Biochemical markers of nutritional status and childhood malaria severity in Cameroon

Abstract

To investigate the part played by undernutrition in malaria severity, some biomarkers of nutritional status were assessed in children with severe malarial anaemia (MA) and cerebral malaria (CM) in comparison with healthy children or those with uncomplicated malaria. Undernutrition was assessed using the weight-for-age Z score (WAZ). Retinol was determined by HPLC; lipid profile, Ca, Mg and albumin were determined by spectrophotometry. Severe and moderate undernutritions were more prevalent in children with MA and those with the combined symptoms of CM and MA, but not in those with CM alone. Some perturbations were noticed in the lipid profile, but most of the values remained within the normal ranges. The risk of vitamin A deficiency, as assessed by plasma retinol concentration, was noteworthy in children with severe malaria: 0·48 £ 10 26 and 0·50 £ 10 26 mol/l, respectively, in children with MA and CM (reference value: .0·7 £ 10 26 mol/l). A significant difference was obtained for retinol values after an ANOVA of all the groups (P¼0·0029), with the value in the MA group being significantly low than that in the control group (P,0·05); likewise, a significant difference was obtained after comparison of all the groups for Mg and albumin (P¼ 0·0064 and 0·0082, respectively). Despite their low number (n 6), fatal cases of CM had a normal mean WAZ on admission, but low values of retinol, albumin and HDL:LDL ratio. Despite these associations, undernutrition itself did not appear to be a primary factor associated with fatal outcome.

Serum lipids and lipoproteins in malaria - a systematic review and meta-analysis

“…Forty-two records [1,5-16,30-57] met the inclusion criteria (Additional file 7: Table S1). Of these, n = 15 for cholesterol [7,9,10,12,30,31,33,35],[38,40,42,44,46,50,52,54]; nine for HDL [10,12,30,33,35,38,42,44],[52]; eight for LDL [10,12,30,33,35,38,42,52]; nine for triglycerides [10,12,30,33,35,40,42,50],[52], contained the necessary data for inclusion in the quantitative analysis (meta-analysis); see PRISMA flow diagram (Figure 1). Four records [11,13,14,47] were excluded from the quantitative synthesis either because means and SD were not reported (n = 3), or mean differences and SD could not be calculated from the available data (n = 1).…”

“…In total, 3,442 patients with malaria were analysed in these studies, and compared with 1,686 controls (patients negative for malaria). Thirty-five were adult studies and seven were paediatric studies [14,30,31,36,44,52,55]. In 26 of these 42 records, serum lipid profiles of malaria patients were compared to a control group.…”

“…In 26 of these 42 records, serum lipid profiles of malaria patients were compared to a control group. These control groups consisted of healthy controls (15 studies) [7,9,11,12,14,30,31,33],[38,40,44,47,50] or “symptomatic” controls [16,35,37,44,46] (malaria-like symptoms but negative for malaria). There were two records including controls with a (very) low parasitaemia [10,32]; one of these two [32] did not report the necessary data and was therefore excluded from the meta-analysis; the other study [10] was included in the meta-analysis for healthy controls.…”

“…Thus, cholesterol is significantly decreased during malaria. For severe malaria, a separate analysis including three studies [12,30,31] was performed (Additional file 5). Mean difference for cholesterol in severe malaria patients versus healthy controls was 1.60 mmol/l or 61.87 mg/dl (95% CI 0.66-2.54), I 2 = 99%, Z = 3.33, P = 0.0009.…”

“…Studies with healthy controls and symptomatic controls were analysed separately. If studies presented results for uncomplicated as well as for severe malaria [12,30,31], the combined data were used (see Additional file 4). Stratified analyses for uncomplicated and severe malaria were conducted (see Additional file 5).…”