PLASMA FERRITIN CONCENTRATION IN RELATION TO VITAMIN-A AND VITAMIN-E STATUS OF CHILDREN WITH SEVERE EDEMATOUS MALNUTRITION

The association between plasma ferritin concentration and vitamin A and E status was studied in 17 children aged 15-72 months with severe oedematous malnutrition. The controls were 10 children of similar age who were apparently well and with no obvious signs of clinical malnutrition. Plasma ferritin concentration in the patients was significantly higher than that in the control children. Conversely, the plasma concentrations of beta-carotene, alpha-tocopherol and retinol in patients were significantly lower than those in plasma of control children. The median (interquartile range) plasma a-tocopherol concentration of patients, 6.03 (5.29-9.50)-mu-mol/l, is below the threshold of vitamin E deficiency (11.6-mu-mol/l). Fifteen of 17 (88%) malnourished patients were found to have plasma tocopherol concentrations below the normal threshold. However, all the patients had a tocopherol: cholesterol ratio > 2.22, indicating adequate vitamin E status for the level of cholesterol present in plasma. Twelve of 17 patients (70.5%) had plasma retinol concentration < 0.70-mu-mol/l, indicative of marginal vitamin A status, while 3 patients had plasma retinol concentrations < 0.35-mu-mol/l, indicating vitamin A deficiency. The median (interquartile range) plasma retinol concentration of patients, 0.51 (0.41-0.93)-mu-mol/l, is significantly less than that of control children, 0.96 (0.74-1.09)-mu-mol/l; p < 0.01 Mann Whitney U test. Furthermore, anaemia (Hb < 110 g/l) was widespread in the patients. The results also indicate no significant correlation between elevated ferritin concentration and the concentrations of beta-carotene, retinol and alpha-tocopherol in the patients' plasma. It is concluded that the elevated plasma ferritin concentration in children with severe oedematous malnutrition was an acute phase reaction to current and underlying infections and that the low concentrations of vitamins was the consequence of infections rather than of malnutrition per se.