TABLE OF CONTENTS
Title page
Abstract
Table of Contents
Abbreviations
CHAPTER ONE: INTRODUCTION
1.1 Background of the study
1.2 Statement of the Research Problem
1.3 Justification for the Study
1.4 Aim and Objectives of the Study
CHAPTER TWO: LITERATURE REVIEW
2.1 Prevalence of PEM
2.2 Assessment of Nutritional Status
2.2.1 Clinical assessment
2.2.2 Anthropometric assessment
2.2.3 Dietary intake assessment
2.2.4 Biochemical assessment
2.3 Classification of PEM
2.3.1 Marasmus
2.3.2 Kwashiorkor
2.3.3 Marasmic-kwashiorkor
2.4 Complications of PEM
2.4.1 Infection
2.4.2 Diarrhoea and dehydration
2.4.3 Heart failure
2.4.4 Hypothermia
2.5 Prevention and Treatment of PEM
2.6 Free Radicals
2.7 Antioxidants
2.7.1 The need for antioxidants defense
2.7.2 Mechanisms of antioxidant functions
2.7.3 Enzymatic antioxidants and their cofactors
2.7.4 Cofactors
2.7.5 Non-enzymatic antioxidants
2.7.6 Oxidative stress
2.8 Roles of Trace Elements in Nutrition
CHAPTER THREE: MATERIALS AND METHODS
3.1 Materials
3.1.1 Study location
3.1.2 Study population
3.1.3 Inclusion criteria for patients
3.1.4 Inclusion criteria for control
3.1.5 Exclusion criteria
3.16 Informed consent
3.1.7 Ethical approval
3.1.8 Sample size determination
3.1.9 Sampling techniques
3.1.10 Blood sample collection
3.1.11 Chemicals
3.1.12 Equipment
3.2 Methods
3.2.1 Questionnaire
3.2.2 Measurement of Biochemical Parameters
3.2.2.1 Serum total protein
3.2.2.2 Serum albumin
3.2.2.3 Serum zinc and copper
3.2.2.4 Serum Superoxide Dismutase
3.2.2.5 Serum glutathione peroxidase
3.2.3 Statistical analysis
CHAPTER FOUR: RESULTS
4.1 Characteristics of Study Population
4.2 Feeding Characteristics of PEM Patients
4.3 Serum Biochemical Parameters in PEM Patients
4.4 Serum Total Protein and Albumin Levels in PEM Patients
4.5 Serum concentrations of some Trace Elements in PEM patients
4.6 Serum Levels of some Antioxidants Enzymes in PEM Patients
4.7 Pearson’s Correlation between some Trace Elements and Antioxidant Enzymes in PEM Patients
CHAPTER FIVE: DISCUSSION
CHAPTER SIX: SUMMARY, CONCLUSION, AND RECOMMENDATIONS
6.1 Summary
6.2 Conclusion
6.3 Recommendations
REFERENCES
APPENDICES
ABSTRACT
Assessment of the relationship between some trace elements and antioxidant enzymes was carried out on 98 under-five children with protein-energy malnutrition (PEM) and 98 age- and sex-matched apparently healthy children (control). The malnourished children involve those with Marasmus, Kwashiorkor and Marasmic-kwashiorkor. Venous blood (2ml) was collected from both PEM children and control for biochemical analysis using standard methods. Results obtained show that mean serum total protein (55.76±3.95) and albumin (26.43±2.78) levels and superoxide dismutase (SOD) (1.87±0.32) and glutathione peroxidase (GPx) (42.38±5.03) activities in malnourished children were significantly lower (p<0 -0.07="" -0.08="" -0.14="" -0.31="" -0.39="" -0.41="" -0.48="" -0.51="" -0.54="" .05="" 0.03="" 0.05="" 0.07="" 0.12="" 0.16="" an="" and="" antioxidant="" antioxidants="" are="" be="" between="" but="" children="" concentrations="" control.="" control="" copper="" correlations="" cu="" decrease="" defense="" done="" due="" effective="" elements="" enzymes="" fact="" for="" free="" gpx-cu:="" gpx-zn:="" gpx="" high="" higher="" in="" increase="" investigation="" kwashiorkor="" laboratory="" levels="" lower="" malnourished="" management="" marasmic-kwashiorkor="" marasmus="" mean="" n:="" n="" of="" oxidative="" p="" pem.="" pem="" points="" predisposed="" production="" radical="" routine="" serum="" should="" significantly="" sod-cu:="" span="" stress="" study="" system.="" than="" that="" the="" there="" therefore="" these="" this="" to="" trace="" u="" were="" with="" zinc="">
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Severe malnutrition is common among developing countries both in rural and urban areas (Psaki et al., 2012). It is responsible for at least half of the 7.6 million child‟s deaths each year in developing countries (Park et al., 2012). Children who are poorly nourished suffer up to 160 days of illness each year (UNICEF, 2008). Malnutrition magnifies the effects of every disease, including measles and malaria. The estimated proportions of deaths in which malnutrition is an underlying cause are diarrhoea (61%), malaria (57%), pneumonia (52%) and measles (45%) (Black et al., 2003). Protein-energy malnutrition (PEM) is one of the most prevalent and devastating forms of malnutrition in the world (Whitney and Rolfes, 2008).
PEM is defined by the WHO as the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions (WHO, 1993). It has long been recognized as a common problem, especially for children in the developing countries whose nutritional intake is deficient for socioeconomic reasons (Collins et al., 2006). PEM results from inadequate intake and absorption which may be due to diseases, insufficient household food security, inadequate maternal and child care, poor sanitation and ignorance (UNICEF, 1990). The earliest symptoms include subtle changes in the mood of the child while further changes include loss of appetite and interest in the surroundings, which lead to decreased social interaction with peers or siblings (Allen, 1995). When PEM becomes more severe, it has adverse effects on the child's cognitive and behavioural development, both in the short and long term (Mendez and Linda, 1999). It may also affect children's mental performance by other indirect mechanisms such as social and economic disadvantages (Johnston and Low.....
PEM is defined by the WHO as the cellular imbalance between the supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions (WHO, 1993). It has long been recognized as a common problem, especially for children in the developing countries whose nutritional intake is deficient for socioeconomic reasons (Collins et al., 2006). PEM results from inadequate intake and absorption which may be due to diseases, insufficient household food security, inadequate maternal and child care, poor sanitation and ignorance (UNICEF, 1990). The earliest symptoms include subtle changes in the mood of the child while further changes include loss of appetite and interest in the surroundings, which lead to decreased social interaction with peers or siblings (Allen, 1995). When PEM becomes more severe, it has adverse effects on the child's cognitive and behavioural development, both in the short and long term (Mendez and Linda, 1999). It may also affect children's mental performance by other indirect mechanisms such as social and economic disadvantages (Johnston and Low.....
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