ABSTRACT

This article addresses the unsettled controversy about the use of iron in the treatment of children with malnutrition. Although many malnourished children are iron-deficient, there are at least two reasons why oral iron may be detrimental: 1) low levels of transferrin are common in such children which decreases the absorption of oral iron, thus promoting the growth of intestinal bacteria; and 2) iron that is absorbed, but which remains unbound, is converted from the ferrous to the ferric state and becomes an aggressive and potentially damaging free oxygen radical. The authors used the bleomycin assay to quantify the free or loosely bound iron in 50 children with kwashiorkor and compared this data with that found in six children with marasmus and 12 well-nourished children. Nonprotein-bound iron was found in 58% of the children with kwashiorkor, but in none of the others.

Many children who are malnourished are deficient in micronutrients, such as vitamins A and E, zinc, and glutathione, which serve as free oxygen scavengers. An imbalance in free radicals and their scavengers results in tissue damage and potentially increases the morbidity and mortality in these precarious children. If the finding of these investigators is substantiated, it will add credence to the argument advising caution in respect to oral iron therapy in children with kwashiorkor.