Thyroid hormone status in children with protein energy malnutrition

Sandeep M., Krishnamurthy B.


Background: Protein energy malnutrition (PEM) continues to be a major public health problem throughout the developing world. PEM is associated with reduced synthesis of plasma proteins; it affects several aspects of secretion and metabolism of thyroid hormones. The present study has been conducted to study the effect of PEM on thyroid hormone, plasma protein levels and to find correlation between thyroid hormones, plasma protein levels in PEM children.

Methods: Present study was a cross sectional hospital based case control study. 125 children with PEM, equal number of controls of age group 1-5 years were included in the study; details were collected in predesigned proforma. Triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), serum total protein, albumin and hemoglobin levels were estimated. The parameters were compared among cases and controls using appropriate statistical tool.

Results: Mean haemoglobin, serum total protein, albumin levels, A/ G ratio, T3 and T4 levels were significantly low in PEM children (cases) as compared to controls. TSH levels were similar in both groups. T3 and T4 levels had a significant positive correlation with haemoglobin, serum total protein and serum albumin levels.

Conclusions: PEM is associated with reduction in T3 and T4 levels without any alteration in TSH levels. The altered thyroid hormone status in children with PEM is perhaps a defense mechanism against excessive metabolic stimulation and energy consumption and protects the malnourished child with low calorie reserve from an early death.



Protein energy malnutrition, Thyroxine, Triiodothyronine, Serum total protein, Albumin

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Muller O, Krawinkel M. Malnutrition and health in developing countries. CMAJ. 2005;173(3):279-86.

World Health Organization. Global burden of protein-energy malnutrition in the year 2000. Geneva: World Health Organization; 2006.

UNICEF. Committing to child survival: a promise renewed- progress report 2013. New York: UNICEF; 2013.

UNICEF. Tracking Progress on child and maternal nutrition: a survival and development priority. New York: UNICEF; 2009.

International Institute for Population Sciences. National Family Health Survey 3 (NFHS-3), 2005-06: India. Mumbai, India: International Institute for Population Sciences; 2006.

Chandra RK. Protein-energy malnutrition and immunological responses. J Nutr. 1992;122(3):597-600.

Mishra SK, Bastola SP, Jha B. Biochemical nutritional indicators in children with protein energy malnutrition attending Kanti Children Hospital, Kathmandu, Nepal. Kathmandu Univ Med J (KUMJ). 2009;7(26):129-34.

Barrett KE, Barman SM, Boitano S, Brooks HL. The thyroid gland. In: Ganong’s review of Medical Physiology. 23rd ed. New York: McGraw-Hill; 2010: 301-14.

Brown PI, Brasel JA. Endocrine changes in the malnourished child. In: Suskind RM, Suskind LL, editors. Nestle nutritional workshop series. Vol. 19. New York:Raven Press; 1990:213-28.

Nutrition Sub-committee of Indian Academy of Pediatrics. Report. Indian Pediatr. 1972;9:360.

de Onis M, Monteiro C, Akre J, Glugston G. The worldwide magnitude of protein-energy malnutrition: an overview from the WHO global database on Child growth. Bull World Health Organ. 1993;71(6):703-12.

Pelletier JG. Severe malnutrition: A global approach. Children in the Tropics. 1993;208-9:1-80.

Laditen AA. Hormonal changes in severely malnourished children. African J Med Sci. 1983;12:125-32.

Kumar N, Gupta N, Kishore J. Kuppuswamy’s socioeconomic scale: Updating income ranges for the year 2012. Indian J Public Health. 2012;56(1):103-4.

Adegbusi H, Sule MS. Anthropometric and biochemical assessment among under five children in Kusada local government area, Katsina state, Nigeria. Bajopas. 2011;4(2):137-40.

Rahman MA, Mannan MA, Rahman MH. Serum iron and total iron binding capacity in severely malnourished children. Bangladesh J Pharmacol. 2007; 2:61-5.

Abrol P, Verma A, Hooda HS. Thyroid hormone status in protein energy malnutrition in Indian children. Indian J Clin Biochem. 2001;16(2):221-3.

Turkay S, Kus S, Gokalp A, Baskin E, Onal A. Effects of protein energy malnutrition on circulating thyroid hormones. Indian Pediat. 1995;32(2):193-7.

Kumar S, Nadkarni J, Dwivedi R. Thyroid hormone status in malnourished children. Indian Pediatr. 2009;46(3):263-4.

Orbak Z, Akin Y, Varoglu E, Tan H. Serum thyroid hormone and thyroid gland weight measurements in protein-energy malnutrition. J Pediatr Endocrinol Metab. 1998;11(6):719-24.

Das BK, Panda BK, Dhingra R, Mishra OP, Agarwal JK. Thyroid hormone studies in protein-energy malnutrition. J Trop Pediatr. 1999;45(6):375-6.

Onuora C, Maharajan G, Singh A, Etta KM. Thyroid status in various degrees of protein-calorie malnutrition in children. Clin Endocrinol (Oxf). 1983;18(1):87-93.