Plasma alpha-tocopherol, retinol, and carotenoids in children with falciparum malaria

Abstract

Cross-sectional interactions by malaria status were investigated between plasma alpha-tocopherol, retinol, and several carotenoids (lutein, beta-cryptoxanthin, lycopene, and alpha- and beta-carotene) and indicators of disease severity (blood parasite count, hemoglobin concentration), acute-phase response (plasma albumin and ceruloplasmin concentrations), hepatic involvement (plasma alanine aminotransferase), oxidant status and antioxidant status (plasma thiobarbituric acid-reactive material and ascorbate), nutritional (weight-for-age) and carrier protein [retinol binding protein (RBP)] status, and cholesterol concentration (as a proxy for lipoprotein) in 100 consecutively admitted children with malaria. There were 50 children with severe and 50 with mild malaria and 50 age- and sex-matched control subjects. alpha-Tocopherol, retinol, and all the carotenoid concentrations were lower in the patients than in the control subjects (P < 0.001). The differences were greater in severe than in mild malaria, except for lutein. In severe malaria only, both retinol and alpha-tocopherol correlated with albumin, ceruloplasmin, and RBP concentrations whereas in all three groups retinol correlated with RBP and alpha-tocopherol correlated with cholesterol (all P < 0.01)). Using multivariate analysis on data from all patients combined, cholesterol was the most significant factor explaining the variance in alpha-tocopherol (29%) whereas RBP was responsible for 95% of the variance in retinol. Plasma cholesterol and RBP values in turn (in the absence of alpha-tocopherol and retinol, respectively) were influenced primarily by acute-phase markers (mainly albumin and ceruloplasmin). Alanine aminotransferase (r = -0.17) and thiobarbituric acid-reactive material (r = -0.17) also showed a small contribution to the variance of RBP but 60-70% remained unexplained. In conclusion, low plasma lipid-soluble micronutrient concentrations in malaria are strongly influenced by the reductions in their carrier molecules, which, in turn, are low as a consequence of the acute-phase response.

Antioxidant status and acute malaria in children in Kampala, Uganda.

“…CRP generally increases quickly during an infection and decreases more rapidly relative to AGP, which increases slowly and stays elevated longer in relationship to an infection. 15 In general, plasma concentrations of ␣-carotene, ␤-cryptoxanthin, lycopene, and vitamin E in children with malaria in Uganda appeared to be higher than values described for children with malaria in India, 16 and this may reflect local differences in dietary intake. Low plasma concentrations of lipid-soluble micronutrients among Indian children with malaria were attributed to reductions in carrier molecules, such as retinol-binding protein and cholesterol, during the acutephase response.…”

Impact of disease on markers of micronutrient status

“…Of course, it is widely held that vitamin E is an important antioxidant and that in a disease like malaria, vitamin E would be under intense pressure from oxidizing free radicals both from the parasites and the inflammatory response of the disease. However, even in patients with severe malaria, as defined by World Health Organization (1990) criteria, vitamin E : cholesterol remained normal (Das et al 1996; Table 5 ) .…”

“…The lipoproteins, however, are larger molecules than RBP so the disease has to be severe enough to increase endothelial permeability sufficiently to influence circulating lipoprotein concentrations. Malaria is a sufficiently severe disease to reduce plasma vitamin E concentrations (Thurnham et al 1990;Das et al 1996;Adelekan et al 1997), but the fact that vitamin E : cholesterol in malaria-infected patients is not different from that of matched controls in studies done in three countries, Thailand (Thurnham et al 1990), Nigeria (Adelekan et al 1997) and India (Das et al 1996), suggests that malaria influences vitamin E via the lipoproteins and not directly ( Table 5). Of course, it is widely held that vitamin E is an important antioxidant and that in a disease like malaria, vitamin E would be under intense pressure from oxidizing free radicals both from the parasites and the inflammatory response of the disease.…”

Anemia in pregnancy in rural Tanzania: associations with micronutrients status and infections

“…An acute phase response can depress s-vitamin A (Hautvast et al, 1998), and malaria has been associated with low s-vitamin A, even when it is subclinical (Das et al, 1996). Das et al, explained the association by a decrease in the carrier molecule retinol binding protein, which can extravasate during inflammation, and may also leak into the urine.…”

“…Only 12 patients with sickle cell disease were identified at Haydom Lutheran Hospital during 1995 -1996 (inpatients and outpatients), and only 38 cases of hookworm were recorded (Haydom Lutheran Hospital (HLH), 1998). There were two HIV positive sera among 733 women examined at antenatal clinics at HLH in 1995-1996(unpublished data from HLH, 2000.…”