ETIOLOGY AND BIOCHEMICAL PARAMETERS IN MALNOURISHED CHILDREN FROM 6 MONTHS TO 5 YEARS OF AGE

medicine

BACKGROUND: PEM is a very common problem in the developing regions of Asia, Africa, and Latin America. It is significantly associated with death among children especially below 5 years of age. There is considerable malnutrition among children in Nepal. Almost half of them are stunted and underweight. There are a number of biochemical changes in child with PEM which can be used to diagnose development of PEM early, assess its severity and manage it properly in a tertiary care setting. OBJECTIVES: To determine the etiology and clinical features of PEM in children under five years of age and to assess the serum levels of glucose, sodium, potassium, protein, albumin and calcium in malnourished children and compare them with children of normal nutritional status. METHODS: A cross sectional study was conducted at Nepalgunj Medical College Teaching Hospital, Kohalpur during the period of November 2013 to November 2014. The study was carried out to determine the etiology and clinical features of PEM in children and find the serum levels of glucose, sodium, potassium, protein, albumin and calcium and compare them with their normal counterparts. RESULTS: A total of 160 children (80 in PEM and 80 in control group) were enrolled in the present study. Among them 42 males and 38 females were in the PEM group (M:F=1.1:1) and 44 males and 36 females in the control group (M:F=1.2:1). In the study 21.25% had moderate stunting and 12.5% had severe stunting. Similarly 27.5% had moderate wasting and 28.5% had severe wasting. Only 10% of mother from the PEM group were literate and 20% of them were contributing economically to the family. The prevalence of low birth weight was high among PEM group (27.5%) as compared to the control group (10%). The children in the PEM group had less calorie (83.75%) and protein intake (92.5%). The common presentations of PEM children were wasting of muscles (58.75%), growth failure (43.75%) and hepatomegaly (35%). The level of blood glucose ranged from 48.2 mg/dl to 192.6 mg/dl (mean of 76.24±1.18 in PEM and 80±0.78 in control group). The incidence of hypoglycemia was significantly not different in both groups. The serum sodium level ranged from 129.8 mEq/L to 153.5 mEq/L (mean of 143±9.7 mEq/l in PEM and 144±3.4 in control group). and hyponatremia was also not significantly different in both PEM and control groups. The serum potassium level ranged from 2.8 mEq/L to 5.8 mEq/L (mean of 4±0.74 mEq/L in PEM and 4.3±0.63 mEq/l in control group). It was also statistically not significant in both groups. Serum protein and albumin level ranged from 5.6 mg/dl to 8.4 mg/dl (mean of 5.8±0.97 in PEM and 6.4±0.59 in control group) and 2.9 mg/dl to 4.2 mg/dl respectively. There was significantly higher levels of hypoproteinemia and hypoalbuminemia in the children of PEM group. The serum calcium level ranged from 7.2 mg/dl to 11.3 mg/dl (mean of 8.8±0.35 mg/dl in PEM and 10±0.22 mg/dl ) and the incidence of hypocalcemia was significantly low in PEM group. CONCLUSION: In the present study, among the various etiological factors, maternal illiteracy, low socio-economic condition, low birth weight, low calorie intake were the most important causes for development of PEM in a child. Most of the children presented with wasting of muscles and growth failure. A significant proportion of children with PEM had low serum levels of glucose, protein, albumin and calcium as compared to their control counterparts. There was significantly higher incidence of hypoproteinemia, hypoalbuminemia and hypocalcemia in PEM children in comparison to normally nourished children. However, no significant difference in the serum levels of glucose, sodium and potassium was found in children with PEM in comparison to normally nourished children. Good correlation was found between PEM and the level of serum total protein, albumin and calcium. Hence biochemical parameters can be used as an early indicator for the assessment of PEM and to assess the prognosis. Keyword : - malnutrition, age, children

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