Antioxidant status and nitric oxide in the malnutrition syndrome kwashiorkor

The pathophysiology of kwashiorkor, a severe edematous manifestation of mal nutrition, is still poorly understood. The syndrome is, however, known to b e associated with alterations in redox metabolism. To further elucidate the role of oxidative stress in kwashiorkor, we carried out a longitudinal stu dy on the major blood antioxidants at the St. Joseph's Hospital, Jirapa, Gh ana. All kwashiorkor patients (K) were followed up for 20 d. In comparison with local healthy controls (C), the plasma total antioxidant status was re duced to less than 50% in the patients (C, 0.87 +/- 0.21 mM; K, 0.40 +/- 0. 20 mM; p < 0.001). Similarly, the major plasma antioxidant albumin (C, 40.9 +/- 2.5 g/L; K, 19.1 +/- 7.4 g/L; p < 0.001) and erythrocyte glutathione ( C, 2.39 +/- 0.28 mM; K, 1.01 +/- 0.33; p ( 0.001) were decreased, whereas t he levels of bilirubin and uric acid were not significantly altered. Nitrit e and nitrate were found to be increased by a factor of 2 in kwashiorkor (C , 120 +/- 46 muM; K, 235 +/- 107 muM; P < 0.001). Over the observation peri od, the trends of albumin and glutathione Levels were related to clinical o utcome. These concentrations rose in patients who recovered and fell in pat ients who did not. Our study strongly supports the hypothesis that oxidativ e and nitrosative stress play a role in the pathophysiology of edematous ma lnutrition. Prophylactic and therapeutic strategies should aim at the caref ul correction of the reduced antioxidant status of the patients.