Cases Of Protein-energy Malnutrition Research Articles

Health inequalities of global protein-energy malnutrition from 1990 to 2019 and forecast prevalence for 2044: data from the Global Burden of Disease Study 2019

ObjectivesProtein-energy malnutrition poses a serious medical problem worldwide. This study aims to describe the global burden, trends, and health inequalities of protein-energy malnutrition and forecasts for future prevalence. Study designThis was a comprehensive analysis based on data provided by the Global Burden of Disease Study 2019. MethodsData were obtained from the Global Health Data Exchange query tool, including prevalence, deaths, disability-adjusted life years (DALYs) and sociodemographic index (SDI). The estimated annual percentage changes were calculated to evaluate temporal trends. We quantified cross-country inequalities in protein-energy malnutrition burden and predicted the prevalence number and rate to 2044. ResultsGlobally, there were 147,672,757 (130,405,923 to 167,471,359) cases of protein-energy malnutrition in 2019, with 212,242 (185,403 to 246,217) deaths. Eastern Sub-Saharan Africa had the highest age-standardised death and DALY rates in 2019. From 1990 to 2019, the global age-standardised prevalence rate of protein-energy malnutrition showed an upward trend, while the age-standardised death rate showed a downward trend. A significant decline occurred in SDI-related health inequality, from 2126.1 DALYs per 100,000 persons between the poorest and richest countries in 1990 to 357.9 DALYs per 100,000 persons in 2019. There was a trend of decreasing age-standardised death and DALY rates along with increases in the SDI. Frontier analyses showed that there is much room for improving the current situation of protein-energy malnutrition in some countries. In the next 35 years, the prevalence of protein-energy malnutrition will continue to increase. ConclusionAlthough the disease burden of protein-energy malnutrition has greatly decreased since 1990 and health inequalities between countries are shrinking, the prevalence in Asian and African countries may continue to increase. Focussing on regional differences and strengthening the nutritional intake of people in underdeveloped areas are necessary to reduce future burdens.

Relationship between serum sodium, serum potassium levels and ankle reflex grades in malnourished children

Background: Malnutrition among children is a major health issue in South East Asia presenting with stunting and wasting. Many research studies have been conducted to establish the signs, symptoms, corresponding effects of malnutrition on child health, growth and development and the current study focusses more specifically on the effects of electrolyte levels on ankle reflex grades in malnourished children.Methods: This is an observational case-control type of study conducted in two teaching hospitals in India. Cases of protein-energy malnutrition (PEM) (n=30), children with mid upper arm circumference (MUAC) lesser than 12.5 along with control group of normal healthy children (n=30), all aged between 1 and 5 years were selected. Ankle reflexes were noted using a knee hammer on three consecutive days and graded based on the NINDS reflex grading scale for cases and controls and noted against the corresponding serum sodium and serum potassium values obtained from the children.Results: A Chi square test performed and p=0.379 obtained for serum sodium and 0.026 for serum potassium for cases.Conclusions: A conclusion could be drawn that serum sodium levels and ankle reflex grades have no statistically significant relationship in cases of controls, while serum potassium levels and ankle reflex grades have statistically significant relationship in cases but not in control group indicating a plausible cause for hyporeflexia in the patients.

Quality attributes and consumer acceptability of custard supplemented with Bambara groundnut protein isolates

Custard, a sole cornstarch-made weaning food in developing country, was enriched with Bambara groundnut protein isolate (BPI) in order to increase its protein content and reduce the cases of protein energy- malnutrition (PEM) that accounted for average global deaths in children. The pasting and functional properties, proximate and amino acid compositions as well as sensory attributes of the supplemented products were determined and evaluated according to the standard methods. The CS-BPI blends had low setback (1636-1186 RVU) but high peak time (5.14-5.37 min) and pasting temperature (75.30-79.57 °C) when compared with the control sample (100% CS). Although, the functional properties of the blends significantly (p < 0.05) decreased at the elevated BPI inclusion but their water interaction (WAC) and gelatinization temperature increased appropriately. Moreso, the CS-BPI blends had high essential and non-essential (∼2-8 and 3-11 g/100 g protein) but low sulphur-containing amino acids, respectively. Majorly, the carbohydrate (56.56 %) and moisture contents of the control (37.61 %) increased with elevated BPI levels in the supplemented samples (41-53%), which might be attributed to the increase in their WAC (67-91%) when compared to 100% CS (60.83%). Meanwhile, the protein content (∼12%) of the CS-BPI blends is 500-fold higher than 100% CS (2.28%). The increase in the protein contents of the blends observably led to a significant (p < 0.05) decrease in the carbohydrate contents of the blend formulations. The 80% CS + 20% BPI blend was the most acceptable sample when compared to the control sample (100% CS), hence could be useful to combat PEM cases.

Niemann-pick disease: Type A presenting as a case of protein energy malnutrition

We hereby report a rare case of a young child with Niemann-Pick disease who had multiple hospital admissions due to repeated gastrointestinal and respiratory tract infections. The disease is overall quite rare in our population however, our case highlights the fact that in any young child with repeated infections of unknown etiology, this condition should be considered and evaluated.

Study on impact of protein energy malnutrition on development in children

Background: Majority of the children in India who live below the poverty line in an environment of deprivation and starvation have physical and developmental retardation. The Objective of this study to study the impact and comparison of protein energy malnutrition on the development with normal children.Methods: This was a hospital based cross sectional study in which total 128 cases of protein energy malnutrition and 30 normal children were enrolled from nutritional rehabilitation center and in patients wards. The study population comprised of children less than 5 years of age, having weight for height/length ≤3 SD, with visible wasting, or bipedal oedema, with mid arm circumference &lt;11.5 cm were assessed for their development in all four domains using Denver II developmental Screening Test (DDST-II).Results: The gross motor milestones are affected in 62.5% with grade4 PEM &amp; 42.85% with grade 3, the fine motor component is affected more in grade 4 with other domains less affected, no significant relation of language delay with PEM was observed in this study, 40% of children with grade 4 PEM shows delay in social domain while 18.18% of the patients with grade 3 PEM show delay in social domain. No patients with grade 1 or grade 2 PEM showed delay in social domain. All four domains are affected in PEM with a maximum effect in gross motor, but the difference does not seem to be significant as the p value is 0.3 i.e. &gt;0.05 which is insignificant.Conclusions: My study on the effect of protein energy malnutrition on development proves that there in increasing delay in all the domains of development with increasing grade of malnutrition. Early detection of malnutrition in community can cause early intervention and increase the productivity of nation.

Comparative Nutritional Assessment of Products made from Fresh and Dried Tiger Nut sold in Makurdi Metropolis

Tiger nut (cyperus esculentus) is taken as optional snacks mainly in its fresh form owing to poor availability of nutritional information on the composition of other forms such as the dried form. To address this gap, this study was designed to assess the nutritional composition of fresh and dried tiger nut milk by determining the proximate composition and amino acid profile using standard analytical methods. The samples were grouped into A, B, C and D representing milk and powder made fresh tiger nuts, as well as milk and powder made from dried tiger nuts respectively. Results of proximate analysis for the samples showed variation in the constituents with highest amounts of carbohydrate found in the fresh form except for the powder product from dried form, which has equivalent amount to those of fresh tiger nut. Amino acid profile generally showed reasonable amounts in all the samples with products made from fresh tiger nut having higher values, while milk and powder products of dried tiger nut contain more of the other nutrient constituents than the fresh one. These findings are key to optimizing nutritional value of tiger nut products made from different forms, thus, is helpful in guiding nutrition and dietetic advice in clinical setting to supplement other choices in resolving cases of protein energy malnutrition and other forms of malnutrition. In addition, the nutrient composition of tiger nut makes it ideal as a valuable substitute for conventional cow milk and other milk sources, which have become unaffordable to people with low economic empowerment, pariticularly among developing nations.

3417 Impact of Protein-Energy Malnutrition on Outcomes of Heart Failure Hospitalizations

OBJECTIVES/SPECIFIC AIMS: Chronically elevated cytokines from un-abating low-grade inflammation in heart failure (HF) results in Protein-Energy Malnutrition (PEM). However, the impact of PEM on clinical outcomes of admissions for HF exacerbations has not been evaluated in a national data. METHODS/STUDY POPULATION: From the 2012-2014 Nationwide Inpatient Sample (NIS) patient’s discharge records for primary HF admissions, we identified patients with concomitant PEM, and their demographic and comorbid factors. We propensity-matched PEM cohorts (32,771) to no-PEM controls (1:1) using a greedy algorithm-based methodology and estimated the effect of different clinical outcomes (SAS 9.4). RESULTS/ANTICIPATED RESULTS: There were 32,771 (~163,885) cases of PEM among the 541,679 (~2,708,395) primary admissions for HF between 2012 and 2014 in the US. PEM cases were older (PEM:76 vs. no-PEM:72 years), Whites (70.75% vs. 67.30%), and had higher comorbid burden, with Deyo-comorbidity index &gt;3 (31.61% vs. 26.30%). However, PEM cases had lower rates of obesity, hyperlipidemia and diabetes. After propensity-matching, PEM was associated with higher mortality (AOR:2.48[2.31-2.66]), cardiogenic shock (3.11[2.79-3.46]), cardiac arrest (2.30[1.96-2.70]), acute kidney failure (1.49[1.44-1.54]), acute respiratory failure (1.57[1.51-1.64]), mechanical ventilation (2.72[2.50-2.97]). PEM also resulted in higher non-routine discharges (2.24[2.17-2.31]), hospital cost ($80,534[78,496-82,625] vs. $43,226[42,376-44,093]) and longer duration of admission (8.61[8.49-8.74] vs. 5.28[5.23-5.34] days). DISCUSSION/SIGNIFICANCE OF IMPACT: In the US, PEM is a common comorbidity among hospitalized HF subjects, and results in devastating health outcomes. Early identification and prevention of PEM in heart failure subjects during clinic visits and prompt treatment of PEM both in the clinic and during hospitalization are essential to decrease the excess burden of PEM.

A case of protein-energy malnutrition caused by superior mesenteric artery syndrome

本病例为一例少见的肠系膜上动脉压迫综合征，以进食后上消化道梗阻症状起病，伴勃起功能障碍、转氨酶升高、白细胞减少等多系统异常，经营养支持治疗基本恢复，其中经验或可为临床借鉴。.

Protein-Energy Malnutrition and Outcomes of Hospitalizations for Heart Failure in the USA

Chronically elevated cytokines from un-abating low-grade inflammation in heart failure (HF) results in Protein-Energy Malnutrition (PEM). However, the impact of PEM on clinical outcomes of admissions for HF exacerbations has not been evaluated in a national data. From the 2012 to 2014 Nationwide Inpatient Sample (NIS) patient's discharge records for primary HF admissions, we identified patients with concomitant PEM, and their demographic and comorbid factors. We propensity-matched PEM cohorts (32,771) to no-PEM controls (1:1) using a greedy algorithm-based methodology and estimated the effect of different clinical outcomes (SAS 9.4). There were 32,771 (∼163,885) cases of PEM among the 541,679 (∼2,708,395) primary admissions for HF between 2012 and 2014 in the US. PEM cases were older (PEM:76 vs no-PEM:72 years), Whites (70.75% vs 67.30%), and had higher comorbid burden, with Deyo-comorbidity index >3 (31.61% vs 26.30%). However, PEM cases had lower rates of obesity, hyperlipidemia and diabetes. After propensity-matching, PEM was associated with higher mortality (AOR:2.48 [2.31 to 2.66]), cardiogenic shock (3.11[2.79 to 3.46]), cardiac arrest (2.30[1.96 to 2.70]), acute kidney failure (1.49[1.44 to 1.54]), acute respiratory failure (1.57[1.51 to 1.64]), mechanical ventilation (2.72[2.50 to 2.97]). PEM also resulted in higher non-routine discharges (2.24[2.17 to 2.31]), hospital cost ($80,534[78,496 to 82,625] vs $43,226[42,376 to 44,093]) and longer duration of admission (8.6[8.5 to 8.7] vs 5.3[5.2 to 5.3] days). In conclusion, PEM is a prevailing comorbidity among hospitalized HF subjects, and results in devastating health outcomes. Early identification and prevention of PEM in HF subjects during clinic visits and prompt treatment of PEM both in the clinic and during hospitalization are essential to decrease the excess burden of PEM.

CONSISTENCY IN ASSESSING PHYSICAL DEVELOPMENT OF CHILDREN WITH CEREBRAL PALSY ACCORDING TO REGIONAL AND SPECIALIZED CENTILE SCALES: A POPULATION-BASED CROSS-SECTIONAL STUD

Background.Children with infantile cerebral palsy (ICP) often have a physical developmental delay due to protein-energy malnutrition (PEM). The assessment of such abnormalities using different centile scales may lead to inconsistent results.Objective.Our aim was to study the consistency in assessing physical development of children with ICP using regional and specialized centile scales.Methods.The assessment of physical development with determination of the proportion of patients with PEM (weight-age and/or heightage values &lt; 10th percentile) was carried out using regional centile scales and the Life Expectancy Project scales taking into account motor disorder levels (I–V) according to GMFCS. The assessment of motor disorders was performed by neurologists of healthcare organizations in 54 municipalities of the Sverdlovsk Region. The accounting period was from September 2016 to January 2017.Results.According to regional centile scales, PEM was identified in 272 (35.7%) children; according to the Life Expectancy Project scales — in 56 (7.4%) out of 761 children with ICP (McNemar's criterion, p &lt; 0.001). Using regional scales the following results were registered: children with GMFCS I had PEM 5 times less than children with GMFCS V — 10 (12.5%) and 107 (66%) cases, respectively (ꭓ2criterion, p &lt; 0.001). When assessing physical development of children with specialized scales, PEM occurred in 4 (5%) patients with GMFCS I and 18 (11.1%) with GMFCS V (p &lt; 0.001).Conclusion.Specialized scales for assessing physical development less often indicate the presence of PEM in children with ICP. When using regional and to a much lesser extent specialized centile scales, the detection rate for PEM cases depends on the level of motor disorders.

Study of lipid profile levels in malnourished and healthy children: a case control study acquired pneumonia in children

Background: Under nutrition causes reduced growth and endocrine adaptations in order to maintain basic life processes. Protein energy malnutrition often coexists with micronutrient deficiencies. Malnutrition results from multiple deficiencies, not necessarily limited to lack of proteins or calories, but also involving other associated or separate factors such as deficiency of trace elements, such as copper and zinc and lipid profile. Methods: A case control study was carried out in department of Pediatrics, Maharani Laxmi Bai (MLB) Medical College, Jhansi from September 2009 to August 2010. 108 cases & 108 matched controls were recruited according to sex, weight and height after written informed consent with the approval of ethical committee. Total cholesterol and fractions (low-density lipoprotein cholesterol, high density lipoprotein cholesterol) and triglycerides concentrations were determined by automated enzymatic methods. The results were analyzed by the appropriate statistical test. Results: In present study, more than half children were suffered from marasmus as an acute malnutrition and most of children were of below 24 months of age. Total cholesterol, triglyceride and HDL levels were lower in PEM children while LDL & VLDL levels were higher in malnourished children group. Conclusion: The prevalence of under nutrition and dyslipidaemia observed in these children is a matter of concern considering the age group evaluated. These Biochemical parameters were found to be sensitive indicators for nutritional status and can be used for diagnosis of sub clinical case of protein energy malnutrition (PEM).

Protein energy malnutrition associates with different types of hearing impairments in toddlers: Anemia increases cochlear dysfunction

ObjectivesThis work aimed to highlight a challenging asymptomatic problem which is early detection of hearing impairment in toddlers with protein energy malnutrition (PEM) as a neuro-cognitive effect of PEM on developing brain in relation to hemoglobin level. Methods100 toddlers, aged 6–24 months, fifty with moderate/severe PEM and fifty healthy children, were included in study. Both TEOAEs and ABR testing were used to assess auditory function. ResultsStudy reported an association between malnutrition and hearing impairment, 26% of cases had conductive deafness secondary to otitis media with effusion using tympanometry; 84.6% showed type B and 15.4% type C which may suggest developing or resolving otitis media. Their ABR showed 46% mild and 53% moderate impairment. 32% of PEM cases had sensory neural hearing loss and with type (A) tympanometry. Those were assessed using ABR; 58% had mild, 34% moderate and 8% profound impairment. 10% of PEM cases had mixed hearing loss with 50% type B and 50% type C tympanometry and their ABR showed moderate to profound impairment. TEOAEs latencies at different frequencies correlate negatively with hemoglobin level. ConclusionsToddlers with moderate/severe PEM had hearing impairments of different types and degrees. Neuro-physiological methods could be early and safe detectors of auditory disorders especially in high-risk toddlers. Anemia increases risk for auditory dysfunction.

Serum Albumin and Selected Antioxidants Status in Children with Protein Energy Malnutrition in Sokoto, Nigeria

Aims: To assess the serum albumin and selected antioxidant status in 51 children with protein energy malnutrition (PEM) in Sokoto, Nigeria. Study Design: A cross-sectional study was performed comparing two groups of children, one with confirmed case of PEM and the other apparently healthy children; both groups were gender, age and socioeconomically matched. Place and Duration of Study: Departments of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto and Chemical Pathology, Faculty of Medical Laboratory Sciences, Usmanu Danfodiyo University, Sokoto, between April, 2014 and September, 2015. Methodology: We included fifty (51) children (of both sexes, aged range 6-60 months) with Original Research Article Mainasara et al.; BJMMR, 15(2): 1-7, 2016; Article no.BJMMR.25130 2 confirmed cases of protein energy malnutrition were included in this study. The modified Wellcome classification was used to classify the protein energy malnourished children into underweight (14), marasmus (17), kwashiorkor (10) and marasmic-kwashiorkor (10). Fifty (50) genderage-and socioeconomically-matched apparently healthy children were used as controls. The subject selection, anthropometric parameters and clinical examinations were performed by the consultant paediatricians in the clinic. Standard procedures were used for the analyses of biochemical parameters. Results: Our results showed that, mean mid-upper arm circumference (MUAC), weight, body mass index (BMI), were significantly (P 0.05) different among the different classes of PEM. Serum Albumin, α-tocopherol, copper and zinc were significantly (P<0.001) lower in the malnourished group compared with the control group. Serum Albumin, αtocopherol, copper and zinc decreased significantly (P<0.001) with increasing severity of malnutrition. Conclusion: Our results showed that serum albumin, α-tocopherol, copper and zinc were significantly lower in the malnourished group than the control group (p<0.001). The decrease in the serum albumin, α-tocopherol, copper and zinc progressed with the increasing severity of malnutrition among the children. These findings suggest an altered protein and antioxidant status in protein energy malnutrition. In addition to providing proteins and calories, adequate supplementations of zinc, copper and α-tocopherol should be provided. These should be part of nutritional rehabilitation of malnourished children in order to achieve optimal results of management and avoid clinical complications associated with zinc, copper and vitamin E deficiencies.

Radiographical Study Showing Asymmetry in the Surface Area of Carpal Bones in Malnourished Children

Protein energy malnutrition, a major health and nutritional problem in India, leads to retardation in bone maturity and eventually physical growth. Many studies have been done on ossification centers of hand bones for estimation of skeletal maturation and to diagnose malnutrition but very few studies have been done so far to see effect of protein energy malnutrition on surface area of carpal bones. The surface areas of carpal bones on radiographs on both sides were calculated, analysed and compared in protein energy malnutrition (PEM) cases and healthy controls upto five years of age to see the variability among study groups. The study was conducted in Department of Paediatrics, Radiodiagnosis and Anatomy of S.N. Medical College, Agra, India consisting of 68 PEM cases and 68 controls of either sex upto five years of age. Radiography of wrist done and surface areas of carpal bones were calculated by using millimeter Graph Transparency paper by Hit method and data were evaluated for significance by using t-test. The surface areas of capitate, hamate and triquetral bones of both hands were reduced in PEM children of all grades as compared to healthy controls. The surface areas of these carpal bones were much reduced in grade 2 and grade 3 PEM cases as compared to healthy controls and grade 1 PEM cases. Asymmetry in surface areas of capitate and hamate bones were ascertained in healthy controls and grade 1 PEM cases but due to delay in appearance of ossification centers and reduced surface areas of these bones, asymmetry could not be ascertained in grade 2 and grade 3 malnutrition children. The surface areas of capitate, hamate and triquetral bones on both sides were reduced in grade 2 and grade 3 PEM cases as compared to controls. Asymmetry in surface area of carpal bones was ascertained in healthy controls and grade 1 PEM cases.

Hematologic and Bone Marrow Changes in Children with Protein-Energy Malnutrition

Background: All systems in an organism are affected by protein-energy malnutrition (PEM), but one of the worst affected is the hematopoietic system. Today PEM remains a very serious problem in developing countries. We examined the relationships between clinical features, hematological, and bone marrow changes with severe PEM from Turkey. Method: We evaluated 34 (11 females and 23 males) consecutive cases of severe PEM, with no underlying diseases aged 3–20 months. The clinical nutritional conditions of the patients were determined using the Wellcome-Trust PEM classification. Ten of the patients were in the Marasmic-Kwashiorkor (M-K) group, 10 were in the Kwashiorkor (KW) group, and 14 were in the Marasmic (M) group. Full blood count, protein, albumin, serum iron (SI), iron-binding capacity (TIBC), ferritin, vitamin B12, folic acid, complement-3 (C3), complement-4 (C4), and bone marrow were investigated in all groups. Results: Anemia was detected in 97% of patients. We determined serum iron levels were low in 67.6% of the patients, TS levels were low in 76.4% of the patients and ferritin levels were low in 20.5%. The level of vitamin B12 was normal in all patients. Bone marrow analysis showed erythroid series hypoplasia in 28.5% of patients in the M group, 50% in the KW group, and 30% in the M-K group. Marrow iron was absent in 58.8% of patients. Conclusion: The most common hematologic change in the children with PEM was anemia and major cause of anemia was iron deficiency in this study. Patients with severe PEM have normal Vit B12 and serum folate levels. Most of the patients with severe PEM had normal cellularity with megaloblastic and dysplastic changes in bone marrow due to the inadequate and imbalanced intake of protein and energy.

The Relationship between Nutritional Status and Anthropometric Measurements of Preschool Children in a Sierra Leonean Clay Factory Displaced Camp

Weight is a sensitive index for the evaluation of nutritional status of preschool children, particularly where their precise ages are known. Regrettably in Sierra Leone there are no known local standards of weight of preschool children and their ages are most times difficult to obtain. Thus weight alone cannot be the most suitable index in the evaluation of the nutritional status of preschool children in Sierra Leone. Thus the current study was undertaken to determine the relative merits of anthropometric measurements commonly used in nutrition survey for the evaluation of the nutritional status of preschool children in the clay factory displaced camp. Three hundred and six (306) children of both sexes aged 1-5 years were classified into three groups: Normal, protein-energy malnutrition (PEM) and vitamin deficiency (VD). The relative importance of the various anthropometric measurements was assessed in these three categories of children through comparison of their mean values and correlation coefficients. A close relationship was observed between the severity of PEM on the one hand and weight, weight-height ratio and mid-upper arm circumference (MUAC) on the other. The indices weight and weight-height ratio were found to be very sensitive in the assessment of nutritional status of the children. Moreover, these indices showed a close association with other measurements. It was concluded that the weight-height ratio which is independent of age, is the most suitable index for the detection of early cases of PEM in our environment. Keywords: Nutritional status, Protein-Energy malnutrition, Vitamin deficiency, Preschool children, Weight-Height Ratio and Mid-upper arm circumference.

Infection associated with severe malnutrition among hspitalised children in East Africa

Severe protein-energy malnutrition (PEM) predisposes affected children to various infections, which either worsens their nutritional status or causes malnutrition, hence complicating their management and outcome. This study was carried out to determine the infections associated with severe malnutrition among children admitted at Kilifi District Hospital (KDH) in Kenya and Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. Data was collected from hospital register books and online system database. A total of 1121 children with severe malnutrition were admitted during a period of one year (2004-2005) (MNH = 781; KDH = 340). The proportion of male children with malnutrition was higher than that of female children. Non-oedematous malnutrition was more prevalent at MNH (N = 504; 64%) than KDH (N = 130; 38%). Conversely, oedematous was more prevalence than non-oedematous malnutrition among children admitted at KDH (N = 2 10; 61.7%). More than 75% of all patients with severe PEM were children < 2 years old. Thirty-six per cent of all severe PEM cases had malaria in both hospitals. Forty-five per cent of all admitted patients with severe PEM at KDH had diarrhoea. Two hundred twenty two (28%) and 64 (19%) of the children with severe malnutrition died at MNH and KDH, respectively. Oedematous PEM was associated with a higher case fatality rate than non-oedematous one (P < 0.05). At MNH, 86% of the patients who died with severe malnutrition had other co-morbidities. More (46%) oedematous malnourished patients with co-infections died at MNH than non-oedematous malnourished patients (19%). At KDH, septicaemia was the leading cause of death (55%) among severely malnourished patients. In conclusion, coinfections complicate the management of severe malnutrition and are associated with higher death rate. Management of such infections is of paramount importance to reduce case fatality rates.

Pancreatic size in protein energy malnutrition: a predictor of nutritional recovery

Pancreatic exocrine dysfunction has been frequently recorded in protein energy malnutrition (PEM) because the pancreas requires optimal nutrition for enzyme synthesis. This pancreatic enzyme insufficiency may play a role in the continuation of PEM. This study was designed to assess the pancreatic head size and exocrine pancreatic functions, namely serum amylase and lipase, in PEM and its subtypes and correlate any defect present with the various clinical and laboratory data of the PEM patients with special emphasis on the effect of nutritional rehabilitation. A total of 33 cases of PEM; 15 marasmus, 10 kwashiorkor (KWO) and eight marasmic kwashiorkor (MKWO) were recruited from Ain Shams University children's hospital, together with 12 matched controls. The mean age of patients was 11.87 +/- 7.8 months and that of the controls was 14.83 +/- 7.7 months. Detailed history taking and thorough clinical examination with special emphasis on anthropometric measurements were taken for each studied infant as well as laboratory investigations which included; complete blood count, liver and kidney functions and serum amylase and lipase. Ultrasonographic assessment of pancreatic head size was performed for the cases and controls. Nutritional rehabilitation program was carried out for 3-6 months followed by reassessment of the cases. The pancreatic head size values were significantly lower in all subtypes of PEM (1.52 +/- 0.6, 2.73 +/- 0.12 and 3.00 +/- 0.54 cm(3) in the marasmus, KWO and MKWO respectively) compared to the controls (5.13 +/- 2.33 cm(3)). The serum amylase and lipase were also significantly lower in all subgroups of PEM when compared to the controls with significant improvement following nutritional rehabilitation coupled by a significant increase in pancreatic head size too. No significant differences were recorded when we compared the subgroups together except for a significant higher rate of change in serum amylase in edematous patients compared to nonedematous ones. The length of nutritional rehabilitation period, age of the patient, weight and serum albumin were the most determinant factors for pancreatic head size as evident from the multiple regression analysis study. The potentially correctable exocrine pancreatic insufficiency in cases of PEM should be carefully thought of when planning the nutritional rehabilitation program for such patients as it could be responsible for the serious continued morbidity issues that they face. We thus recommend that estimation of pancreatic head size and exocrine function should be included in the evaluation of PEM patients and they could also be used as a prognostic parameter. The patients enrolled were among those admitted and managed freely in the children's Hospital Faculty of Medicine Ain Shams University, including the use of the ultrasound apparatus, while the kits have been purchased by authors who contributed in financing the study.

Liver Function Status in some Nigerian Children with Protein Energy Malnutrition

Objective: To ascertain functional status of the liver in Nigeria Children with Protein energy malnutrition Materials and Methods: Liver function tests were performed on a total of 88 children with protein energy malnutrition (PEM). These were compared with 22 apparently well-nourished children who served as controls. High performance enzymatic colorimetric commercial kits (RANDOX Laboratories Ltd. UK) were used for the assay. Anthropometry, haematocrit, liver enzymes and bilirubin levels of the patients and controls were measured. Results: Serum total proteins and albumin fraction were significantly reduced (p < 0.05) in all the types of PEM compared with the controls. There was marked hypoproteinaemia and hypoalbuminaemia in kwashiorkor. Haemoglobin (Hb), packed cell volume (PCV) and alkaline phosphatase (ALP) levels were reduced (p < 0.05) while aspartate transaminase (AST), and alanine transaminase (ALT) were significantly elevated (p < 0.05). Although serum unconjugated bilirubin was reduced in the PEM cases, its value did not differ significantly in marasmic patients. Conclusion: These findings suggest that abnormalities in serum levels of these parameters occur in any form of PEM and are related to the severity of the condition. Key Words: Liver Function status in PEM; Nigeria Orient Journal of Medicine Vol.15(1&2) 2003: 58-63

Intraerythrocytic potassium levels and early insulin release in children with moderate malnutrition.

Potassium deficiency and insulin releasing defect in severe protein-energy malnutrition (PEM) have been reported previously. The aim of this study was to investigate the existence of potassium deficiency and early insulin releasing defect in moderate PEM, which is more common in children. This study was carried out prospectively in the Pediatrics Department at Trakya University. The study group comprised 30 children with moderate PEM who were also classified as stunted, wasted, and stunting-wasting. Thirty healthy children were selected as controls. Although there was no statistical difference between the study and control groups in terms of serum potassium and initial insulin levels, intraerythrocytic potassium and early insulin release in patients were significantly lower than in controls. The stunting-wasting cases had the lowest intraerythrocytic potassium and early insulin response to intravenous glucose administration. This study suggests that it is appropriate to evaluate moderate PEM cases for intraerythrocytic potassium deficiency and early insulin releasing defect. Potassium supplements should be given if necessary.