Alteraciones inmunoinflamatorias en la desnutrición infantil. Efecto biológico de la recuperación nutricional

Resumo

Undernourishment is a nutritional síndrome characterized by a multifactorial status in which the energetic and proteic deficit is predominant; this constitutes a public health problem due to its high prevalence and relationship with the mortality rate, with the physical growth deterioration, as well as an inadequate social and economic development. The undernourished child shows a dysfunction in his or her immune and oxidative response that can significantly increase the morbility and mortality by infections. In this study, the seric oncentrations of a soluble mediator group (IL-1α, IL-4, IL-6, IL-10, IL-12, IL-17, IFN- and TNF-α), acute phase reactants (reactive proteín C and C3), micronutrients (zinc) and oxidative stress (NO and MDA) were determined in children with different levels of nutritional deficit and in children with severe or serious undernourishment undergoing nutritional recoveryl. The selected population was constituted of 149 children (06 mo – 6 years old), from socioeconomic levels IV and V, nutritionally classified according to clinic and anthropometric criteria in eutrophies without infection (n= 25), infected eutrophies (n= 20), infected undernourished (n= 20), non-infected undernourished (n= 64), and seriously undernourished(n= 20). Enzymatic immuneanalysis was used to determine the seric concentrations from the different cytokines, turbidimmetry for the reactive protein C and C3 concentrations, the instrumental technique of atomic absorbtion spectrometry with electrothermical atomization (ETA-AAS) to determine zinc, the Gries reaction and the tiobarbituric acid trial to determine nitric acid and malonaldehide, respectively. Analyzing the results, IL-1α showed a significant increase (p < 0.001) in its concentrations on severe undenourished (7.53 ± 3.46 pg/mL). An equal behaviour was observed in TNF-α, which showed a significant increase in its seric values(p < 0.05) in the severely undernourished (34.79 ± 6.21 pg/mL). IL-6 showed significant changes (p < 0.01) regarding the severely undernourished (32.12 ± 10.26 pg/mL). In relation to the reactive Protein C seric concentrations, findings showed that the severely undernourished infected increased its value significantly (80.80 ± 38.39 mg/L) compared to the non infected (8.17 ± 3.06 mg/L) (p < 0.001). There were also statistically significant differences among the severely undernourished infected and the group of infected eutrophic (p < 0.001) which presented higher values. In the undernourished infected, a significant difference was found among the severely undernourished regarding the rest of the groups (mild and moderate) and the eutrophic control group (p < 0.05); however, their concentrations remained within the normal range of values. C3 component, on the other hand, showed a decrease in its seric values (1.04 ± 28 g/L) in the group of severely undernourished with significant differences (p < 0.001) for all the selected groups. The results of the seric concentrations of Zn gave significant differences (p < 0.001) among the severely undernourished group(15.48 ± 10.44 µg/dL) and the mildly undernourished (39.73 ± 14.97µg/dL) and moderately undernourished (35.07 ± 28.13 µg/dL). Regarding the daily intake of Zn, a statistically significant difference (p < 0,001) was observed only in the severely undernourished (1.87 ± 0.54 mg/day) when compared to the rest of the groups and the eutrophic control. In relation to the severely undernourished undergoing nutritional recovery, a statistically significant difference was observed (p < 0.0001) in the seric concentrations of IL-12, IL-17, TNF-α, NO and MDA before and after treatment. The sum of these results leads to the conclusion that, in the undernourished, the capacity to produce soluble and inflammatory mediators is preserved, which concentrations are affected in relation to the intensity of the nutritional deficit, being this last aspect of influence on the concentrations and intake of Zinc. Regarding the nutritional recovery, this ssems to favor the immune and oxidative response in the severely undernourished due to an important decrease produced in the seric values of cytokines and xidative stress markers after the treatment.