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Antioxidant status in children with protein-energy malnutrition (PEM) living in Cairo, Egypt
M N Ashour1, S I Salem, H M El-Gadban
1Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Canada.
Insights
Children with protein-energy malnutrition (PEM) exhibit impaired antioxidant status, including lower levels of key vitamins and enzymes. This deficiency increases susceptibility to oxidative stress and associated health issues like edema.
Area of Science:
- Nutritional Biochemistry
- Pediatric Nutrition
- Oxidative Stress Research
Background:
- Free radicals contribute to various diseases, and their imbalance with antioxidants causes tissue damage.
- Protein-energy malnutrition (PEM) in children is linked to edema and anemia, potentially due to oxidative stress.
- Evaluating antioxidant status in PEM is crucial for understanding disease pathogenesis.
Purpose of the Study:
- To assess the antioxidant status in children diagnosed with protein-energy malnutrition (PEM).
- To investigate the levels of specific antioxidant enzymes, trace elements, and vitamins in malnourished children.
Main Methods:
- Studied 68 children (3 months-3 years) in Cairo, Egypt, including 46 with PEM (26 kwashiorkor, 20 marasmus) and 22 healthy controls.
- Measured antioxidant status via red blood cell copper-zinc superoxide dismutase (Cu-Zn SOD), whole blood glutathione peroxidase (GPX), and plasma ceruloplasmin.
- Assessed plasma levels of copper (Cu), zinc (Zn), selenium (Se), vitamin A, vitamin E, and vitamin C.
Main Results:
- PEM children (kwashiorkor and marasmus) showed lower whole blood GPX, plasma vitamins A, E, C, ceruloplasmin, copper, and selenium compared to controls.
- Erythrocyte SOD activity was higher in PEM children, while plasma zinc was unchanged or increased.
- Kwashiorkor cases exhibited decreased hemoglobin and significantly increased plasma free iron (Fe).
Conclusions:
- PEM children demonstrate compromised antioxidant defenses, indicated by reduced GPX, ceruloplasmin, and antioxidant vitamins.
- Elevated red cell SOD and increased plasma iron, particularly in kwashiorkor, suggest heightened susceptibility to oxidative stress.
- These findings highlight the potential role of oxidative stress in the clinical manifestations of PEM, such as edema.
Objectives:
Free radicals are implicated in many diseases. The rise in free radicals associated with antioxidant deficiency results in tissue damage. The pathogenesis of oedema and anaemia commonly found in children with protein-energy malnutrition (PEM) has been suggested to be caused by an imbalance between the production of toxic radicals and their safe disposal. The aim of this study was to evaluate antioxidant status in children with PEM.
Design:
A total of 68 children (age range: 3 months to 3 years) living in Cairo, Egypt were recruited. Forty-six of these subjects had different degrees of PEM; they were admitted at the Abo-Elrish Hospital, Cairo. Of these, 26 children had kwashiorkor (KWO) and twenty had marasmus (MAR). Twenty-two age and sex matched healthy well-nourished children were recruited from the local community, and used as controls.
Methods:
The antioxidant status of the study population was determined by measuring copper-zinc superoxide dismutase (Cu-Zn, SOD) in red blood cells, glutathione peroxidase (GPX) in whole blood, and ceruloplasmin in plasma. In addition, the plasma levels of trace-elements involving antioxidant activities, such as copper (Cu), zinc (Zn), and selenium (Se) were determined, along with a select group of vitamins. The latter included vitamin A (retinol), vitamin E (alpha-tocopherol) and vitamin C (ascorbic acid).
Results:
The mean whole blood GPX activity along with plasma levels of vitamins A, E and C as well as ceruloplasmin, Cu and Se were all lower in children with either KWO or MAR than their corresponding control subjects. The erythrocyte SOD activity, on the other hand, was increased while the plasma Zn concentrations were either increased or not changed in the malnourished children. It was of interest that while haemoglobin concentrations were decreased, the plasma free iron (Fe) levels were significantly increased in children with KWO.
Conclusions:
The significant increase in red cell SOD activity associated with the decrease in plasma ceruloplasmin, antioxidant vitamins and the whole blood GPX activity in PEM children suggest that these children are potentially susceptible to high oxidative stress. An elevated plasma Fe concentrations, especially with KWO may augment the harmful effect of free radicals with a clinical consequence of oedema.
