INFLAMMATORY MEDIATORS IN CHILDREN WITH PROTEIN-ENERGY MALNUTRITION

Edema is a typical sign in kwashiorkor, which is present in a subset o f 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 severa l mediators of the inflammatory cascade. Concentrations of interleukin 6 (IL-6), C-reactive protein, and the soluble receptors of tumor necr osis factor alpha (sTNFR-p55 and sTNFR-p75) are greater in children wi th PEM, particularly in those with kwashiorkor, whereas soluble recept ors of IL-6 (sIL6R-gp80) and IL-1 receptor antagonist concentrations a re not significantly different from those of healthy children. In addi tion, concentrations of n-6, sTNFR-p55, and sTNFR-p75 are greater in k washiorkor patients irrespective of the presence of infection. Antioxi dant status, as determined by plasma concentrations of glutathione and vitamin E, is significantly reduced in kwashiorkor patients. These da ta support the notion that children with edematous malnutrition show i ncreased inflammatory reactivity that may contribute to edema formatio n.