Pro-Inflammatory Cytokines as markers for the diagnosis of protein energy malnutrition
Protein-energy malnutrition (PEM) is a public health problem and is associated with high morbidity and mortality. There are altered biochemical and immunological parameters which may serve as indicators of PEM.The study was aimed at assessing the use of pro-inflammatory cytokines as diagnostic indicator for Protein energy malnutrition in children. A total of 115 children (35 healthy controls and 80 malnourished children) aged 8 – 36 months attending the Maternal and Child Health Hospital (MCHH), Kumasi were recruited for the study. The study was conducted between December 2009 and June 2010. Anthropometric measurements including weight, height and mid-upper arm circumference were taken for the study population and immunoassays on interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) and biochemical analysis of albumin and total protein) assayed. When categorized for PEM, 67.5% had marasmus, 18.8% had marasmic kwashiorkor and 13.8% had kwashiorkor. Mothers in the control group had attained higher education (p=0.0021) and were gainfully employed (p=0.0038) when compared to mothers of the subject group. Children in the subject group had a significantly low birth weight (<2.5kg, p=0.0255) as compared to controls and were more likely to have an exclusive breastfeeding period of less than three months (p=0.058). There were no statistically significant differences (p>0.05) in the mean total protein concentration of the controls (68.37± 1.43 g L-1) when compared to that of the subjects before (66.27± 1.61 g L-1) and after (69.55± 1.69 g L-1) treatment. Serum albumin concentration in the control group (43.21 ± 0.90 g L-1) was significantly higher than the concentration in the subject group before treatment (38.65 ± 0.90 g L-1, p=0.0027). The mean concentration of IL-6 in the subjects at baseline (46.08 ± 7.48 pg mL-1, p=0.0008) and after treatment (26.25 ± 5.19 pg mL-1, p=0.0148) were significantly higher than those in the control group (7.01 ± 1.37pg mL-1). A 43.8% decrease in the mean concentration of IL-6 was observed after treatment. TNF-α concentration before treatment (82.07 ± 6.02 pg mL-1) was significantly higher when compared to the mean concentration in the control group (55.81 ± 2.20 pg mL-1).The study observed increases in pro-inflammatory response in malnourished children with IL-6 concentration being a significant indicator of PEM in the subjects compared to TNF- α. The impact of dietary intervention on biochemical indices assessed in this study shows the ability of nutritional intervention to promote growth in malnourished children. Above all, the level of education and the socio-economical status of the mothers of malnourished children in this study had a significant impact on malnourishment.
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirements for the award of the Degree of Master of Philosophy, 2010