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Inflammatory mediators in children with protein-energy malnutrition
R W Sauerwein1, J A Mulder, L Mulder
1Department of Medical Microbiology, University Hospital Nijmegen, Netherlands. R.Sauerwein@MMB.AZN.NL
Insights
Children with kwashiorkor, a form of protein-energy malnutrition (PEM), exhibit increased inflammatory markers and reduced antioxidant levels. These factors may contribute to the characteristic edema seen in this condition.
Area of Science:
- Biochemistry
- Pediatrics
- Immunology
Background:
- Edema is a common sign in kwashiorkor, a subset of protein-energy malnutrition (PEM).
- The exact cause of edema in kwashiorkor is not fully understood.
- Reduced antioxidant levels in kwashiorkor suggest impaired free radical neutralization and potential tissue damage.
Purpose of the Study:
- To investigate the role of inflammatory mediators in the pathophysiology of edema in children with PEM.
- To assess the relationship between inflammatory markers, antioxidant status, and edema in kwashiorkor.
Main Methods:
- Measured plasma concentrations of inflammatory mediators, including interleukin-6 (IL-6), C-reactive protein, and tumor necrosis factor alpha soluble receptors (sTNFR-p55, sTNFR-p75).
- Assessed antioxidant status by measuring plasma concentrations of glutathione and vitamin E.
- Compared these levels in children with PEM (with and without kwashiorkor) and healthy children.
Main Results:
- Children with PEM, especially those with kwashiorkor, showed significantly higher concentrations of IL-6, sTNFR-p55, and sTNFR-p75 compared to healthy controls.
- These elevated inflammatory markers were present in kwashiorkor patients even without infection.
- Plasma concentrations of glutathione and vitamin E were significantly reduced in kwashiorkor patients, indicating compromised antioxidant status.
Conclusions:
- Children with edematous malnutrition (kwashiorkor) exhibit heightened inflammatory reactivity.
- Increased inflammation and reduced antioxidant capacity are potential contributors to edema formation in kwashiorkor.
Abstract:
Edema is a typical sign in kwashiorkor, which is present in a subset of patients with protein-energy-malnutrition (PEM). The pathophysiology of this edema is not well established. One of the abnormalities found in kwashiorkor is reduced concentrations of antioxidants, suggesting a compromised capacity to neutralize free radicals, which are known to induce tissue damage. We have studied plasma concentrations of several mediators of the inflammatory cascade. Concentrations of interleukin 6 (IL-6), C-reactive protein, and the soluble receptors of tumor necrosis factor alpha (sTNFR-p55 and sTNFR-p75) are greater in children with PEM, particularly in those with kwashiorkor, whereas soluble receptors of IL-6 (sIL6R-gp80) and IL-1 receptor antagonist concentrations are not significantly different from those of healthy children. In addition, concentrations of IL-6, sTNFR-p55, and sTNFR-p75 are greater in kwashiorkor patients irrespective of the presence of infection. Antioxidant status, as determined by plasma concentrations of glutathione and vitamin E, is significantly reduced in kwashiorkor patients. These data support the notion that children with edematous malnutrition show increased inflammatory reactivity that may contribute to edema formation.