Intended for healthcare professionals

Rapid response to:

Clinical Review

Management of the severely malnourished child: perspective from developing countries

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7381.146 (Published 18 January 2003) Cite this as: BMJ 2003;326:146

Rapid Response:

This could be "failure to thrive" due to low DHEA

(My explanation of "failure to thrive" may be a part of this (below).
This may be due to insufficient DHEA. It is noteworthy that DHEA is known
to provide protection from infections of all kinds. Low DHEA may explain
the increased infections in these children as well as other pathologies.)

Possible Explanation of “Failure to Thrive”
Infants May Have a Reduced “Melatonin – DHEA Cycle”

It is my hypothesis that melatonin and dehydroepiandrosterone (DHEA)
were involved in evolution of mammals (Rivista di Biologia / Biology Forum
2001; 94: 177-184) and humans (Rivista di Biologia / Biology Forum 2001;
94: 345-362). This is derived from my principal hypothesis that DHEA
optimizes transcription and replication of DNA and, therefore, DHEA may
have been involved in evolution of eukaryotes. It is my opinion that
melatonin and DHEA directly affect each others’ production and release and
this cycle determine our circadian rhythms (the melatonin – DHEA cycle,
1997). DHEA and melatonin are directly involved in the growth and
development and maintenance of all tissues. Therefore, I suggest the
syndrome of poor growth and development of infants called “failure to
thrive” may result from disruption of this cycle. The fact that attention
and contact ameliorates “failure to thrive” infants may be due to
promotion of the melatonin – DHEA cycle.

Studies link melatonin with infant growth and development. “6-
sulfatoxymelatonin [the melatonin metabolite excreted in urine] levels at
16 weeks of age were significantly lower in infants with abnormal vs
normal development at 3 months of age (7.27 + 1.44 vs 7.97 + 1.06, p =
0.05) as well as at 6 months of age (7.15 + 1.29 vs 7.95 + 1.10, p =
0.04). no other significant relation was evident among growth, perinatal
complications, medical problems, and 6-sulfatoxymelatonin excretion at 8
weeks of age and at 16 weeks of age. low melatonin excretion in the first
weeks of life correlates with delayed psychomotor achievements at 3 and 6
months of age. this association suggests a causal or predictive link
between melatonin and neurodevelopment in infants.” (Pediatr Neurol 2002
May;26(5):379-82). “Massage therapy” by mothers of normal infants
significantly increased melatonin production. “At 12 weeks, nocturnal 6-
sulphatoxymelatonin excretions were significantly higher in the treated
infants (1346.38 +/- 209.40 &mgr;g/night vs 823.25 +/- 121.25
&mgr;g/night, respectively; <.05). (J Dev Behav Pediatr 2002
Dec;23(6):410-415). It is known that maternal touch is lacking in
“failure to thrive” infants” (J Am Acad Child Adolesc Psychiatry 1994
Oct;33(8):1098-105). I suggest melatonin is directly involved in normal
development of infants and may be part of the mechanism that is lacking in
reduced maternal touching in “failure to thrive infants”

It has been determined that DHEA-sulfate (DHEAS), the large,
background supply of DHEA, increases production of melatonin by rat pineal
glands (Steroids 2000 Sep;65(9):491-6) and that melatonin treatment
increases DHEAS (Neuroendocrinol Lett 2002 Apr;23 Suppl 1:17-9). This
supports the “melatonin – DHEA cycle,” which I suggest may be involved in
growth and development. DHEA is a mild androgenic, steroid hormone which
produces positive effects on many tissues. I suggest the positive effects
of touch on “failure to thrive” infants results from stimulation of the
melatonin – DHEA cycle. In some infants, failure of this cycle alone may
result in “failure to thrive” and attentive care, such as touching, may
not, alone, ameliorate this problem.

Competing interests:  
None declared

Competing interests: No competing interests

18 January 2003
James M. Howard
independent biologist
1037 North Woolsey Avenue, Fayetteville, Arkansas 72701-2046, U.S.A.