Abstract
Background The relationship between protein energy malnutrition (PEM) and malaria is controversial. While most studies demonstrate that PEM is associated with greater malaria morbidity, some indicate that PEM may in fact have a protective effect. PEM is differentiated into three subgroups: kwashiorkor (marked protein deficiency), marasmus (calorie deficiency), and kwashiorkor/marasmus. None of the studies concerning PEM and malaria seem to distinguish between these subgroups, and significant differences in susceptibility to malaria between these subgroups may have been overlooked. Plasmodium parasites and malaria infected erythrocytes are sensitive to oxidative stress. Since kwashiorkor patients seem to display an excess of prooxidants and as serum albumin is an important antioxidant, we hypothesized that patients with different forms of PEM might have different levels of malaria parasitaemia. Methods 72 PEM children older than 6 months admitted to Kwale Family Life Training Programme (Kenya) were included in the study. Results Mean parasitaemia was significantly lower in the kwashiorkor group than in the marasmus group (p < 0,001). There was no correlation between serum albumin and parasitaemia. Conclusion Our study suggests a protective effect of kwashiorkor against malaria, warranting further studies.
Highlights
The relationship between protein energy malnutrition (PEM) and malaria is controversial
Ten patients were assigned to the K/M group based on the presence of symptoms of both kwashiorkor and marasmus, and serum albumin was obtained from nine of them
Serum albumin concentration was determined from the majority of the PEM children; i.e., in 10 with K, 9 with K/M, and 30 with M
Summary
The relationship between protein energy malnutrition (PEM) and malaria is controversial. While most studies demonstrate that PEM is associated with greater malaria morbidity, some indicate that PEM may have a protective effect. None of the studies concerning PEM and malaria seem to distinguish between these subgroups, and significant differences in susceptibility to malaria between these subgroups may have been overlooked. Since kwashiorkor patients seem to display an excess of prooxidants and as serum albumin is an important antioxidant, we hypothesized that patients with different forms of PEM might have different levels of malaria parasitaemia. Mean parasitaemia was significantly lower in the kwashiorkor group than in the marasmus group (p < 0,001). There was no correlation between serum albumin and parasitaemia. Our study suggests a protective effect of kwashiorkor against malaria, warranting further studies
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