Nutritional Edema. I. Effect of Level and Quality of Protein Intake on Nitrogen Balance,Plasma Proteins and Edema

Nutritional edema is apparently another type of edema in which the mechanism of its production is related to the low level of plasma proteins, similar to that of nephrosis and plasmapheresis. In nutritional edema, however, the lowered plasma proteins are brought about by a deficiency in protein in diet. Denton and Kohman 1 produced edema in a large proportion of rats fed largely on carrots. This work was confirmed by Frisch, Mendel and Peters, 2 who in addition showed that the plasma proteins were low in their rats. Recently Shelburne and Egloff 3 succeeded in producing edema in a dog fed on a low protein diet. We add the following preliminary report of a study on the nitrogen balance, plasma proteins and extent of edema in 2 cases of nutritional edema under the influence of different dietary regimes.

The 2 patients, aged 11 and 20 respectively, were inmates of an orphanage in which they subsisted for a long time on a diet deficient in protein. They presented evidence of undernutrition with marked edema. There was no evidence of cardiac or renal disease. Case 1 had a total plasma protein value of 3.46% and albumin 1.43%. Case 2 had 4.01% for total proteins and 2.17% for albumin. Throughout the 21 periods of 4 days each their total caloric intake was kept at 1400, salt at 6 gm., and water at 1500 cc, while the level and character of the proteins in the diets were varied. Each diet was given for 2 to 5 periods. Diet 1 contained 23.5 gm. (Case 1) and 27.5 gm. (Case 2) of vegetable proteins, estimated intake of protein for them while in the orphanage. With this diet their nitrogen balance was barely maintained, and their plasma proteins showed a slight tendency to increase, and their edema after an initial decrease did not completely subside.