Cortical and Trabecular Bone

During the normal growth and development of man and animals the bones grow in length and width and undergo progressive changes in their architecture, a process known as maturation. These normal processes are governed by numerous and complex forces but one of them, the plane of nutrition during the growing period, is of major importance. Undernourished children are small in stature and have bones which are at an earlier stage of development than normal (Berridge and Prior, 1954; Jones and Dean, 1956). These disturbances of skeletal growth and maturation are found in children deprived of calories (marasmus) and protein (kwashiorkor); experimental studies have confirmed these clinical observations. When animals are subjected to severe and prolonged undernutrition from early in their development, growth is retarded and the bones are abnormal in structure and composition; this happens with experimentally-induced deficiencies of calories (Dickerson and McCance, 1961; and ofprotein (Platt and Stewart, 1962; El-Maraghi, Platt, and Stewart, 1965), though the changes produced are not identical in the 2 conditions (Adams, 1969). Children with kwashiorkor have small bones which are less mature than normal (Jones and Dean, 1956) and which commonly show transverse lines of arrested growth visible at x-ray (Jones and Dean, 1956; Platt, Stewart, and Platt, 1963); a deficiency of cortical bone has also been found (Gain et al., 1964). Wayburne (1968) has reported a loss of trabecular bone in South African children with kwashiorkor; but many of them have rickets, and this complicates the precise interpretation of bony changes and of the role of protein deficiency in their production. In contrast to other findings, Reichman and Stein (1968) reported few abnormalities in the bones of Bantu children with protein deficiency.