1 Wellcome Trace Element Research Group, Tropical Metabolism Research Unit, University of the West Indies, Kingston 7, Jamaica
To the Editor.
Kumar and Anday1 describe three premature infants presenting with edema and hypoproteinemiathe classical signs of kwashiorkorbetween 5 and 9 weeks of age. Such cases are not uncommon in developing countries. Kumar and Anday's patients had low plasma zinc concentrations (43, 37, and 42 µg/dL). On this basis the authors claim that edema and hypoproteinemia is a clinical presentation of zinc deficiency not previously reported.
We reported2 a clear association between "nutritional" edema and a low plasma zinc concentration in 1979; our subsequent experience has confirmed that edema of this type is always associated with a low plasma zinc concentration, as indeed Kumar and Andays' cases demonstrate.