Plasma zinc, copper, selenium, ferritin and whole blood manganese concentrations in children with kwashiorkor in the acute stage and during refeeding

Abstract

Plasma zinc, copper, selenium, ferritin and whole blood manganese concentrations were measured in 22 children with kwashiorkor on admission to hospital and on days 5, 10 and 30 of refeeding. Twenty similarly aged, healthy, well nourished children served as controls. The mean (SEM) zinc, copper and selenium concentrations of 7.5 (0.93), 10.8 (0.64) and 0.29 (0.02) mumol/l, respectively, in the children with kwashiorkor on admission were all significantly lower than the values of 13.7 (0.66), 25.6 (1.72) and 0.72 (0.04) mumol/l in the controls. In contrast, the erythrocyte manganese level of 1.67 (0.09) micrograms/gHb and the median ferritin concentration of 293 micrograms/dl were significantly higher than in the controls. After 30 days there was full clinical recovery with significant weight gain and a return of the plasma albumin, caeruloplasmin, copper and ferritin to normal. However, manganese remained elevated and zinc and selenium concentrations remained significantly low. Our results suggest that nutritional rehabilitation of children with kwashiorkor is incomplete by 30 days and cannot be judged purely by a return of the plasma proteins to normal. Addition of selected trace elements to the diet may hasten full recovery.

Antioxidant status in children with protein-energy malnutrition (PEM) living in Cairo, Egypt

“…Unlike Cu, the plasma levels of Zn remained unaffected in KWO but increased in the presence of MAR, when compared with the control children. These results are in contrast with others (Subotzky et al, 1992), who reported a reduced Zn status in the presence of PEM. It is thought that gross hypoalbuminaemia may contribute to the lower level of zinc.…”

“…Mean whole blood GPX activity was signi®cantly depressed in parallel with plasma Se in PEM children compared with control subjects. These results are in agreement with others (Golden & Ramdath 1987;Ahmed et al, 1990;Subotzky et al, 1992;Sive et al, 1993). During GPX de®ciency, hydrogen peroxide that escapes dissipation may metabolize by catalase enzyme.…”

“…Plasma usually contains 100 mg Cuadl (Subotzky et al, 1992), and about 95% of Cu is ®rmly bound to ceruloplasmin (Hansen & Lehman, 1969). In this present study, the circulatory levels of both Cu and its carrier protein were reduced in the presence of either KWO or MAR.…”

“…An oxidative haemolysis has been suggested to be a possible mechanism for erythrocyte destruction leading to the PEM-associated anaemia (Golden & Ramdath, 1987). This hypothesis is supported by reduced levels of antioxidant enzymes (Vertongen et al, 1981;Sive et al, 1993;Subotzky et al, 1992;Houssaini et al, 1997) and their cofactors found in patients with PEM. Therefore, erythrocyte copper-zinc superoxide dismutase (Cu ± Zn, SOD) and selenium-glutathione peroxidase (GPX) along with plasma concentrations of copper (Cu), zinc (Zn) and selenium (Se) have been reported to be low in malnourished subjects.…”

Antioxidant Status and Nitric Oxide in the Malnutrition Syndrome Kwashiorkor

“…Our data indicate that apart from albumin, other plasma proteins contributing to the TAOS are also reduced. This is supported by studies demonstrating decreased levels of transferrin and ceruloplasmin in kwashiorkor (29). It should, however, also be noted that the extrapolation of a TAOS to the in vivo situation is limited.…”