Blood selenium in Thai children with protein-calorie malnutrition

Selenium and zinc protect brain mitochondrial antioxidants and electron transport chain enzymes following postnatal protein malnutrition

AIMS

Selenium (Se) and zinc (Zn) are trace elements required for optimal brain functions. Thus, the role of Se and Zn against protein malnutrition induced oxidative stress on mitochondrial antioxidants and electron transport chain (ETC) enzymes from rats' brain were investigated.

MAIN METHODS

Normal protein (NP) and low protein (LP) rats were fed with diets containing 16% and 5% casein respectively for a period of 10weeks. Then the rats were supplemented with Se and Zn at a concentration of 0.15mgL(-1) and 227mgL(-1) in drinking water for 3weeks after which the rats were sacrificed.

KEY FINDINGS

The results obtained from the study showed significant (p<0.05) increase in lipid peroxidation (LPO), ROS production, oxidized glutathione (GSSG) levels and mitochondrial swelling and significant (p<0.05) reductions in catalase (CAT) and Mn-superoxide dismutase (Mn-SOD) activities, glutathione (GSH) levels, GSH/GSSG ratio and MTT reduction as a result of LP ingestion. The activities of mitochondrial ETC enzymes were also significantly inhibited in both the cortex and cerebellum of LP-fed rats. Supplementation with either Se or Zn restored the alterations in all the parameters.

SIGNIFICANCE

The study showed that Se and Zn might be beneficial in protecting mitochondrial antioxidants and ETC enzymes against protein malnutrition induced oxidative stress.

Proposed Recommended Nutrient Densities for Moderately Malnourished Children

Recommended Nutrient Intakes (RNIs) are set for healthy individuals living in clean environments. There are no generally accepted RNIs for those with moderate malnutrition, wasting, and stunting, who live in poor environments. Two sets of recommendations are made for the dietary intake of 30 essential nutrients in children with moderate malnutrition who require accelerated growth to regain normality: first, for those moderately malnourished children who will receive specially formulated foods and diets; and second, for those who are to take mixtures of locally available foods over a longer term to treat or prevent moderate stunting and wasting. Because of the change in definition of severe malnutrition, much of the older literature is pertinent to the moderately wasted or stunted child. A factorial approach has been used in deriving the recommendations for both functional, protective nutrients (type I) and growth nutrients (type II).

The possible role of essential fatty acids in the pathophysiology of malnutrition: a review

Biochemical evidence of essential fatty acid deficiency (EFAD) may exist in protein-energy malnutrition (PEM). EFAD is characterised by low 18:2omega6, often in combination with low 20:4omega6 and 22:6omega3, and high 18:1omega9 and 20:3omega9. Some PEM symptoms, notably skin changes, impaired resistance to infections, impaired growth rate and disturbed development may at least partly be explained by EFAD. One or more of the following factors could induce EFAD in PEM: low EFA intake, poor lipid digestion, absorption, transport, desaturation and increased EFA beta-oxidation and peroxidation. EFAD may perpetuate itself by decreasing lipid absorption and transport, and aggravate PEM by impairing nutrient absorption and dietary calorie utilisation. Micronutrient deficiencies may contribute to the impaired EFA bioavailability and metabolism. Nutritional rehabilitation strategies in PEM may consider adequate intakes of EFA and micronutrients, e.g. by promoting breastfeeding. More research is required to gain detailed insight into the role of EFAD in PEM.

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

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.

Selenium status in Turkey. I. Serum selenium levels in infants and children in Ankara

This study was initiated to evaluate the status of selenium in Turkish residents. Serum selenium level of 76 healthy children, living in Ankara, aged 2 mo-13 y was determined by a spectrofluorometric method. Average selenium level was found to be 88.1 +/- 12.4 micrograms/L (mean +/- SD). Selenium levels showed a tendency to increase with age and mean selenium level in early infancy was lower than that of school children; no relation to the sex and hematological parameters such as hemoglobin concentration and white blood cell counts were observed.

Fatty acid composition of plasma lipids in Nigerian children with protein-energy malnutrition

The fatty acid (FA) composition of the main plasma lipids was analysed in eight well-nourished, generally healthy Nigerian children aged 14.1 +/- 7.2 months and in 17 malnourished children (8 marasmus, 9 kwashiorkor) aged 14.6 +/- 3.8 months within the first 2 days of admission at the Dept. of Child Health, University of Benin. In comparison to the control group, the malnourished children showed a marked decrease of polyunsaturated FA with low linoleic acid, mainly in sterol esters (STE), and severely reduced linoleic acid metabolites, including arachidonic acid, in all lipid fractions. omega-3-FA were not altered except for a reduction of docosapentaenoic and docosahexaenoic acids in phospholipids. Clearly increased values were found for saturated FA in STE and for the non-essential monoenoic FA in all lipid classes. This pattern indicates the presence of essential fatty acid deficiency in the malnourished children. There was no significant difference between marasmus and kwashiorkor. Eight malnourished children were followed up in the early phase of recovery during hospital treatment 14.0 +/- 3.1 days after obtaining the first sample. Linoleic acid had increased again in STE, but its metabolites were as low or even lower than before. An impaired activity of delta-6-desaturase, the rate limiting enzyme of linoleic acid metabolism, in suggested by elevated substrate-product-ratios of this enzyme in untreated children with protein energy malnutrition and in the early phase of recovery, which may be due to low insulin levels, protein and zinc deficiency. The trientetraen ratio (20:3 omega 9/20:4 omega 6) thus is not a reliable indicator of essential FA status in protein-energy malnutrition.

Selenium status of malnourished hospitalized patients

We evaluated selenium (Se) status of 44 hospitalized patients with protein-energy malnutrition. The patients were assigned to "normal" or "low" Se groups-1 and 2, respectively-based on whether the plasma Se level exceeded or was below the value of the mean-2SD of healthy Georgians'. Plasma and erythrocyte Se levels correlated significantly (r = .52, P less than .01). Erythrocyte glutathione peroxidase activity was highly correlated with plasma Se (r = .68) in group 2; there was no significant correlation between these parameters in group 1. In group 2 the mean plasma prealbumin level was significantly lower, and the mean corpuscular volume and serum glutamic oxaloacetic transaminase level were significantly higher compared to group 1. Other nutritional parameters did not correlate with Se status. Concomitant deficiencies of other nutrients were common in both patient groups. Se levels may relate to protein status, and abnormal hematologic and hepatic parameters may reflect low Se status and/or protein-energy malnutrition. Low Se status is common in malnourished patients from a low Se area, and Se supplementation should be included in their nutritional-repletion regimens.

Elevated serum selenium in diabetic children

Twenty-seven diabetic children, 16 girls and 11 boys, 5-18 years of age, with a duration of the disease ranging from 2-15 years, comprised the study group. Thirteen children with a similar age and sex distribution, living in the same area served as healthy controls. All 40 children had a normal growth pattern. The mean serum selenium concentration in the diabetic children, determined by neutron activation analysis, was 7.4 +/- 0.8 micrograms/100 ml (mean +/- SD) and in the healthy controls 6.5 +/- 0.8 micrograms/100 ml. The difference between the two groups was statistically highly significant (p less than 0.01). Boys and girls in both groups had nearly identical mean serum selenium levels and no correlation was observed between the selenium concentrations and either the age, weight or height of the children or the indicators of diabetic control. The selenium status in diabetic children has not been reported previously. The possibility of elevated serum selenium in diabetic children in response to altered lipid metabolism is discussed.

The selenium status of Belgian population groups : II. Newborns, children, and the aged

The selenium state of 40 elderly Belgian people, residing in geriatric homes, has been evaluated. Data are presented on the selenium (Se) contents of their blood, plasma, and erythrocytes. The activity of glutathione peroxidase (GSH-Px) has been assayed. All data were compared with those obtained for 164 young, working adults as presented in Part I of this study. Plasma selenium levels were significantly lower in the old (73 ng/mL) as compared to the young people (97 ng/mL), but erythrocyte Se levels (200 ng/mL) and GSH-Px activity were significantly higher.The selenium concentration in plasma during infancy has also been estimated. The results reveal a very low Se level during the first months of life, with a gradual increase with age. The results are discussed in the light of literature data.

Selenium: childhood poisoning and cystic fibrosis

Two cases of selenium ingestion in children are described; one child with severe cystic fibrosis died. Both children had cystic fibrosis and both had low serum chloride in association with selenium usage. Neither child was exposed to excessive heat or cold weather, factors known to salt-deplete children were cystic fibrosis, although one child was dehydrated during a summer month on initial presentation. One child had protein-calorie malnutrition, a condition known to enhance selenium toxicity in animals. We conclude that selenium is a potential hazard in its use as a health food fad for children with cystic fibrosis and in overdose ingestions. Thus selenium supplementation may have contributed to the morbidity and mortality reported here.

Selenium requirements in patients with inborn errors of amino acid metabolism and selenium deficiency

The diets of 5 patients with phenylketonuria of maple-syrup-urine disease were supplemented with yeast which was rich in selenium. For 120 days the patients received 45 micrograms Se/day to increase the Se content of their diets to 10--12 ng Se/Kjoule. Before supplementation the selenium content of serum (5--15 ng/ml) and whole blood (10--27 ng/ml), and the activity of the erythrocyte glutathione peroxidase (0.19--2.69 U37/g Hb), amounted to only 10--20% of normal. The serum selenium content reached normal values within 4 weeks of supplementation, followed by normalisation of the selenium content of whole blood within 4--8 weeks. Restoration of the activity of erythrocyte glutathione peroxidase took 9 to 15 weeks--the red cell life span. There was a significant positive correlation between the selenium content of the erythrocytes and the activity of erythrocyte glutathione peroxidase.

Relation between erythrocyte selenium concentrations and glutathione peroxidase (EC 1.11.1.9) activities of New Zealand residents and visitors to New Zealand

1. Erythrocyte, plasma and whole blood selenium concentrations and glutathione peroxidase (EC 1.11.1.9; GSHPx) activities were measured (1) in 104 healthy New Zealand residents living in Otago, a low-soil-Se area (2) in sixty-four surgical patients, including nineteen patients on total parenteral nutrition and twenty-three cancer patients (3) in fifty-two 'overseas subjects' (twenty-five visitors to Otago from outside New Zealand and twenty-seven Otago residents on return from overseas travel). 2. Blood Se concentrations reflected dietary Se intake; means for Otago patients, healthy subjects and overseas subjects were different 0.043, 0.059, 0.136 micrograms Se/ml blood respectively) and mean for overseas residents was greater than for New Zealand overseas travellers. 3. Erythrocyte Se concentration was always greater than plasma Se, and plasma Se was a smaller proportion of erythrocyte Se for patients compared with the controls. 4. GSHPx activities were different in the three groups, and varied directly with erythrocyte Se until a plateau was reached at approximately 0.14 micrograms Se/ml erythrocytes. 5. Overseas subjects showed no relationship between erythrocyte Se and GSHPx activity. This agrees with some overseas studies and the significance of this finding is discussed. 6. Plasma Se concentration remained the most sensitivie index of short-term changes in Se status, and erythrocyte Se and GSHPx activities for long-term changes in New Zealand subjects. Use of these measurements for overseas subjects with higher blood levels is discussed.

Neonatal erythrocyte glutathione peroxidase deficiency as a consequence of selenium imbalance during pregnancy

The red blood cell (RBC) glutathione peroxidase (GSH-Px) activity and routine haematological parameters were measured in 38 healthy north Italian full-term pregnant women and in their newborn infants. In 31 pairs the serum selenium concentration was also measured. Data were compared with those of 20 normal adult controls (10 males and 10 females). Newborn infants exhibited significantly lower RBC GSH-Px activity and serum selenium concentrations than adult controls. Pregnant women had serum selenium values intermediate between those of adult female controls and their newborn infants. In both the pregnant women and newborns the RBC GSH-Px activity correlated with the level of selenium in serum which suggests that the neonatal RBC GSH-Px deficiency may be partially due to insufficient availability of selenium during pregancy. Factors other than selenium concentration, e.g. hormonal and genetic, might also affect the RBC GSH-Px activity as suggested by sex differences and mother/child concordances in enzyme activity found in our cases.

Selenium and total parenteral nutrition

Despite the increasing recognition of selenium (Se) as an essential trace element in man, little is known about its metabolism during total parenteral nutrition (TPN) and the possible development of Se deficiency in high risk patients. From a general population known by its geographical location to have low Se blood levels, we studied a group of 23 surgical patients receiving TPN for at least one week. Whole blood Se levels were less than in the normal general population and, being some of the lowest observed in adult man, approached levels observed in animals with Se-responsive syndromes. Se continued to be lost predominantly in the urine although the Se content of the TPN fluids was very low (less than 0.6 micrograms/24 hr). Patients with excessive volumes of gastrointestinal excretion lost more Se. Se supplementation may be required in some patients receiving TPN.

Selenium and vitamin E in cord blood from preterm and full term infants

Selenium was determined in erythrocytes and serum, and vitamin E and beta-lipoprotein in serum from cord blood samples of 31 full term and 20 preterm infants. Venous samples from 21 mothers at birth and 15 normal adult women were also analyzed. No difference for either selenium or vitamin E was found between the preterm and full term infants. The selenium concentration in red blood cells was the same for newborn, mothers at birth, and normal adult women. The serum concentration of selenium was, however, significantly lower in the newborn, the mean level in the children being 64% of that in the mothers. The level in the mothers did not differ from that in non-pregnant women. The vitamin E concentration was found to correlate very well with the beta-lipoprotein concentration. This indicates that differences in the transport capacity account for the large difference in the serum tocopherol levels of mothers at birth and newborn.

The selenium state of children. II. Selenium content of serum, whole blood, hair and the activity of erythrocyte glutathione peroxidase in dietetically treated patients with phenylketonuria and maple-syrup-urine disease

The selenium content of serum, whole blood and hair was measured by neutron activation analysis in dietetically treated patients with phenylketonuria (PKU) and maple-syrup-urine disease (MSUD). Follow-up studies showed a decrease of the serum selenium content and the glutathione peroxidase activity of erythrocytes--a selenoenzyme--from normal values at the beginning of the diet to 20% (selenium) and 50% (gluthione peroxidase) of normal within 10--12 weeks of dietary treatment. In 36 patients the serum selenium content was lower at 6.7--28 X 10(-9) g/ml, independent of the age of the patients (0.5 to 10 years). The selenium content of whole blood was reduced: median = 98 X 10(-9) g/g dry weight; range 75 to 165 X 10(-9) g/g dry weitht (healthy children: median = 381 X 10(-9) g/g dry weight; range 245 to 588 X 10(-9) g/g dry weight). The selenium content of hair was markedly lower in the patients (median = 62 X 10(-9) g/g; range 13--140 X 10(-9) g/g) than in healthy children (median = 429; range 213 to 720 X 10(-9) g/g). The mean glutathione peroxidase activity of erythrocytes was reduced to 4.6 +/- 0.64 U37/g Hb, comparison to normal values (mean = 8.8 +/- 0.88 U37/g Hb).

The selenium state of healthy children. I. Serum selenium concentration at different ages; activity of glutathione peroxidase of erythrocytes at different ages; selenium content of food of infants

The selenium concentration of serum is age-dependent. The median value at birth (chi=50 X 10(-9)g/ml) amounts to half of the median value of adults (chi=102 X 10(-9)g/ml). After a decrease in early infancy to chi=34 X 10(-9)g/ml it steadily increases to chi=58 X 10(-9)g/ml in the second half of the first year, to chi=82 X 10(-9)g/ml in 1--5 year old children, and to chi=92 X 10(-9)g/ml in school children. The activities of the selenium containing enzyme glutathione peroxidase of erythrocytes are also reduced in early infancy (chi=7.2 +/- 0.36 U37/g Hb), whereas the enzyme activities of cord blood erythrocytes (chi=8.72 +/- 0.76 U37/g Hb) are in the same range as those of older children or adults. The selenium content of some commercially available milk formulas for infants are lower than those of human and cow's milk.

Evaluation of a new mineral and trace metal supplement for use with synthetic diets

In an earlier study (Alexander et al., 1974) it was shown that the mineral mixture used in association with a synthetic diet was deficient in zinc, copper, iron, and manganese. A new mixture containing appropriately increased amounts of these trace metals has now been evaluated by means of metabolic balance studies carried out on children with phenylketonuria. This new mixture was shown to be satisfactory for zinc, copper, and iron, but minor changes have been recommended for manganese.