Dietary cysteine is used more efficiently by children with severe acute malnutrition with edema compared with those without edema

Abstract

Background: Children with edematous severe acute malnutrition (SAM) produce less cysteine than do their nonedematous counterparts. They also have marked glutathione (GSH) depletion, hair loss, skin erosion, gut mucosal atrophy, and depletion of mucins. Because GSH, skin, hair, mucosal, and mucin proteins are rich in cysteine, we hypothesized that splanchnic extraction and the efficiency of cysteine utilization would be greater in edematous than in nonedematous SAM.

Objective: We aimed to measure cysteine kinetics in childhood edematous and nonedematous SAM.

Design: Cysteine flux, oxidation, balance, and splanchnic uptake (SPU) were measured in 2 groups of children with edematous (n = 9) and nonedematous (n = 10) SAM at 4.4 ± 1.1 d after admission (stage 1) and at 20.5 ± 1.6 d after admission (stage 2) when they had replenished 50% of their weight deficit.

Results: In comparison with the nonedematous group, the edematous group had slower cysteine flux at stage 1 but not at stage 2; furthermore, they oxidized less cysteine at both stages, resulting in better cysteine balance and therefore better efficiency of utilization of dietary cysteine. Cysteine SPU was not different between groups but was ∼45% in both groups at the 2 stages.

Conclusion: These findings suggest that children with edematous SAM may have a greater requirement for cysteine during early and mid-nutritional rehabilitation because they used dietary cysteine more efficiently than did their nonedematous counterparts and because the splanchnic tissues of all children with SAM have a relatively high requirement for cysteine. This trial was registered at clinicaltrials.gov as NCT00069134.

FIGURE 1.

Mean (±SEM) cysteine endogenous flux, balance, oxidation, and efficiency of utilization in children diagnosed with nonedematous (shaded bars; n = 10) and edematous (open bars; n = 9) severe childhood malnutrition at stage 1, ∼4 d after admission, when severely malnourished, and at stage 2 ∼20 d after admission when the children had replaced 50% of their weight deficit. Analyses were performed by using repeated-measures ANOVA. Flux: main effect of diagnosis and stage terms, P < 0.02; stage-by-diagnosis interaction, P = 0.4. Balance: *Significantly different from nonedematous patients in the same clinical phase, P < 0.05. ^#Significantly different from corresponding clinical phase, P < 0.05; stage-by-diagnosis interaction, P < 0.02. Oxidation: main effect of diagnosis and stage terms, P < 0.001; stage-by-diagnosis interaction, P = 0.05. Efficiency of cysteine utilization: main effect of diagnosis term, P < 0.03; stage-by-diagnosis interaction, P = 0.42.