Marasmus and
kwashiorkor are manifestations of
protein energy malnutrition. The pathophysiology of these disorders is poorly understood. We studied a number of blood
antioxidants [
glucose-6-phosphate dehydrogenase (G6PDH),
glutathione reductase (GR) and its cofactor
flavin adenine dinucleotide (
FAD), the tripeptide
glutathione as the major nonprotein
thiol],
serum albumin, and
retinol-binding protein in 12 children suffering from
kwashiorkor with all classical symptoms, in 13 patients with clinically severe
marasmus, in 19 marasmic but active children, and in 23 controls. Significant changes were observed for erythrocyte
glutathione and correspondingly for nonprotein
thiols in whole blood (0.72 +/- 0.29 mM
thiols in controls, 0.50 +/- 0.22 mM in
marasmus, 0.35 +/- 0.23 mM in severe
marasmus, and 0.22 +/- 0.13 mM in
kwashiorkor). These differences were paralleled by a decrease in
serum albumin concentration so that the molar ratio of nonprotein
thiols/
albumin had an average value of approximately 1.5 in all groups. The erythrocyte
glutathione-reducing system, represented by G6PDH and
glutathione reductase, showed only slight differences among the four groups of children; the supposition that
kwashiorkor occurs predominantly in children with aberrant G6PDH could not be substantiated. Unexpectedly, erythrocyte
FAD, an index of
riboflavin status, was normal in most malnourished patients. Discussed is the prospect of administering
glutathione in
kwashiorkor patients.