Street children constitute a marginalized group in most societies. In the world, millions of children live in the streets. In many regions, most of these children use psychoactive substances and malnurition is the major problem for them. Thus, we aimed to investigate biochemical parameters of street children.
Methods: This study includes 100 healthy and 50 street children whose ages range from 10-17. cell blood count, vitamin E,C,A and vitamin B1, B2, B6, malondialdehyde, glutathione peroxidase, coenzyme Q10, ferritin parameters were studied in blood samples. Also HbsAg, Anti-HCV, Anti-HIV and superoxide dismutase levels were detected.
Results: Levels of cell blood count, vitamin B1,B6 and C were found different and statistically significant between two groups (respectively p<0.001, p<0.01). Glutation peroxidase, superoxide dismutase and HbsAg levels were quite important statistically (p<0.005).
Conclusions: Antioxidant vitamin levels and some parameters of street children have shown a reasonable difference from that of controls. It is thought that this difference is based on malnutrition and their addiction problem. Furthermore, HbsAg level being significant according to the controls might depend both on their drug usage by the same injectors, and their lack of vaccination since most of them do not attend schools where the regular hepatitis vaccinations are made, which is for the benefit of controls.
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Key words: Children, vitamin, antioxidant, coenzyme, peroxidase, dismutase.
Street children form an incongruous group in social terms. Millions of children of the world live in the streets. It endangers the mental, physical, social and emotional state of these children since they are subjected to harmful environmental conditions and hazardous substances constantly. Some of these children use alcohol and other physico-active substances. Therefore, malnutrition is a frequently encountered condition (Pomm J, 2005; Scanlon TJ et al, 1998). Anthropometric studies conducted every year on street children show that the frequency for chronic malnutrition is 30-35 % as it is 8-10 % for acute malnutrition. The tendency for malnutrition increases especially when the children are ill. Another factor for these children to suffer from malnutrition is that the deficiency of micronutrients such as iron, iodine and vitamin A (UNHCR, 2011). Oxidative stress is defined as the increase in oxidants and/or the decrease in the antioxidant capacity. Small quantities of free radicals are produced during the metabolic processes of the body of healthy people. Under normal circumstances, these free radicals are neutralized by antioxidants produced as endogens and that are taken by diet, and the oxidant-antioxidant balance is maintained (Uttara et al, 2009; Erel, 2004).
Reactive oxygen species may lead to nucleic acid base changes or disruption of lipids, proteins and DNA double helix in order. This results in chromosomal mutations and cytotoxicity (Halliwell, 1984; Ames et al, 1993; Marotta et al, 2007). There are strong defence mechanisms in organisms which prevent the harmful effects of free radicals. These systems are called antioxidant defense mechanisms (Ames et al, 1993). It should be noted that most of the antioxidant systems do not act through only one mechanism, but they take effect through several mechanisms. One of the major endogenous mechanisms includes enzymes. Some of these enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase (GSH-Px) have a major role in intracellular defense against the harms of oxygen radicals in aerobic cells. Distribution of SOD enzyme in organisms should be taken into consideration together with catalase enzyme; because of the fact that the resultant product of a reaction catalyzed by SOD is one of the toxic products of oxygen, and its accumulation is prevented by catalase (Stehbens, 2004). It is the enzyme responsible for removal of hydroperoxides from the cells (Czucjezko et al, 2003). GSH-Px is the most important enzyme that protects lipids from peroxidation across intracellular distance. Therefore, this enzyme, that takes part especially at cytosolic compartment of the cell, protects structure and function of the cell (Baskol et al, 2007). Deficiency of ECA vitamins which are endogenously acting antioxidants is extremely important since they are closely related with nutrition. The fundamental function of vitamin E is to protect the lipids of plants from oxidative damages (disruption of the lipids) as it is mostly found in fatty plants. GSH-Px and vitamin E present supplementary effect on each other against free radicals. Vitamin E prevents the synthesis of peroxides as the enzyme removes the already present ones.
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As a reducing agent and a free radical scavenger, ascorbic acid provides a preservative effect against reactive oxygen species. Moreover, ascorbic acid is a functional compound that can act as a free radical resource (Ames et al, 1993; Halliwell, 1987). It is found that Î²-carotene can suppress singlet oxygen, clean superoxide radical, and have an antioxidant function by reacting directly with peroxy radicals (Dimascio et al, 1993).
In this research, it is aimed to study the health conditions of street children which have become a prominent social problem. In this context, parameters to be studied will disclose how their health is affected by the environmental conditions. It is further aimed to determine how volatile organic compounds affect the oxidant levels especially in children who are drug abusers. Compounds such as thinner consist of volatile compounds like benzene, toluene, white spirit, etc. Extensive exposure to these compounds may lead to changes in several mechanisms of the body although the issue is not fully understood. Thus, we aimed to investigate biochemical parameters of street children.
Materials and Methods
50 street children between the ages of 10-17 and 100 healthy children are included in the study. Questionnaire forms on demographic characteristics of the study groups when held. Street children were found in body weight was 51.8Â±10.7. Healthy volunteers were weight 53.7Â±13.8. Weight, there was no difference between the groups. Street children were chosen among those addicted to substances for at least 2 years.
The majority of street children, children who commits a crime by the police in the children.
Only a small fraction of children were found by the municipality of Gaziantep. Municipalities, as well as child support and police were on this subject. At the same time allowed for the project were included in the governor's office.
The municipality as well as child support and police were on this subject. At the same time allowed for the project were included in the governor's office. Healthy volunteers taking no medicine, healthy children who were selected from routine examinations. This permission was received from the governor's office as well as for children and their families were included in the check. For this project, the number of Gaziantep University, the local ethics committee it was decided to 06. 2008 /115. This study by the research office of Gaziantep University (SHMYO.06.01) is supported.
Blood samples are studied for clinical count blood cell (RBC, HGB, HCT, MCH, MCHC, PLT, MPV) using the method of laser device Sysmex K1000 set. Vitamin E, C, A, B1, B2, B6, malondialdehyde (MDA), GSH-Px and coenzyme Q10 are studied using HPLC method; ferritin using chemiluminescence method (Immulite 2000); and iron, iron-binding capacity are studied using spectrophotometric method. ELISA method is used for the determination of serum HbsAg, Anti-HCV, Anti-HIV parameters, and of SOD levels in the hemolysate prepared beforehand. Working parameters mean and standard deviations were calculated. Groups were compared using Student's t-test. In addition, pearson correlation analysis was performe (Habbema et al, 2002).
The differences between hematology results regarding RBC, HBG, HCT and MPV levels are found to be statistically significant in both of the groups (p<0.003, p<0.002, p<0.001). The difference in vitamin B1, vitamin B6, and vitamin C levels of both groups were also found to be statistically significant (p<0.005, p<0.01 and p<0.05). The differences in antioxidant levels; namely, glutathione peroxidase and SOD, and HbsAg levels were also found to be statistically significant (p<0.01, p<0.001, respectively).
As a result, some of the antioxidant and vitamin levels of the street children as well as some of their hematology parameters presented statistically significant differences (p<0.05, p<0.001).
Studied parameters and relevant statistical results of street children and healthy children included in the study are given in below tables as arithmetic mean and standard deviation. As a result of independent t-test, statistical p values are added in the tables. In table 1, a significant difference is observed between the levels of vitamin B1, B6, and C of the two groups (p<0.005, p<0.01, p<0.05; respectively).
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Table 2 gives the antioxidant levels and anti-hepatitis levels of street children and the control group. As for the antioxidants, the difference between glutathione peroxidase and SOD levels are found to be statistically significant than that of healthy children (p<0.01, p<0.01; respectively). HBsAg levels compared to healthy children, street children were significant (p<0.001).
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Clinical hematology results for both of the groups are given in Table 3. RBC, HBG, HCT, and MPV levels are found to be significantly different (p<0.003, p<0.002, p<0.001; respectively).
Although many questions with social content were asked, the demographic data were not included in the evaluation because of the fact that it would be more ethical and proper for a sociologist to evaluate the results. Therefore, only the age, height, and weight data were taken into consideration.
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Correlation analyses for street children have shown that; There is a significantly positive correlation between vitamins B1 and B2, and vitamin B6 (p<0.05). Levels of vitamins B6 and E, and vitamin A present a statistically significant positive correlation between them (p<0.01).Vitamin C is found to have a significant positive correlation with MDA, Anti-HCV, HBsAg and Anti-HIV (p<0.01). Also, there is a positive correlation between MDA levels and HBsAg as well (p<0.05). There is a negative correlation between serum iron and vitamin B2, and SOD (p<0.05, p<0.01). Vitamins A and E are negatively correlated with coenzyme Q10 (p<0.05).
Even though there are some demographic studies regarding the street children, there are only few studies in which the biochemical aspect of these children are investigated (Turkmen et al, 2004). Therefore, we consider this study to be valuable though in need of support with new projects.
5% of the worldâ€™s population (350-400 million) are HbsAg carriers and 1/3 of them are seropositive (antigen or antibody positive) in HBV. Similar numbers are also valid in our country. Approximately 5% of the population is carriers of HbsAg, and 1/3 is seropositive. Individuals with HbsAg positive state for more than six months are considered as carriers of HBV infection. The majority of the carriers are formed by inactive carriers (Alavian, 2007). It is reported that hepatitis B virus can cause the release of reactive oxygen species and pro-oxidant cytokines such as tumor necrosis factor alpha by activating the phagocytic cells while it can also affect the pro-oxidant and anti-oxidant balance by inhibiting the antioxidant enzymes such as SOD (Waris and Ahsan, 2006; Tanikawa and Torimura, 2006). In patients with hepatitis C; MDA, SOD, GHS-Px enzyme activities in erythrocytes are compared to the control group, and increased MDA and SOD enzyme activities together with decreased GSH-Px activity are observed (Ko et al, 2005). These results are not consistent with the results of our study. In a study regarding antioxidant defense in 100 children with chronic viral hepatitis B and C, significantly decreased catalase and SOD levels with respect to the control group, and increased GSH-Px levels are observed, which indicates insufficient antioxidant defense (Chrobot M et al, 2000).
Our study supports the study of Chrobot et al. Regarding the antioxidant levels, a statistically significant increase in GSH-Px levels of the experimental group, and a decrease in SOD levels with respect to the control group is observed (p<0.01 and p<0.01; respectively). HbsAg levels of the street children, on the other hand, are found to be significantly different between the two groups (p<0.01).
Another study also presents similar results with our study. In this study, selenium, glutathione concentrations, and GSH-Px enzyme activities in patients with hepatitis B and C are compared to the control group, and it is found that selenium and glutathione concentrations are decreased as the GSH-Px enzyme activity is slightly increased (Czucjezko et al, 2003).
In another study regarding the relation between antioxidant enzymes and lipid peroxidation in patients infected with hepatitis B virus; SOD, catalase, and MDA parameters are evaluated. As a result of the study, decrease in antioxidant enzyme activities in HBV infected patients, and elevations in MDA levels are detected. However, these alterations are not found to be linked to the viral burden of the patients (Gorenek et al, 2006).
According to the results of our research, it can be seen that vitamin C is significantly correlated positively with MDA, Anti-HCV, and HBsAg (p<0.01). Moreover, there is a positive correlation between the MDA levels and HBsAg as well (p<0.05). MDA levels of the patients and antioxidant levels have also a positive correlation between them. In another study, an oxidative stress is generated in order to observe the effects of it on SOD levels and coenzyme Q10 levels which are altered indeed (Belardinelli et al, 2008). Free radicals can cause cellular damage as they act as reducing or oxidizing agents, or in some cases as both. They also have harmful effects on DNA, cellular proteins, and lipids. Furthermore, they affect the calcium metabolism and cause free intracellular calcium ion to increase uncontrollably, harming the cell or leading to its death as a result (Mccormick et al, 2000).
As for the vitamin levels, it is observed that there is a significant difference in vitamin B1, vitamin B6, and vitamin C levels of the two groups (p<0.005, p<0.01, p<0.05; respectively) while no significant difference is observed in the levels of vitamin B2, vitamin A, and vitamin E of the two groups. In pediatric patients with glycogen storage disease, a difference in vitamin A, C, and E and antioxidant enzymes is detected (Kalkan et al, 2009). Vitamin B1 and B2 have a significant positive correlation with vitamin B6 (p<0.05). Vitamins B6 and E also present a positive correlation with vitamin A (p<0.01).
It is observed, in a study conducted with a group given fresh fruits and vegetables that vitamin C, alpha tocopherol, beta carotene, retinol, vitamin B6 levels, and antioxidant levels are altered (Polidori et al, 2009). Another study shows low levels of vitamin C and vitamin B in relation with the environmental pollution (Shan et al, 2009). In our study, levels of both of the vitamins in question are found to be elevated, and it is considered that it is the result of living in inappropriate environmental conditions and consuming insufficient amount of fruit and vegetables.
It is observed that iron levels of the experimental group increase as the SOD levels decrease. The reason for this is thought to be the elevated radical production as a result of free iron that is not used for the synthesis, and the relevant decrease in SOD activity which normally provides for the peroxide production. Moreover, anaemia is also observed in these children; however, it is considered that the reason is not the Fe deficiency, but the possible decrease in the synthesis of pyrrole ring necessary for heme and for the synthesis of globin which is due to insufficient protein synthesis. It is also argued that the decrease in Heme synthesis is caused by the fact that the children may be exposed to heavy metals that therefore have correspondingly inactive ALA synthase and Fe-chelatase enzymes.
As it can be seen in this research, malnutrition and inappropriate environmental conditions as well as abusing drugs lead these children to a dysfunction and deficiency syndrome in many ways. Especially, low levels of vitamin B can cause the disruption of the energy cycle as well as the inefficient nerve myelinization. As a result, street children tend to be more aggressive and vicious. Together with the environmental conditions, behavioral disorders become inevitable for these children.
All they depend on is the enzymatic antioxidants in their young bodies, which may not hold for long against chronic problems of these children. Synthesis of these enzymes which are made up of proteins can also be disrupted.
Another conclusion deduced from the study is that this study is crucial for other studies as it sets an example. If another study is to be conducted, it should involve an extensive group including a sociologist, a psychiatrist, a children police, and a children related, non governmental organization affiliated with the local administration. Those who are not actively involved in the project may not be able to be beneficial due to the principle of volunteerism.
Conflict of Interests
Authors have no conflict of interests.
All authors planned and conducted the study procedure and performed data analyses and wrote.
All authors read and approved the final draft of the manuscript.