A study of plasma proteins (serum total protein, serum albumin), and thyroid function in children with protein-energy malnutrition
DOI:
https://doi.org/10.18203/2349-3291.ijcp20232886Keywords:
Protein energy malnutrition, Serum total protein, Serum albumin, TSH, Serum total T3, Serum total T4Abstract
Background: The study's objective was to evaluate and compare total serum protein, serum albumin, and thyroid hormones in children with PEM (protein-energy malnutrition) and healthy controls.
Methods: In this cross-sectional study, 100 children with PEM served as cases, while an equal number of age and gender-matched healthy children served as controls. 4 ml of venous blood were taken (3 ml in a plain vial and 1 ml in an EDTA vial) and immediately submitted for further investigation. SPSS software (version 25) was used to analyze the data. A p value of ≤0.05 was considered statistically significant.
Results: PEM children have lower serum total protein, albumin level, total T3 (TT3), and total T4 (TT4) levels compared to healthy controls (p<0.0001). Mean TSH levels in cases and controls were nearly similar. There was no significant difference between serum TSH concentrations in PEM children and the controls. Grade I PEM had the highest mean total protein, serum albumin, T3, and T4 levels, followed by grades II, III, and IV. When mean total protein, serum albumin, T3, and T4 levels of each grade of PEM were compared to controls, mean total protein, serum albumin, T3, and T4 levels were substantially lower in each grade of PEM (p<0.0001).
Conclusions: PEM children have low serum total protein and albumin levels. This is probably due to decreased oral intake of proteins and reduced biosynthesis. Serum TT3 and TT4 levels are lower in children with PEM than in healthy controls, which is most likely due to reduction in circulating plasma proteins.
References
De Onis M, Monteiro C, Akré J, Glugston G. The worldwide magnitude of protein-energy malnutrition: an overview from the WHO Global Database on Child Growth. Bull World Health Organiz. 1993;71(6):703.
Abrol P, Verma A, Hooda HS. Thyroid hormone status in protein energy malnutrition in Indian children. Ind J Clin Biochem. 2001;16:221-3.
UNICEF. Division of Communication, & UNICEF. (2009). Tracking progress on child and maternal nutrition: a survival and development priority. Unicef. Available at: https://data.unicef.org/resources/tracking-progress-child-maternal-nutrition-survival-development-priority. Accessed on 14th March 2023.
IIPS, O. (2017). National Family Health Survey (NFHS-4): 2014-15: India. Mumbai: International Institute of Population Sciences. Available at: https://dhsprogram.com/pubs/pdf/fr339/fr339.pdf. Accessed on 14th March 2023.
Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney L, et al. Defining pediatric malnutrition: a paradigm shift toward etiology‐related definitions. J Parent Enter Nutr. 2013;37(4):460-81.
Onis MD, Blossner M. WHO global database on child growth and malnutrition. WHO. 1997. [Last retrieved on 2010 Oct 01]. Available at: http://whqlibdoc.who.int/hq/1997/WHO_NUT_97.4.pdf. Accessed on 14th March 2023.
Gragnolati M, Shekar M, DasGupta M, Bredenkamp C, Lee YK. India's undernourished children: a call for reform and action. HNP. 2005.
Mishra SK, Bastola SP, Jha B. Biochemical nutritional indicators in children with protein energy malnutrition attending Kanti Children Hospital, Kathmandu, Nepal. Kathmandu Univer Med J. 2009;7(2):129-34.
Pelletier JG. Severe malnutrition: a global approach. Children Trop. 1993;208:209.
Brown PI, Brasel JA. Endocrine changes in the malnourished child. Nestle nutrition workshop series. Handbook of Famine, Starvation, and Nutrient Deprivation. USA; 1990: 1-21.
Shah PM. Nutrition subcommittee of Indian academy of pediatrics. Report of Convenor. Indian Pediatr. 1972;9:360.
Turkay S, Kus S, Gokalp A, Baskin E, Onal A. Effects of protein energy malnutrition on circulating thyroid hormones. Ind Pediatr. 1995;32:193-3.
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.
Adegbusi HS, Sule MS. Anthropometric and biochemical assessment among under five children in Kusada Local Government Area, Katsina State, Nigeria. Bayero J Pure Appl Sci. 2011;4(2):137-40.
Sah SP, Arora M, Kumar S, Batra J, Mustafa I, Yadav L. Effect of PEM on thyroid status, serum total protein and A/G ratio in pre-school going children. Int J Res Med Sci. 2017;5(10):4486.
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. 2009;7(2):129-34.
Rahman MA, Mannan MA, Rahman MH. Serum iron and total iron binding capacity in severely malnourished children. Bangla J Pharmacol. 2007;2(2):61-5.
Chowdhury MSI, Akhter N, Haque M, Aziz R, Nahar N. Serum total protein and albumin levels in different grades of protein energy malnutrition. J Bangla Soc Physiol. 2008;3:58-60.
Raval D, Chauhan ARDH. Estimation of serum albumin and serum total protein levels in children with protein energy malnutrition. Int J Paediatr Geriatr. 2020;3(1):76-8.
Sandeep M, Krishnamurthy B. Thyroid hormone status in children with protein energy malnutrition. Int J Contemp Pediatr. 2016;3(1):193-9.
Gupta S, Chaurasiya OS. Evaluation of thyroid functions in severely malnourished children. Int J Res Rev. 2019;6(6):199-202.
Meah MM, Sharma JD, Alam MB, Ahmed MU. Effect of severe protein-energy malnutrition on circulating thyroid hormones. J Nat Sci Res. 2018;8.
