Pro-inflammatory cytokines, oxidative stress and intelligent quotient [IQ] in malnourished pediatric patients

ABSTRACT

Protein energy malnutrition [PEM] is one of the most common health problems among children of developing countries. Children with PEM lose their resistance to infection because of a disordered immune system. Protein energy malnutrition produces changes in inflammation related proteins characteristic off a low grade systemic inflammatory response and, thus, can serve as an inflammatory stimulus. Antioxidant status of PEM patients is significantly reduced. An increasing body of evidence indicates a link between malnutrition and poor cognitive ability in children [in particularly in early onset malnutrition]. This study included 28 children having malnutrition [17 patients had marasmus [loss of subcutaneous fat over the thigh or over the abdomen or loss the buccal bad of fat] and 11 patients had kwashiorkor[presented by generalized edema, sparse easily detachable hair, flag sign, cracky paint dermatosis and apathy], 15 males 13 females, their ages ranged from 4 months to 24 months, admitted to Gastroenterology Unit, Assuit University Children Hospital from April 2007 to December 2007 as well as 15 apparently healthy children of matchable ageand sex. All patients subjected to full history, complete clinical examination and the following investigations serum levels of TNF-alpha, lL-6, nitric oxide [NO], lipid peroxide and zinc as well as Intelligent Quotient [IQ] were done. Serum levels TNF-alpha, lL-6, NO were significantly higher in patients with kwashiorkor and in patients with marasmus than in controls as well as higher in patient with kwashiorkor than in patients with marasmus. Serum levels of peroxide, was only significantly higher in patients with kwashiorkor and in patients with marasmus than in control. Also serum zinc level and I.Q were significantly lower in patients with kwashiorkor and in patients with marasmus than in controls as well as in patients with kwashiothor than in patients with marasmus. There are negative correlations between serum levels of TNF-alpha, lL-6 and lipid peroxide with I.Q in patients with marasums and patients with kwashiorkor. Also there is a positive correlation between serum level of zinc with IQ in patients with marasmus and in patients with kwashiorkor. in conclusion, oxidative stress imbalance and zinc deficiency in children with PEM play an important role in their neurocognitive development