Protein loss and fungi responsible for lowered selenium in children with persistent diarrhoea
Universitas Indonesia led the cross-sectional study that assessed 60 children between the ages of one and 12. Half the subjects had persistent diarrhoea, while the other half did not. Clinical examinations and blood routine tests were performed on all the children, who also had their erythrocyte glutathione peroxidase (GPX) activity, plasma selenium levels, and stool alpha-1 antitrypsin (AAT) concentration tested.
The study found that the “mean plasma selenium was significantly lower in children with persistent diarrhoea than in children without diarrhoea”, while “mean stool AAT concentration was significantly higher” in the former group. Still, mean erythrocyte GPX activity was similar in both groups.
The children with persistent diarrhoea were also malnourished, with 17 suffering from moderate malnutrition and the remaining 13 suffering from severe malnutrition. In contrast, 20 of the 30 children were appropriately nourished, while the other 10 were moderately malnourished.
Furthermore, “anaemia was observed in 70% of the children with persistent diarrhoea and in 17% of the children without diarrhoea”.
In a developing country like Indonesia, “intestinal damage by viral, bacterial, or parasitic agents is the current primary event in the majority of persistent diarrhoea cases”. A low concentration of selenium, an essential trace element known for its “antioxidant and immune activity and its anti-inflammatory and antiviral properties”, could be involved in incidences of persistent diarrhoea.
The study also noted a “weak association” between decreased selenium and increased AAT, suggesting that decreased plasma selenium might be caused by protein loss that occurs in diarrhoea, for which stool AAT is a marker. Enhanced faecal protein loss was considerably higher in the children with persistent diarrhoea caused by pathogens, i.e., bacterial, parasitic or viral agents.
However, selenium concentration is not always lower in cases of persistent diarrhoea. The study stated that “GPX activity in plasma and red blood cells and the plasma selenium concentration may decrease, increase, or remain within the reference range, depending on the cause of gastrointestinal disorder”.
The “markedly higher” selenium status of the study’s subjects as compared to that of children in other countries, could explain why GPX activity stayed within the reference range even in subjects who had persistent diarrhoea. In fact, the selenium concentration in this group exceeded the proposed value for optimum red blood cell activity.
Additionally, it was revealed that 23% of the study’s subjects with persistent diarrhoea had been infected by fungi. The study hypothesised that “several pathogeneses might be involved”, such as “antibiotic treatment and immunodeficiency associated with diarrhoea”.
Source: Asia Pacific Journal of Clinical Nutrition
Volume 26, supplement 1
“Selenium status and fungi in the protein-losing enteropathy of persistent diarrhoea”
Authors: Pramita G Dwipoerwantoro, et al.
