GLUTATHIONE AND ASSOCIATED ANTIOXIDANT SYSTEMS IN PROTEIN-ENERGY MALNUTRITION - RESULTS OF A STUDY IN NIGERIA

Marasmus and kwashiorkor are manifestations of protein energy malnutri tion. The pathophysiology of these disorders is poorly understood. We studied a number of blood antioxidants [glucosed-phosphate dehydrogena se (G6PDH), glutathione reductase (GR) and its cofactor flavin adenine dinucleotide (FAD), the tripeptide glutathione as the major nonprotei n thiol], serum albumin, and retinol-binding protein in 12 children su ffering from kwashiorkor with all classical symptoms, in 13 patients w ith clinically severe marasmus, in 19 marasmic but active children, an d in 23 controls. Significant changes were observed for erythrocyte gl utathione and correspondingly for nonprotein thiols in whole blood (0. 72 +/- 0.29 mM thiols in controls, 0.50 +/- 0.22 mM in marasmus, 0.35 +/- 0.23 mM in severe marasmus, and 0.22 +/- 0.13 mM in kwashiorkor). These differences were paralleled by a decrease in serum albumin conce ntration so that the molar ratio of nonprotein thiols/albumin had an a verage value of approximately 1.5 in all groups. The erythrocyte gluta thione-reducing system, represented by G6PDH and glutathione reductase , showed only slight differences among the four groups of children; th e supposition that kwashiorkor occurs predominantly in children with a berrant G6PDH could not be substantiated. Unexpectedly, erythrocyte FA D, an index of riboflavin status, was normal in most malnourished pati ents. Discussed is the prospect of administering glutathione in kwashi orkor patients.