Plasma fatty acid status in Moroccan children: increased lipid peroxidation and impaired polyunsaturated fatty acid metabolism in protein-calorie malnutrition.

In previous studies on plasma fatty acid and antioxidant status in 29 malnourished Moroccan children (12 with mild protein-calorie malnutrition, 17 with severe protein-calorie malnutrition) compared to 15 healthy control children from the same area, we pointed out that these populations were heterogeneous in terms of their essential fatty acid and antioxidant status. The aim of the present study was to classify the children using the Waterlow classification and their essential fatty acid status. The discrepancies in lipid parameters, nutritional and inflammatory markers, blood oxidative indexes, antioxidant micronutrients or trace elements (selenium, zinc, vitamin E) related to polyunsaturated fatty acids were checked in these populations. Eight of the control subjects and nine of the severe protein-calorie malnutrition children were essential fatty acid-deficient, compared to only one of the mild protein-calorie malnutrition group. Examination of the essential fatty acid-sufficient subjects with mild protein-calorie malnutrition, compared to the essential fatty acid-sufficient control subjects, showed only a decrease in Z scores and a non-significant decrease in selenium and vitamin E. In severely malnourished children, albumin, cholesterol and low density lipoprotein (LDL) cholesterol, plasma selenium, vitamin E and zinc were low, whereas inflammatory proteins and triglycerides were high. These features worsened with essential fatty acid deficiency. In all protein-calorie malnutrition subjects, there was oxidative stress (increase in thiobarbituric-acid reactants, imbalance between plasma polyunsaturated fatty acid, vitamin E and selenium levels), even in the absence of essential fatty acid deficiency. Monounsaturated fatty acids, oleic acid/stearic acid (C18:1 n-9/C18:0) delta9 desaturase and n-3 and n-6 elongase activity indexes increased. The C18:1/C18:0 delta9 desaturase activity index was negatively correlated to Z scores (r = -0.44, P< 0.01 for Z score weight, r = -0.39, P < 0.01 for Z score height), albumin (r = -0.82, P < 0.01) and zinc (r = -0.51, P< 0.01) levels. In essential fatty acid-deficient, severe protein-calorie malnutrition subjects, delta6 desaturase activity was impaired, and there was a non-significant decrease in arachidonic acid. Essential fatty acid deficiency is a type of malnutrition, and is associated with an aggravation of all parameters in severe protein-calorie malnutrition. The increase in the C18:1/C18:0 delta9 desaturase activity and enhanced lipid peroxidation without any essential fatty acid deficiency could be early markers of protein-calorie malnutrition.

Lipids, lipoproteins, and fatty acids during infantile marasmus in the Fès area of Morocco.

The lipid composition of plasma, including total HDL and LDL cholesterol, triglycerides, apo AI, apo B, and fatty acids was investigated in 29 malnourished Moroccan children in two groups: 12 children with mild PCM, and 17 with severe PCM. Normally nourished children from the same area (n = 15) served as controls. The severe malnourished children showed a significant reduction of apo AI, total and LDL cholesterol, and an increase in the levels of triglycerides. Furthermore, these children showed a decrease in the saturated fatty acids myristic and stearic acid, and a similar decrease in the essential fatty acid (EFA) metabolites, especially eicosatrienoic acid, arachidonic acid, and eicosapentaenoic acid, with an increase in the oleic and cisvaccenic monounsaturated fatty acids. In contrast, the PCM group showed only an increase of docosatetraenoic and docosapentaenoic, with an associated decrease in myristic acid and palmitic acid. On the other hand, the indexes of delta 9 desaturase and elongase n-3 and n-6 were increased, and this was found to be related to the severity of the malnutrition. These results suggest that the severity of malnutrition is associated with an increase of desaturation and elongation of PUFA, EFA deficiency and/or peroxidation.

Trace elements and protein-calorie malnutrition in the Fès area (Morocco).

Copper and selenium are essential micronutrients for development and growth as well as being necessary for the immune system and as an antioxidant defense. These trace elements present a variable distribution according to geographic regions. Several studies have shown reduced serum copper and selenium levels, as well as the activity of erythrocyte copper-zinc superoxide dismutase (SOD) and selenium-glutathione peroxidase (GPX) in protein-calorie malnutrition (PCM). The aim of this study was to evaluate the erythrocyte enzymatic activity depending on copper or selenium and the levels of these elements in serum. Fifty-six Moroccan children between the age of 6 to 60 months were selected, then divided into 20 control group children and 36 patients suffering from PCM (15 mildly malnourished and 21 severely malnourished). The malnourished group showed a significant decrease of selenium and copper levels that was related to the severity of malnutrition. Serum selenium decreased more than serum copper. No differences were noted between the groups in erythrocyte GPX activity, whereas SOD activity showed more discrepancy than in the copper levels in malnutrition. Serum copper or ceruloplasmin levels could be used as indicators of the severity of malnutrition, whereas the selenium levels could be used as indicators of the nutritional status.

[Evaluation of oxidative stress and antioxidant defences in malnourished Moroccan children]. / Evaluation du stress oxydant et des défenses antioxydantes chez i'enfant malnutri marocain.

In Morocco, malnutrition is a public health problem. Indeed, 25% of 6- to 60-month-old children suffer from malnutrition. Imbalance between antioxidant protection and prooxidant stress has been reported to accurately predict the survival of malnourished children. Therefore, we determined blood antioxidant vitamins (retinol, alpha-tocopherol and carotenoids), trace elements (serum zinc, copper and selenium) and enzymes (erythrocyte Se glutathione peroxydase and Cu-Zn superoxide dismutase) as well as blood oxidative stress index [ferritine, thiobarbituric-acid reactants (TBARS)] in 21 children suffering from severe malnutrition, 15 children suffering from mild malnutrition and in 20 healthy control children. Selenium, retionol, alpha-tocopherol and carotenoids were significantly decreased in malnourished children. These decreases were related to the severity of malnutrition. Moreover, the percentage of vitamin and trace element concentrations under deficient cutoff were high in malnourished children. On the contrary, TBARS, ferritin and prognostic inflammatory and nutritional index (PINI) were significantly increased in malnourished children. Except for TBARS, these increases were related to the severity of malnutrition. On the other hand, blood retional, alpha-tocopherol, beta-carotene and selenium were negatively related to alpha 1-acid glycoprotein. Blood beta-cryptoxanthin, lycopene, carotenes and copper were positively related to weight. Finally, blood lutein/zeaxanthin and copper were positively related to height. These results confirm the imbalance between antioxidant protective factors and oxidative stress index in malnourished children. Moreover, the decrease in antioxidant protective factors is related to inflammation or stature. These results suggest that antioxidant micronutrient supplementation of the refeeding diet could be required in the nutritional rehabilitation of malnourished children.