Antioxidant supplementation for the prevention of kwashiorkor in Malawian children: randomised, double blind, placebo controlled trial

Abstract

Objective To evaluate the efficacy of antioxidant supplementation in preventing kwashiorkor in a population of Malawian children at high risk of developing kwashiorkor. Design Prospective, double blind, placebo controlled trial randomised by household. Setting 8 villages in rural southern Malawi. Participants 2372 children in 2156 households aged 1-4 years were enrolled; 2332 completed the trial. Intervention Daily supplementation with an antioxidant powder containing riboflavin, vitamin E, selenium, and N-acetylcysteine in a dose that provided about three times the recommended dietary allowance of each nutrient or placebo for 20 weeks. Main outcome measures The primary outcome was the incidence of oedema. Secondary outcomes were the rates of change for weight and length and the number of days of infectious symptoms. Results 62 children developed kwashiorkor (defined by the presence of oedema); 39/1184 (3.3%) were in the antioxidant group and 23/1188 (1.9%) were in the placebo group (relative risk 1.70, 95% confidence interval 0.98 to 2.42). The two groups did not differ in rates of weight or height gain. Children who received antioxidant supplementation did not experience less fever, cough, or diarrhoea. Conclusions Antioxidant supplementation at the dose provided did not prevent the onset of kwashiorkor. This finding does not support the hypothesis that depletion of vitamin E, selenium, cysteine, or riboflavin has a role in the development of kwashiorkor.

A Study of Oxidative Stress Biomarkers and Effect of Oral Antioxidant Supplementation in Severe Acute Malnutrition

“…They further explained that hypoalbuminaemia contributed to low zinc levels, which supported the fact that there was poor food intake and over utilization of zinc during infections. Mushi S et al, and Gerardo Weisstaub et al, described that, the zinc deficiency in patients with diarrhoea was caused by zinc loss, pneumonia and impairment of intestinal absorption which was caused by mucosal damage and prolonged reduction in dietary intake due to anorexia [21,22]. Savitri Thakur reported that zinc scarcity was mainly due to common factors like less food intake, lack of breast feeding and formation of measles [23].…”

Malnutrition and health in developing countries

“…This may possibly be the result of inappropriate experimental design. 44,45 One essential aspect of severe protein-energy malnutrition is the fatty degeneration of such diverse organs as the liver and heart. This degeneration is not just a sign of severe malnutrition; it causes subclinical or overt cardiac insufficiency, especially when malnutrition is accompanied by edema.…”

Aflatoxin Contamination in Foods and Feeds: A Special Focus on Africa

“…An alternative mechanism suggested was that the condition was caused by oxidative species not being regulated by anti-oxidants, e.g., vitamin E, which were depleted because of the poor diet (Golden and Ramdath, 1987). In order to test this, children in Malawi were treated with antioxidants such as riboflavin, vitamin E and selenium (Ciliberto et al, 2005) but both the treated and control group given placebos showed similar levels as kwashiorkor as evidenced by oedema. More recent work seems to suggest that the incidence of kwashiorkor in Africa may be dropping, as evidenced by a Nigerian study (Oyelami and Ogunlesi, 2007).…”