RESUMEN

El niño con desnutrición grave tiene una disfunción de la respuesta inmune que puede aumentar de manera significativa la morbilidad y la mortalidad por infecciones. El objetivo de la presente investigación fue evaluar el efecto de la recuperación nutricional en las concentraciones séricas de citocinas inflamatorias; tales como: interleucina 12 (IL-12), interleucina 17 (IL-17), interferón gamma (IFN-γ) y factor de necrosis tumoral alfa (TNF-α). En un estudio de tipo prospectivo y longitudinal, se seleccionó la población con base a criterios clínicos y antropométricos, constituida por 24 niños desnutridos graves en edades comprendidas entre 1 y 2 años, quienes formaban parte de un programa de recuperación nutricional. La concentración sérica de las citocinas investigadas se determinó antes y después del tratamiento nutricional, empleando la técnica de Inmunoanálisis Enzimático (ELISA) de doble anticuerpo. Para establecer comparaciones se utilizó la t de Student, y se consideró una p<0,05 como estadísticamente significante. Se observó una diferencia en las concentraciones de IL-12, IL-17, IFN-γ y TNF-α antes y después del tratamiento (p<0,05), lo cual parece indicar que la desnutrición per se provoca un estado inflamatorio y que 2 meses de apoyo nutricional intensivo, favorecen no solo la recuperación clínica del niño desnutrido grave, sino también la recuperación de su respuesta inmunitaria en cuanto a la producción de mediadores solubles como son las citocinas.

Children with severe malnutrition have a dysfunction of the immune response that can significantly increase morbidity and mortality from infections. The aim of this investigation was to evaluate the effect of nutritional recovery in serum measurements of inflammatory cytokines; such as interleukin 12 (IL-12), interleukin 17 (IL-17), interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). In a prospective and longitudinal study, 24 severe malnourished children aged between 1 and 2 years-old, who were part of a program of nutritional recovery, were selected based on clinical and anthropometric criteria. Serum measurements of cytokines were determined before and after dietary treatment, using the technique of sandwich Enzyme-Linked ImmunoSorbent Assay (ELISA). For comparisons, Student’s t test was used, considered p <0.05 as statistically significant. A difference was observed in the concentrations of IL-12, IL-17, IFN-γ and TNF-α before and after treatment (p <0.05), which suggests that malnutrition provokes an inflammatory state and two months of intensive nutritional support, not only promotes the clinical recovery of severe malnourished children, but also the recovery of the immune response with regard to the production of soluble mediators, such as cytokines.

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Children with severe malnutrition have a dysfunction of the immune response that can significantly increase morbidity and mortality from infections. The aim of this investigation was to evaluate the effect of nutritional recovery in serum measurements of inflammatory cytokines; such as interleukin 12 (IL-12), interleukin 17 (IL-17), interferon gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α). In a prospective and longitudinal study, 24 severe malnourished children aged between 1 and 2 years-old, who were part of a program of nutritional recovery, were selected based on clinical and anthropometric criteria. Serum measurements of cytokines were determined before and after dietary treatment, using the technique of sandwich Enzyme-Linked ImmunoSorbent Assay (ELISA). For comparisons, Student's t test was used, considered p <0.05 as statistically significant. A difference was observed in the concentrations of IL-12, IL-17, IFN-γ and TNF-α before and after treatment (p <0.05), which suggests that malnutrition provokes an inflammatory state and two months of intensive nutritional support, not only promotes the clinical recovery of severe malnourished children, but also the recovery of the immune response with regard to the production of soluble mediators, such as cytokines.

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Introducción: Como consecuencia de la desnutrición, se producen alteraciones que comprometen la respuesta antioxidante y la inmunocompetencia. El objetivo del presente estudio es evaluar el efecto de la recuperación nutricional sobre las concentraciones séricas de Oxido Nítrico (NO), Malonaldehído (MDA) y TNF-α en el desnutrido grave. Metodología: Se estudiaron prospectivamente 47 niños con edades comprendidas entre 2 meses y 8 años, distribuidos en 27 niños con desnutrición grave de tipo mixto y 20 controles, que asistieron al Servicio de Educación y Recuperación Nutricional del Hospital Chiquinquirá de Maracaibo-Venezuela. El NO y el MDA determinaron por ensayo de Diazotización y derivados del ácido tíobarbitúrico respectivamente, y el TNF-α mediante la técnica de ELISA. Resultados: Las concentraciones de NO y MDA no mostraron diferencias estadísticamente significativas con los controles, no obstante se encontró un descenso en estas concentraciones cuando se compararon con las obtenidas al inicio de la terapia (p ≤ 0,0001 para NO y p ≤ 0,001 para MDA. Los valores séricos de TNF-α presentaron significancia estadística en relación con los controles y al inicio del tratamiento (p < 0,0001). Conclusión: La terapia de recuperación nutricional incide en la disminución de las concentraciones séricas de NO, MDA y TNF-α, debido probablemente a la suplementación de vitaminas y micronutrientes administrados durante dicho tratamiento.

Introduction: Alterations involving antioxidant response and immunological competence are consequences of malnutrition. The aim of this study is to assess the effect of nutritional recovery on serum concentrations of nitric oxide (NO), malonaldehyde (MDA) and TNFα in the severely malnourished child. Methods: 47 children were prospectively studied (2 months to 8 years old): 27 children with mixed type severe malnutrition and 20 controls who attended the Department of Education and Nutritional Recovery at the Chiquinquirá Hospital in Maracaibo-Venezuela. NO and the MDA were determined by Diazotization trial and derivatives of the barbituric acid respectively; TNF-α was assessed by the ELISA technique. Results: NO and MDA concentrations showed no significant difference with controls, although there was a significant decrease with respect to pre-treatment values (p ≤ 0,0001 for NO and p ≤ 0,001 for MDA. Values for TNF-α were significantly different from controls and pre-treatment values (p< 0,0001). Conclusions: Nutritional recovery therapy affects the decrease in serum concentrations of NO, MDA and TNF-α, probably due to the supplementation of vitamins and micronutrients during this treatment.

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The Malassezia genus contains a group of lipophilic yeasts that form part of the normal microbiota of human and animals skins. The presence of Malassezia species was studied on healthy skin in children, who attended day care centers, located in Maracaibo, Zulia state, Venezuela. Children without skin lesions that were anthropometrically classified as malnourished (48) and eutrophics (40), were studied. Samples were taken from different anatomic regions with a transparent plastic tape. The direct examination was done using blue methylene (0.25%) and then, samples were cultivated in Dixon medium with antibiotic. The identification of the isolated yeasts was done by classical methodology. The results obtained indicate that malnourished and eutrophics children were positive to Malassezia in relatively high prevalences (66.6% and 65.0% respectively). It is worthy of notice that M. furfur was predominantly present in malnourished children (77%). It was isolated from all the anatomic locations in both groups of children. M. slooffiae was mainly located in the back of the eutrophic children. M. furfur was isolated preferently in malnourished male children, while in the eutrophic children, it was observed in females. It was demonstrated that M. furfur was predominantly present in the healthy skin of malnourished and eutrophic children.

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El género Malassezia comprende un grupo de levaduras lipofílicas, integrantes de la microbiota normal de la piel del hombre y de animales. Se estudió la presencia de especies de Malassezia en piel sana de niños, que asistían a multihogares de cuidado diario de la ciudad de Maracaibo, estado Zulia, Venezuela. La evaluación antropométrica permitió el diagnóstico de niños desnutridos (n = 48) y eutróficos (n = 40). Estos niños, entre 1 y 6 años de edad, que no presentaban lesiones en la piel, se seleccionaron para el estudio. Las muestras de la piel se tomaron de distintas regiones anatómicas. Se empleó el método de la impronta con cinta plástica transparente. Se realizó un examen directo con azul de metileno (0,25%) y se cultivó en el medio Dixon con antibiótico. La identificación de los aislados se hizo según la metodología clásica. Los resultados indican que los niños desnutridos y eutróficos presentaron una colonización por Malassezia en un elevado porcentaje (66,6% y 65,0%, respectivamente). Se observó en los desnutridos un predominio significativo de M. furfur (77,0%). Esta especie se aisló en todas las localizaciones, tanto en los desnutridos como en los eutróficos, mientras que M. slooffiae predominó en la espalda en los eutróficos. Por otra parte, se observó en los desnutridos un predominio significativo de M. furfur en el sexo masculino y en los eutróficos en el femenino. Esta investigación demostró el predominio de M. furfur en piel sana de niños desnutridos y eutróficos.

The Malassezia genus contains a group of lipophilic yeasts that form part of the normal microbiota of human and animals skins. The presence of Malassezia species was studied on healthy skin in children, who attended day care centers, located in Maracaibo, Zulia state, Venezuela. Children without skin lesions that were anthropometrically classified as malnourished (48) and eutrophics (40), were studied. Samples were taken from different anatomic regions with a transparent plastic tape. The direct examination was done using blue methylene (0.25%) and then, samples were cultivated in Dixon medium with antibiotic. The identification of the isolated yeasts was done by classical methodology. The results obtained indicate that malnourished and eutrophics children were positive to Malassezia in relatively high prevalences (66.6% and 65.0% respectively). It is worthy of notice that M. furfur was predominantly present in malnourished children (77%). It was isolated from all the anatomic locations in both groups of children. M. slooffiae was mainly located in the back of the eutrophic children. M. furfur was isolated preferently in malnourished male children, while in the eutrophic children, it was observed in females. It was demonstrated that M. furfur was predominantly present in the healthy skin of malnourished and eutrophic children.

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Determinar las concentraciones séricas de citocinas Th2 (IL4 e IL10), en niños desnutridos y eutróficos sin infección, en edades comprendidas entre 6 meses y 6 años. Se seleccionaron 89 niños; 64 niños con algún grado de desnutrición (leve, moderada y grave) y 25 niños eutróficos. Las citocinas se midieron en sangre periférica utilizando el método de ELISA doble sandwich. Para el análisis estadístico se utilizo el test de ANOVA con post test de Tukey. Se presentan como media + DE. La IL4 mostró en el grupo de desnutridos, niveles más elevados: leves (0.46 ± 0.04 pg/ml), moderados (0.48 ± 0.10 pg/ml) y graves (0.55 ± 0.006 pg/ml), presentando cada grupo diferencias significativas p < 0.001 en relación con el grupo control (0.37 ± 0.004 pg/ml). También hubo diferencias significativas entre los grupos de desnutridos leves y moderados con los graves p < 0.001. La IL10 mostró diferencias significativas entre los desnutridos moderados (9.91 ± 3.17 pg/ml) y graves (10.88 ± 5.13 pg/ml) con el grupo control (6.53 ± 2.59 pg/ml) p < 0.01. Los valores elevados de IL4 e IL10 en el niño desnutrido son consecuencia de un daño en la capacidad de activación de las células inmunitarias en los mismos, sumándose el grado de infestación parasitaria con helmintos que presentan, que condiciona la elevación de IL4.

To determine the cytokine serum measurements Th2 (IL4 and IL10), in malnourished children and eutrophic without infection, in ages understood between 6 months and 6 years. 89 children were selected; 64 children with some grade of malnourishment (mild, moderate and severe) and 25 eutrophic children. The cytokines was measured in outlying blood using ELISA'S double sandwich method. For the statistical analysis we use the test of ANOVA with post test of Tukey. They are presented like Mean + SD. The IL4 showed in the group of malnourished, higher levels: mild (0.46 ± 0.04 pg/ml), moderate (0.48 ± 0.10 pg/ml) and severe (0.55 ± 0.006 pg/ml), presenting each group significant differences (p < 0.001) in relation with the control group (0.37 ± 0.004 pg/ml). There were also significant differences among the groups of mild malnourished and moderate with the severe ones p < 0.001. The IL10 showed significant differences among the moderate malnourished (9.91 ± 3.17 pg/ml) and the severe (10.88 ± 5.13 pg/ml) with the control group (6.53 ± 2.59 pg/ml) (p < 0.01). The high values of IL4 and IL10 in the malnourished children are consequence of damage in the capacity of activation of the immune cells in the same ones, being added the grade of parasitic infection with worms that present that conditions the rise of IL4.

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A multicentrical clinical study was designed with the purpose of measuring C-reactive protein (CRP) in normal and malnourished children, with and without infection. Blood samples were collected without anticoagulant from 109 venezuelan children, between the ages of 6 months and 6 years. The statistical analysis was carried out using the t Student and ANOVA. The values of CRP were higher (80.80 +/- 38.39 mg/L) in severe malnourished infected than non-infected malnourished children (8.17 +/- 3.06 mg/L, p < 0.001). There were statistical differences between severe malnourished infected and eutrophic infected children (p < 0.001). There was also a difference between the non infected, severely malnourished children and the rest of them, although they kept their values within a normal range. These findings indicate that the malnourished child is able to produce CRP in response to infection but in a different way that the eutrophic child. In children without infection, the CRP levels were kept within the normal range.

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Con la finalidad de investigar la síntesis de Proteína C Reactiva (PCR) en niños con diferentes grados de desnutrición y entre desnutridos graves infectados y eutróficos infectados; así como en un grupo control de niños eutróficos, se determinó las concentraciones de esta proteína por el método turbidimétrico en 109 niños venezolanos en edades comprendidas entre 6 meses y 6 años. Los resultados encontrados mostraron que el desnutrido grave infectado aumenta su valor de PCR de manera significativa (80,80 ± 38,39 mg/L) en relación con el no infectado (8,17 ± 3,06 mg/L) (p < 0,001). Igualmente hubo diferencias estadísticamente significativas entre los desnutridos graves infectados y el grupo de eutróficos infectados (p < 0,001) quienes presentaron valores más elevados. En relación con los grupos de desnutridos no infectados se encontró diferencia significativa entre los desnutridos graves con el resto de los grupos y el grupo control eutrófico (p < 0,05), no obstante, sus concentraciones permanecieron dentro del valor normal. Estos resultados permiten concluir que el desnutrido infectado es capaz de sintetizar PCR en respuesta a procesos infecciosos graves pero que difiere significativamente cuando sus valores se comparan con los del eutrófico infectado. Por otra parte el desnutrido libre de infección cualquiera que sea su grado de desnutrición mantiene sus valores de PCR en límites normales

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