The malarial impact on the nutritional status of Amazonian adult subjects

Pereira, Paulo C. M.; Meira, Domingos A.; Curi, Paulo R.; Souza, Nelson de; Burini, Roberto C.

doi:10.1590/S0036-46651995000100004

Abstracts

The anthropometric (body weight, height, upper arm circumference, triceps and subescapular skinfolds; Quetelet index and arm muscle circunference) and blood biochemistry (proteins and lipids) parameters were evaluated in 93 males and 27 females, 17-72 years old voluntaries living in the malarial endemic area of Humaita city (southwest Amazon). According to their malarial history they were assembled in four different groups: G1-controls without malarial history (n:30); G2 - controls with malarial history but without actual manifestation of the disease (n:40); G3 - patients with Plasmodium vivax (n:19) and G4 - patients with Plasmodium falciparum (n:31). The malarial status was stablished by clinical and laboratory findings. The overall data of anthropometry and blood biochemistry discriminated the groups differently. The anthropometric data were low sensitive and contrasted only the two extremes (G1>G4) whereas the biochemistry differentiated two big groups, the healthy (G1+G2) and the patients (G3+G4). The nutritional status of the P. falciparum patients was highly depressed for most of the studied indices but none was sensitive enough to differentiate this group from the P. vivax group (G3). On the other hand the two healthy groups could be differentiated through the levels of ceruloplasmin (G1<G2) and alpha nitrogen (G1>G2). Thus it seems that the malaria-malnourishment state exists and the results could be framed either as a consequence of nutrient sink and/or the infection stress both motivated by the parasite.

Malaria; Nutritional assessment; Malarial-malnourishment

A avaliação antropométrica (pêso, altura, circunferência branquial, prega cutânea tricipital, prega cutânea subescapular, índice de Quetelet e circunferência muscular do braço) e bioquímica (proteínas e lipides) foi realizado em 120 indivíduos (93 masculinos e 27 do sexo feminino), de 17 a 72 anos de idade, moradores de área endêmica de malária (Humaitá -AM). De acordo com a história da doença (malária) eles foram divididos em 4 grupos: G1 - controle (n = 30), sem história de malária; G2 - controle (n = 40), com história de malária, mas sem manifestação de doença atual; G3 - doentes com Plasmodium vivax (n = 19) e G4 - doentes com Plasmodium faleiparum (n = 31). O diagnóstico de malária foi estabelecido por manifestações clínicas e confirmado laboratorialmente (gota espessa e esfregaço). No global as medidas antropométricas e bioquímicas discriminaram os grupos diferentemente. As medidas antropométricas do pêso, altura, reservas calóricas e estoque proteicos somáticos, apresentaram pouca sensibilidade, discriminado apenas os grupos extremos (Gl > G4). As medidas bioquímicas, no geral diferenciaram dois grandes grupos, os sadios e os doentes (G1+G2) e (G3+G4). Os doentes com Plasmodium falciparum (G4) foram os que se apresentaram em pior estado nutricional para a maioria das variáveis, sem entretanto, nenhuma variável individual que os discriminasse significativamente do G3. Estes dados permitem concluir que a malária resulta em desnutrição do hospedeiro, cuja gravidade está relacionada ao tipo e estágio da doença.

PARASITOLOGY

The malarial impact on the nutritional status of Amazonian adult subjects

Impacto da malaria no estado nutricional de doentes adultos da Amazônia

Paulo C. M. Pereira; Domingos A. Meira; Paulo R. Curi; Nelson de Souza; Roberto C. Burini

Nutritional Biochemistry Laboratory and Tropical Medicine Departament, UNESP Medical School, Botucatu, SP, Brasil

^{Correspondence to} Correspondence to: Dr. Paulo C. M. Pereira Departamento de Medicina Tropical, Fac. Medicina/UNESP 18618-000 Botucatu, SP, Brasil

SUMMARY

The anthropometric (body weight, height, upper arm circumference, triceps and subescapular skinfolds; Quetelet index and arm muscle circunference) and blood biochemistry (proteins and lipids) parameters were evaluated in 93 males and 27 females, 17-72 years old voluntaries living in the malarial endemic area of Humaita city (southwest Amazon). According to their malarial history they were assembled in four different groups: G1-controls without malarial history (n:30); G2 - controls with malarial history but without actual manifestation of the disease (n:40); G3 - patients with Plasmodium vivax (n:19) and G4 - patients with Plasmodium falciparum (n:31). The malarial status was stablished by clinical and laboratory findings. The overall data of anthropometry and blood biochemistry discriminated the groups differently. The anthropometric data were low sensitive and contrasted only the two extremes (G1>G4) whereas the biochemistry differentiated two big groups, the healthy (G1+G2) and the patients (G3+G4). The nutritional status of the P. falciparum patients was highly depressed for most of the studied indices but none was sensitive enough to differentiate this group from the P. vivax group (G3). On the other hand the two healthy groups could be differentiated through the levels of ceruloplasmin (G1<G2) and alpha nitrogen (G1>G2). Thus it seems that the malaria-malnourishment state exists and the results could be framed either as a consequence of nutrient sink and/or the infection stress both motivated by the parasite.

Keywords: Malaria; Nutritional assessment; Malarial-malnourishment.

RESUMO

A avaliação antropométrica (pêso, altura, circunferência branquial, prega cutânea tricipital, prega cutânea subescapular, índice de Quetelet e circunferência muscular do braço) e bioquímica (proteínas e lipides) foi realizado em 120 indivíduos (93 masculinos e 27 do sexo feminino), de 17 a 72 anos de idade, moradores de área endêmica de malária (Humaitá -AM). De acordo com a história da doença (malária) eles foram divididos em 4 grupos: G1 - controle (n = 30), sem história de malária; G2 - controle (n = 40), com história de malária, mas sem manifestação de doença atual; G3 - doentes com Plasmodium vivax (n = 19) e G4 - doentes com Plasmodium faleiparum (n = 31). O diagnóstico de malária foi estabelecido por manifestações clínicas e confirmado laboratorialmente (gota espessa e esfregaço). No global as medidas antropométricas e bioquímicas discriminaram os grupos diferentemente. As medidas antropométricas do pêso, altura, reservas calóricas e estoque proteicos somáticos, apresentaram pouca sensibilidade, discriminado apenas os grupos extremos (Gl > G4). As medidas bioquímicas, no geral diferenciaram dois grandes grupos, os sadios e os doentes (G1+G2) e (G3+G4). Os doentes com Plasmodium falciparum (G4) foram os que se apresentaram em pior estado nutricional para a maioria das variáveis, sem entretanto, nenhuma variável individual que os discriminasse significativamente do G3. Estes dados permitem concluir que a malária resulta em desnutrição do hospedeiro, cuja gravidade está relacionada ao tipo e estágio da doença.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

ACKNOWLEDGEMENTS

We are grateful to Maria Rita C. Mathias for her technical assistance. Special and grateful thanks to Dr. Benjamin Caballero for his critical review of the manuscript.

Recebido para publicação em 25/04/1994.

Aceito para publicação em 31/08/1994.

1. ANDERSON, T.W. - Introduction to multivariate statistical analysis. New York, John Wiley & Sons, 1958.
2. BEISEL, W.R. - Magnitude of the host nutritional response to infection. Amer. J. clin. Nutr., 30: 1236-1247, 1977.
3. BEISEL, W.R. - Effects of infection on nutritional status and immunity. Fed. Proc, 13: 3105-3108, 1980.
4. BLACKBURN, G.L. - Nutritional assessment and support during infection. Amer. J. clin. Nutr., 30: 1493-1497, 1977.
5. BOYD, M.F. - Surveys: epidemiologic and entomologic. In: BOYD, M.F., ed. Malariology. Philadelphia, W. B. Saunders, 1949. p. 831-873.
6. FLETCHER, K.A. - Biochemical approaches to research in malaria. Ann. trop. Med. Parasit., 81: 587-589, 1987.
7. FRISANCHO, A.R. - Tricips skinfold and upper arm muscle size norms for assessment of nutritional status. Amer. J. clin. Nutr., 27: 1052-1058, 1974.
8. FUCHS, R.J.; THEIRS, C.F. & LANCASTER, M.C. - A nomogram to predict lean body mass in men. Amer. J. clin. Nutr., 31: 673-678, 1978.
9. HOLTZ Jr., G.G.; BEACH, D.H. & SHERMAN, I.W. - Octadecenoic fatty acids and their association with hemolysis in malaria. J. Protozool., 24: 566-574, 1977.
10. JELLIFFE, D.B. & JELLIFFE, E.F. - An evaluation of upper arm measurements used in nutritional assessment; letter. Amer. J. clin. Nutr., 33: 2058-2059, 1980.
11. MANCINI, G.; CARBONARA, A.O. & HEREMANS, J.F. - Immunochemical quantification of antigens single radial diffusion. Immunochemistry, 2: 235-254, 1965.
12. MARQUES, A.C. - Migraçăo e disseminaçăo da malária no Brasil. In: SIMPÓSIO INTERNACIONAL SOBRE MALARIA, 1., Rio de Janeiro, 1986. Anais. Rio de Janeiro, Fundaçăo Oswaldo Cruz, 1986. p. 5.
13. MAUROIS, P.; VERNES, A. & CHARET, P. - Transient changes in serum lipoproteins during antimalarial therapy and malaria; letter Lancet, 2: 269, 1978.
14. MAUROIS, P. & CHARET, P. - Kinetic study of serum lipoprotein, total cholesterol and triacylglicerides in various models of experimental rodent malaria. Ann. trop. Med. Parasit., 74: 17-28, 1980.
15. MAUROIS, P.; CHARET, P.; FOURNET, B. & FRUCHART, J.C. - Metabolism of lipoproteins in Rodent malaria. Relation between lipolysis, steatosis and increased biosynthesis of VLDL. Ann. Parasit. hum. comp., 56: 9-19, 1981.
16. McGREGOR, I.A. - Malaria: nutritional implications. Rev. infect. Dis., 4: 798-804, 1982.
17. McGREGOR, I.A. - Paludisme: current concepts concerning man's resistance to infection with malaria. Bull. Soc. Path. exot., 76: 433-445, 1983.
18. MEIRA, D.A.; CURI, P.R.; MARCONDES, J. et al. - Malaria at Humaita country, Amazonas state, Brazil. XVII. Immune response in patients with Plasmodium falciparum according to gametocytes. Rev. Inst. Med. trop. S. Paulo, 27: 229-237, 1985.
19. MEIRA, D.A.; PEREIRA, P.C.M.; MARCONDES MACHADO, J. et al. - Malária do município de Humaitá, estado do Amazonas. XL. Avaliaçăo da clindamicina no tratamento de doentes com infecçăo pelo Plasmodium falciparum. Rev. Soc. bras. Med. trop., 19(suppl.): 90, 1986.
20. MOURA, R.A.A. - Técnicas de laboratório. 2 ed. Rio de Janeiro, Atheneu, 1982.
21. POWADA, M.C. - Changes in body balances of nitrogen and other key nutrients: description and underlying mechanism. Amer. J. clin. Nutr., 30: 1254-1268, 1977.
22. SCUDERI, P.; LAM, K.S.; RYAN, K.J. et al. - Raised serum levels of tumor necrosis factor in parasitic infections. Lancet, 2: 1364-1365, 1986.
23. SESHADRI, C.; SCHETTY, B.R.; GOWRI, N.; VENKA-TARAGHAVAN, S. & CHARI, M.V. - Serum cholesterol and total lipids in P. vivax malaria; a preliminary study. Indian J. med. Res., 74: 513-516, 1981.
24. SHERMAN, I.W. - Mechanisms of molecular trafficking in malaria. Parasitology, 96: 557-581, 1988.
25. WATSON, R.R. & PETRO, T.M. - Resistance to bacterial and parasitic infections in the nutritionally compromised host. CRC crit. Rev. Microbiol., 10: 297-315, 1984.
26. WOOD, K.; SWADE, C.; HARWOOD, J. et al. - Comparison of methods for the determination of total and free tryptophan in plasma. Clin. chim. Acta, 80: 299-303, 1977.

Correspondence to:

Dr. Paulo C. M. Pereira

Departamento de Medicina Tropical, Fac. Medicina/UNESP

18618-000 Botucatu, SP, Brasil

Publication Dates

Publication in this collection
22 Feb 2007
Date of issue
Feb 1995

History

Received
25 Apr 1994
Accepted
31 Aug 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ANDERSON, T.W. - Introduction to multivariate statistical analysis. New York, John Wiley & Sons, 1958.

[2] 2. BEISEL, W.R. - Magnitude of the host nutritional response to infection. Amer. J. clin. Nutr., 30: 1236-1247, 1977.

[3] 3. BEISEL, W.R. - Effects of infection on nutritional status and immunity. Fed. Proc, 13: 3105-3108, 1980.

[4] 4. BLACKBURN, G.L. - Nutritional assessment and support during infection. Amer. J. clin. Nutr., 30: 1493-1497, 1977.

[5] 5. BOYD, M.F. - Surveys: epidemiologic and entomologic. In: BOYD, M.F., ed. Malariology. Philadelphia, W. B. Saunders, 1949. p. 831-873.

[6] 6. FLETCHER, K.A. - Biochemical approaches to research in malaria. Ann. trop. Med. Parasit., 81: 587-589, 1987.

[7] 7. FRISANCHO, A.R. - Tricips skinfold and upper arm muscle size norms for assessment of nutritional status. Amer. J. clin. Nutr., 27: 1052-1058, 1974.

[8] 8. FUCHS, R.J.; THEIRS, C.F. & LANCASTER, M.C. - A nomogram to predict lean body mass in men. Amer. J. clin. Nutr., 31: 673-678, 1978.

[9] 9. HOLTZ Jr., G.G.; BEACH, D.H. & SHERMAN, I.W. - Octadecenoic fatty acids and their association with hemolysis in malaria. J. Protozool., 24: 566-574, 1977.

[10] 10. JELLIFFE, D.B. & JELLIFFE, E.F. - An evaluation of upper arm measurements used in nutritional assessment; letter. Amer. J. clin. Nutr., 33: 2058-2059, 1980.

[11] 11. MANCINI, G.; CARBONARA, A.O. & HEREMANS, J.F. - Immunochemical quantification of antigens single radial diffusion. Immunochemistry, 2: 235-254, 1965.

[12] 12. MARQUES, A.C. - Migraçăo e disseminaçăo da malária no Brasil. In: SIMPÓSIO INTERNACIONAL SOBRE MALARIA, 1., Rio de Janeiro, 1986. Anais. Rio de Janeiro, Fundaçăo Oswaldo Cruz, 1986. p. 5.

[13] 13. MAUROIS, P.; VERNES, A. & CHARET, P. - Transient changes in serum lipoproteins during antimalarial therapy and malaria; letter Lancet, 2: 269, 1978.

[14] 14. MAUROIS, P. & CHARET, P. - Kinetic study of serum lipoprotein, total cholesterol and triacylglicerides in various models of experimental rodent malaria. Ann. trop. Med. Parasit., 74: 17-28, 1980.

[15] 15. MAUROIS, P.; CHARET, P.; FOURNET, B. & FRUCHART, J.C. - Metabolism of lipoproteins in Rodent malaria. Relation between lipolysis, steatosis and increased biosynthesis of VLDL. Ann. Parasit. hum. comp., 56: 9-19, 1981.

[16] 16. McGREGOR, I.A. - Malaria: nutritional implications. Rev. infect. Dis., 4: 798-804, 1982.

[17] 17. McGREGOR, I.A. - Paludisme: current concepts concerning man's resistance to infection with malaria. Bull. Soc. Path. exot., 76: 433-445, 1983.

[18] 18. MEIRA, D.A.; CURI, P.R.; MARCONDES, J. et al. - Malaria at Humaita country, Amazonas state, Brazil. XVII. Immune response in patients with Plasmodium falciparum according to gametocytes. Rev. Inst. Med. trop. S. Paulo, 27: 229-237, 1985.

[19] 19. MEIRA, D.A.; PEREIRA, P.C.M.; MARCONDES MACHADO, J. et al. - Malária do município de Humaitá, estado do Amazonas. XL. Avaliaçăo da clindamicina no tratamento de doentes com infecçăo pelo Plasmodium falciparum. Rev. Soc. bras. Med. trop., 19(suppl.): 90, 1986.

[20] 20. MOURA, R.A.A. - Técnicas de laboratório. 2 ed. Rio de Janeiro, Atheneu, 1982.

[21] 21. POWADA, M.C. - Changes in body balances of nitrogen and other key nutrients: description and underlying mechanism. Amer. J. clin. Nutr., 30: 1254-1268, 1977.

[22] 22. SCUDERI, P.; LAM, K.S.; RYAN, K.J. et al. - Raised serum levels of tumor necrosis factor in parasitic infections. Lancet, 2: 1364-1365, 1986.

[23] 23. SESHADRI, C.; SCHETTY, B.R.; GOWRI, N.; VENKA-TARAGHAVAN, S. & CHARI, M.V. - Serum cholesterol and total lipids in P. vivax malaria; a preliminary study. Indian J. med. Res., 74: 513-516, 1981.

[24] 24. SHERMAN, I.W. - Mechanisms of molecular trafficking in malaria. Parasitology, 96: 557-581, 1988.

[25] 25. WATSON, R.R. & PETRO, T.M. - Resistance to bacterial and parasitic infections in the nutritionally compromised host. CRC crit. Rev. Microbiol., 10: 297-315, 1984.

[26] 26. WOOD, K.; SWADE, C.; HARWOOD, J. et al. - Comparison of methods for the determination of total and free tryptophan in plasma. Clin. chim. Acta, 80: 299-303, 1977.