OBJECTIVE Free radicals are implicated in many diseases. The rise in free radicals associated with antioxidant deficiency results in tissue damage. The pathogenesis of oedema and anaemia commonly found in children with protein-energy malnutrition (PEM) has been suggested to be caused by an imbalance between the production of toxic radicals and their safe disposal. The aim of this study was to evaluate antioxidant status in children with PEM. METHODS A total of 68 children (age range: 3 months to 3 years) living in Cairo, Egypt were recruited. Forty-six of these subjects had different degrees of PEM; they were admitted at the Abo-Elrish Hospital, Cairo. Of these, 26 children had kwashiorkor (KWO) and twenty had marasmus (MAR). Twenty-two age and sex matched healthy well-nourished children were recruited from the local community, and used as controls. METHODS The antioxidant status of the study population was determined by measuring copper-zinc superoxide dismutase (Cu-Zn, SOD) in red blood cells, glutathione peroxidase (GPX) in whole blood, and ceruloplasmin in plasma. In addition, the plasma levels of trace-elements involving antioxidant activities, such as copper (Cu), zinc (Zn), and selenium (Se) were determined, along with a select group of vitamins. The latter included vitamin A (retinol), vitamin E (alpha-tocopherol) and vitamin C (ascorbic acid). RESULTS The mean whole blood GPX activity along with plasma levels of vitamins A, E and C as well as ceruloplasmin, Cu and Se were all lower in children with either KWO or MAR than their corresponding control subjects. The erythrocyte SOD activity, on the other hand, was increased while the plasma Zn concentrations were either increased or not changed in the malnourished children. It was of interest that while haemoglobin concentrations were decreased, the plasma free iron (Fe) levels were significantly increased in children with KWO. CONCLUSIONS The significant increase in red cell SOD activity associated with the decrease in plasma ceruloplasmin, antioxidant vitamins and the whole blood GPX activity in PEM children suggest that these children are potentially susceptible to high oxidative stress. An elevated plasma Fe concentrations, especially with KWO may augment the harmful effect of free radicals with a clinical consequence of oedema.