” and Jenks.1#{176}These workers demonstrated that regeneration of hemoglobin in laboratory animals made anemic through phlebotomy is enhanced if the diet is supplemented with protein. Rats kept on a protein-deficient diet consistently develop anemia which is microcytic and hypochromic.11 The reports on the morphologic type of anemia in Kwashiorkor are variable. Normocytic normochromic anemia is reported most commonly,37”2’13 but hypochromic5 and megaloblastic types are also reported.7’14 Disturbances in iron absorption, and a fall in serum iron and iron binding capacity have been found in human’5’16 and experimental protein malnutrition.17’18 Changes in serum folic acid and vitamin B12 have been also observed.’9’20 The role of these changes in the pathogenesis of anemia in protein malnutrition is not known. We have been able to induce in rhesus monkeys a syndrome very similar to human Kwashiorkor by tube-feeding them a diet deficient only in protein but adequate in all other nutrients and calories.21-23 Using this experimental primate model, we attempted to elucidate the role of protein deficiency per se in the pathogenesis of anemia. In this communication we present the results of this study with special reference to the disturbances in iron metabolism.